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Moynihan KM, Sharma M, Mehta A, Lillie J, Ziegenfuss M, Festa M, Chan T, Thiagarajan R. Race-Conscious Research Using Extracorporeal Life Support Organization Registry Data: A Narrative Review. ASAIO J 2024; 70:721-733. [PMID: 38648078 PMCID: PMC11356683 DOI: 10.1097/mat.0000000000002206] [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: 04/25/2024] Open
Abstract
Race-conscious research identifies health disparities with 1) rigorous and responsible data collection, 2) intentionality and considered analyses, and 3) interpretation of results that advance health equity. Individual registries must overcome specific challenges to promote race-conscious research, and this paper describes ways to achieve this with a focus on the international Extracorporeal Life Support Organization (ELSO) registry. This article reviews ELSO registry publications that studied race with outcomes to consider whether research outputs align with race-conscious concepts and describe the direction of associations reported. Studies were identified via secondary analysis of a comprehensive scoping review on ECMO disparities. Of 32 multicenter publications, two (6%) studied race as the primary objective. Statistical analyses, confounder adjustment, and inclusive, antibiased language were inconsistently used. Only two (6%) papers explicitly discussed mechanistic drivers of inequity such as structural racism, and five (16%) discussed race variable limitations or acknowledged unmeasured confounders. Extracorporeal Life Support Organization registry publications demonstrated more adverse ECMO outcomes for underrepresented/minoritized populations than non-ELSO studies. With the objective to promote race-conscious ELSO registry research outputs, we provide a comprehensive understanding of race variable limitations, suggest reasoned retrospective analytic approaches, offer ways to interpret results that advance health equity, and recommend practice modifications for data collection.
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Affiliation(s)
- Katie M Moynihan
- From the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Meesha Sharma
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, California
| | - Anuj Mehta
- Division of Pulmonary and Critical Care Medicine, Department of Medicine Denver Health and Hospital Authority, Denver, Colorado
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jon Lillie
- Pediatric Intensive Care, Evelina London Children's Hospital, London, United Kingdom
| | - Marc Ziegenfuss
- Adult Intensive Care Services, Prince Charles Hospital, Queensland Intensive Care Clinical Network and State Emergency Coordination Centre, Brisbane, Australia
- Australian and New Zealand Intensive Care Society (ANZICS), Australia
| | - Marino Festa
- New South Wales Kids ECMO Referral Service, Australia
- Kids Critical Care Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Titus Chan
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Ravi Thiagarajan
- From the Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, Massachusetts
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Takeshita Y, Katsuta N. Activities of psychiatrists in specialized coronavirus disease 2019 wards at Juntendo Hospital. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e228. [PMID: 39071170 PMCID: PMC11272825 DOI: 10.1002/pcn5.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/30/2024]
Abstract
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic in 2020, specialized COVID-19 wards have been established in general hospitals across Japan. Juntendo Hospital also established a dedicated COVID-19 ward; however, many hospitalized patients were found to have psychiatric symptoms, such as delirium and depression. Juntendo Hospital's COVID-19 specialist beds were staffed mainly by internists, who specialized in physical illnesses and were unfamiliar with psychiatric symptoms, making it difficult for them to provide adequate treatment. Some staff members were also found to be suffering from mental illness, compounding these issues. In 2021, to address these challenges, Juntendo Hospital's psychiatry department began having psychiatrists make rounds once a week in specialized COVID-19 wards. The number of consultations varied depending on the status of the COVID-19 epidemic; however, in the peak month, 45 consultations were made per month. Most consultations involved delirium and neurotic conditions, and there had been over 200 consultations for both by August 2023. We addressed not only the mental symptoms of the patients, but also the health status of the staff at the hospital beds, and took measures to maintain the mental health of the staff. Consequently, the hospital has not experienced any large-scale medical breakdowns due to excessive staff fatigue. New pandemics of emerging infectious diseases will likely occur in the future, and we believe that we need to learn from this pandemic and prepare for future pandemics.
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Affiliation(s)
- Yoshihide Takeshita
- Department of PsychiatryJuntendo University Faculty of MedicineTokyoJapan
- Division of Medical EducationJuntendo University Faculty of MedicineTokyoJapan
| | - Narimasa Katsuta
- Department of PsychiatryJuntendo University Faculty of MedicineTokyoJapan
- Department of Safety and Health PromotionJuntendo UniversityTokyoJapan
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Zhang CX, Quigley MA, Bankhead C, Kwok CH, Parekh N, Carson C. Ethnic inequities in 6-8 week baby check coverage in England 2006- 2021: a cohort study using the Clinical Practice Research Datalink. Br J Gen Pract 2024; 74:e595-e603. [PMID: 38621807 PMCID: PMC11289950 DOI: 10.3399/bjgp.2023.0593] [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: 11/14/2023] [Accepted: 03/04/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Inequities in the coverage of 6-8-week maternal checks, health visitor reviews, and infant vaccinations have been reported in England. Ethnic inequities in 6-8-week baby checks have not been studied nationally. AIM To examine the effect of maternal ethnicity on 6-8 week baby check coverage in England 2006-2021. DESIGN AND SETTING This cohort study used electronic health records from primary care in England. METHOD Baby check coverage was calculated in 16 ethnic groups, by year and region. Risk ratios were estimated using modified Poisson regression. Coverage and timing of baby checks in relation to maternal checks and infant vaccinations by ethnic group were calculated. RESULTS Ethnic inequities in 6-8 week baby check coverage in England varied by year and region. Coverage increased 2006-2007 to 2015-2016, then stabilised to 80-90% for most groups. Coverage was lowest for Bangladeshi and Pakistani groups 2006-2007 to 2011-2012. In the West Midlands, coverage was lowest at approximately 60% for four groups: Bangladeshi, Caribbean, African, and Any other Black, African or Caribbean background. In the North West, coverage was lowest for Bangladeshi (65.3%) and Pakistani (69.2%) groups. These patterns remained after adjusting for other factors and persisted over time. Coverage was highest in those whose mothers received a maternal check and those who received at least one dose of 8-week infant vaccinations. CONCLUSION Coordinated action at the level of integrated commissioning boards, primary care networks, and GP practices is required to better understand the reasons behind these inequities and redress the persistent disparities in 6-8 week baby check coverage.
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Affiliation(s)
- Claire X Zhang
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford
| | - Maria A Quigley
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Chun Hei Kwok
- University of Oxford, Oxford, and Applied Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford
| | | | - Claire Carson
- NIHR Policy Research Unit in Maternal and Neonatal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford
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Kenny KS, Wanigaratne S, Merry L, Siddiqi A, Urquia ML. Discrimination and Racial Inequities in Self-reported Mental Health Among Immigrants and Canadian-Born Individuals in a Large, Nationally Representative Canadian Survey. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02128-4. [PMID: 39164490 DOI: 10.1007/s40615-024-02128-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 08/22/2024]
Abstract
We examined the link between discrimination and self-rated mental health (SRMH) among immigrants and Canadian-born individuals, stratified according to an individual's identification as racialized or white. Using data from Canada's General Social Survey (2014) (weighted N = 27,575,000) with a novel oversample of immigrants, we estimated the association of perceived discrimination with SRMH separately among immigrants and Canadian-born individuals and stratified by racialized status. Among immigrants, we also investigated whether age-at-arrival attenuated or strengthened associations. The prevalence of discrimination was higher among racialized compared to white immigrants (18.9% versus 11.8%), and among racialized compared to white non-immigrants (20.0% versus 10.5%). In the adjusted model with immigrants, where white immigrants not reporting discrimination were the referent group, both white (adjusted prevalence odds ratio [aPOR] 6.11, 95% confidence interval [CI] 3.08, 12.12) and racialized immigrants (aPOR 2.28, 95% CI 1.29, 4.04) who experienced discrimination reported poorer SRMH. The associations were weaker among immigrants who immigrated in adulthood. In the adjusted model with non-immigrants, compared to unexposed white respondents, Canadian-born white respondents who experienced discrimination reported poorer SRMH (aPOR 3.62, 95% CI 2.99, 4.40) while no statistically significant association was detected among racialized respondents (aPOR 2.24, 95% CI 0.90, 5.58). Racialized respondents experienced significant levels of discrimination compared to white respondents irrespective of immigrant status. Discrimination was associated with poor SRMH among all immigrants, with some evidence of a stronger association for white immigrants and immigrants who migrated at a younger age. For Canadian-born individuals, discrimination was associated with poor SRMH among white respondents only.
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Affiliation(s)
- Kathleen S Kenny
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Susitha Wanigaratne
- Edwin S.H. Leong Centre for Healthy Children, SickKids Research Institute & the University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Lisa Merry
- Faculty of Nursing, University of Montreal, Montreal, Canada
- SHERPA University Institute, Montreal, Canada
| | - Arjumand Siddiqi
- Division of Epidemiology, Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Understanding and tackling cancer inequities: What opportunities does intersectionality offer researchers, policymakers, and providers? A scoping review. J Psychosoc Oncol 2024:1-28. [PMID: 39120128 DOI: 10.1080/07347332.2024.2361642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
PROBLEM IDENTIFICATION We summarised the international evidence relating to the role of intersectionality in patients' lived experience of inequities along the cancer care pathway. We produced guidance to use intersectionality in future research. LITERATURE SEARCH We included 42 articles published between 1989 to 2023 that used intersectionality to guide the study and interpretation of inequities in cancer care. DATA EVALUATION/SYNTHESIS Articles predominantly comprised North American (n = 37), followed by European (n = 4) and Asian (n = 1) studies. Similar compounding effects of racism, homophobia, and discrimination across countries exacerbated inequities in cancer care experience and cancer outcomes particularly for women of color and sexual/gender minority groups. Professionals' knowledge, attitudes, and behaviors toward minoritised groups affected patient-provider relationships and influenced cancer patients' psychosocial responses. CONCLUSION Intersectionality provides a framework to assess the personal, interpersonal, and structural processes through which cancer inequities manifest within and across countries.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
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Loring B, Curtis E. How racism plays out in contemporary public health practice (commentary). Aust N Z J Public Health 2024; 48:100167. [PMID: 38945054 DOI: 10.1016/j.anzjph.2024.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 04/25/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024] Open
Affiliation(s)
- Belinda Loring
- Public Health Physician and Senior Research Fellow, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
| | - Elana Curtis
- Public Health Physician, Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
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Chang AB, Kovesi T, Redding GJ, Wong C, Alvarez GG, Nantanda R, Beltetón E, Bravo-López M, Toombs M, Torzillo PJ, Gray DM. Chronic respiratory disease in Indigenous peoples: a framework to address inequity and strengthen respiratory health and health care globally. THE LANCET. RESPIRATORY MEDICINE 2024; 12:556-574. [PMID: 38677306 DOI: 10.1016/s2213-2600(24)00008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 04/29/2024]
Abstract
Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which are associated with increased risks of morbidity and mortality. Despite the imperative to address global inequity, research focused on strengthening respiratory health in Indigenous peoples is lacking, particularly in low-income and middle-income countries. Drivers of the increased rates and severity of chronic respiratory diseases in Indigenous peoples include a high prevalence of risk factors (eg, prematurity, low birthweight, poor nutrition, air pollution, high burden of infections, and poverty) and poor access to appropriate diagnosis and care, which might be linked to colonisation and historical and current systemic racism. Efforts to tackle this disproportionate burden of chronic respiratory diseases must include both global approaches to address contributing factors, including decolonisation of health care and research, and local approaches, co-designed with Indigenous people, to ensure the provision of culturally strengthened care with more equitable prioritisation of resources. Here, we review evidence on the burden of chronic respiratory diseases in Indigenous peoples globally, summarise factors that underlie health disparities between Indigenous and non-Indigenous people, propose a framework of approaches to improve the respiratory health of Indigenous peoples, and outline future directions for clinical care and research.
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Affiliation(s)
- Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Tom Kovesi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Gregory J Redding
- School of Medicine, University of Washington, Seattle, WA, USA; Pediatric Pulmonary Division, Seattle Children's Hospital, Seattle, WA, USA
| | - Conroy Wong
- Department of Respiratory Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand; School of Medicine, University of Auckland, Auckland, New Zealand
| | - Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Nantanda
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Beltetón
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala
| | - Maynor Bravo-López
- Centro Pediátrico de Guatemala, Guatemala City, Guatemala; Department of Pediatrics, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maree Toombs
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Paul J Torzillo
- Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia; Nganampa Health Council, Alice Springs, NT, Australia
| | - Diane M Gray
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Zemouri C, Nait Kassi A, Arrazola de Oñate W, Çoban G, Kissi A. Exploring discrimination and racism in healthcare: a qualitative phenomenology study of Dutch persons with migration backgrounds. BMJ Open 2024; 14:e082481. [PMID: 38834316 PMCID: PMC11163629 DOI: 10.1136/bmjopen-2023-082481] [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] [Received: 11/29/2023] [Accepted: 05/24/2024] [Indexed: 06/06/2024] Open
Abstract
OBJECTIVE To explore and characterise the discrimination and racism experienced in healthcare from the perspective of Dutch patients with a migration background. DESIGN This was a qualitative phenomenological study incorporating an inductive thematic analysis of the answers provided to a free form online survey. Descriptive and differential analyses were conducted for the closed-ended questions. SETTING This study used an online survey distributed in Dutch about experiences of discrimination and racism in healthcare to the general population in the Netherlands. PARTICIPANTS The survey was completed by 188 participants (Mage=39.89, SDage=10.2). Of whom 80 (Mage=37.92, SDage=10.87) met the eligibility criteria for thematic analysis (ie, has a migration background or a relative with a migration background and experienced discrimination in healthcare based on their background) and were thus included in the analysis. RESULTS From the total sample, women, relative to men, were 2.31 times more likely to report experiencing healthcare discrimination (OR=2.31; 95% CI 1.23 to 4.37). The majority of the participants (60.1%) had a Moroccan or Turkish background. Six themes were identified relating to experienced discrimination in healthcare based on one's migration background: (1) explicit discrimination, (2) prejudice, (3) not being taken seriously, (4) discriminatory behaviour, (5) language barriers and (6) pain attribution to cultural background. Some participants reported that their attire or religion was linked to their migration background, thus contributing to their experiences of discrimination. CONCLUSION Dutch patients with a migration background may experience discrimination based on their ethnic identity or other factors related to their backgrounds, such as their faith, culture and skin colour. Discrimination manifests as intersectional and may take different forms (eg, discrimination based on the intersection between race and gender). Therefore, healthcare discrimination may increase health inequities and lead to unequal access to healthcare services. Implicitly or explicitly discriminating against patients is immoral, unethical, illegal and hazardous for individual and public health. Further research on the magnitude of discrimination in healthcare and its relation to health is needed.
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Affiliation(s)
| | | | | | | | - Ama Kissi
- Department of Experimental-Clinical and Health Psychology, Universiteit Gent, Gent, Belgium
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Stevens AJ, Boukari Y, English S, Kadir A, Kumar BN, Devakumar D. Discriminatory, racist and xenophobic policies and practice against child refugees, asylum seekers and undocumented migrants in European health systems. THE LANCET REGIONAL HEALTH. EUROPE 2024; 41:100834. [PMID: 39119094 PMCID: PMC11306214 DOI: 10.1016/j.lanepe.2023.100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/20/2023] [Accepted: 12/29/2023] [Indexed: 08/10/2024]
Abstract
Child refugees, asylum seekers and undocumented migrants who have been forcibly displaced from their countries of origin have heightened health needs as a consequence of their migration experiences. Host countries have a duty to respond to these needs, yet across Europe we are seeing a rise in potentially harmful discriminative, hostile and restrictive migration policies and practices. Research exploring the role racism, xenophobia and discrimination in European health systems may play in child migrant health inequities is lacking. This Personal View seeks to highlight this knowledge gap and stimulate discourse on how discrimination in health information systems, data sharing practices, national health policy, healthcare entitlements, service access, quality of care, and healthcare workers attitudes and behaviours may infringe upon the rights of, and impact the health of child refugees, asylum-seekers and undocumented migrants. It calls for action to prevent and mitigate against potentially harmful policies and practices.
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Affiliation(s)
| | - Yamina Boukari
- Institute of Health Informatics, University College London, UK
| | - Sonora English
- Institute for Global Health, University College London, London, UK
| | - Ayesha Kadir
- Save the Children International, St Vincent House, London, UK
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
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Moodley J, Unger-Saldaña K. The role of racial and ethnic discrimination in breast cancer disparities. Lancet 2024; 403:1827-1830. [PMID: 38636534 DOI: 10.1016/s0140-6736(24)00699-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Jennifer Moodley
- Cancer Research Initiative and School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, South Africa.
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Lua I, Magno L, Silva A, Pinto P, Bastos JL, Jesus G, Coelho R, Ichihara M, Barreto M, Santos CT, Moucheraud C, Gorbach P, Macinko J, Souza L, Dourado I, Rasella D. The intersecting effects of race, wealth, and education on AIDS incidence, mortality, and case-fatality rate: a Brazilian cohort study of 28.3 million individuals. RESEARCH SQUARE 2024:rs.3.rs-4314004. [PMID: 38766107 PMCID: PMC11100896 DOI: 10.21203/rs.3.rs-4314004/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The relationships between race, education, wealth, their intersections and AIDS morbidity/mortality were analyzed in retrospective cohort of 28.3 million individuals followed for 9 years (2007-2015). Together with several sensitivity analyses, a wide range of interactions on additive and multiplicative scales were estimated. Race, education, and wealth were each strongly associated with all of the AIDS-related outcomes, and the magnitude of the associations increased as intersections were included. A significantly higher risk of illness (aRR: 3.07, 95%CI:2.67-3.53) and death (aRR: 4.96, 95%CI:3.99-6.16) from AIDS was observed at the intersection of Black race, lower educational attainment, and less wealth. A higher case-fatality rate (aRR: 1.62, 95%CI:1.18-2.21) was also seen for the same intersectional group. Historically oppressed groups lying at the intersections of race, education, and wealth, had a considerably higher risk of illness and death from AIDS. AIDS-related interventions will require the implementation of comprehensive intersectoral policies that follow an intersectionality perspective.
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Affiliation(s)
- Iracema Lua
- Institute of Collective Health, Federal University of Bahia (UFBA); Department of Health, State University of Feira de Santana (UEFS)
| | - Laio Magno
- Department of Life Sciences, State University of Bahia (UNEB). Institute of Collective Health, Federal University of Bahia (UFBA)
| | - Andréa Silva
- Institute of Collective Health, Federal University of Bahia; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvado
| | - Priscila Pinto
- Institute of Collective Health, Federal University of Bahia; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvado
| | | | | | - Ronaldo Coelho
- Department of Chronic Conditions, Diseases, and Sexually Transmitted Infections at the Brazilian Ministry of Health
| | - Maria Ichihara
- The Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation (FIOCRUZ)
| | - Mauricio Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ)
| | - Carlos Teles Santos
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
| | - Corrina Moucheraud
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health
| | - Pamina Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health
| | - James Macinko
- Department of Health Policy and Management, University of California
| | - Luis Souza
- Institute of Collective Health, Federal University of Bahia (UFBA)
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (UFBA)
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Freitas L, Torres TS, Hoagland B, Silva MS, Veloso VG, Grinsztejn B, Bastos JL, Luz PM. Discriminatory experiences among gay, bisexual, and other men who have sex with men, and transgender and non-binary individuals: a cross sectional analysis. LANCET REGIONAL HEALTH. AMERICAS 2024; 33:100737. [PMID: 38623451 PMCID: PMC11017276 DOI: 10.1016/j.lana.2024.100737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024]
Abstract
Background Several systems of oppression combine in complex ways to impact the lives of minority populations. Following an intersectionality framework, we assessed the frequency and perceived reasons for discrimination among gay, bisexual, and other cisgender men who have sex with men (MSM) and transgender and non-binary individuals (TGNB), stratified by race. Methods Online survey among MSM and TGNB ≥18 years living in Brazil, between November/2021 and January/2022. We used the 18-item Explicit Discrimination Scale to assess day-to-day experiences of differential treatment, and perceived discrimination. For each item, participants indicated their perceived reasons for differential treatment using 14 pre-defined options. Negative binomial regression models assessed if race was a significant predictor of discrimination. Subsequent models, stratified by race, examined associations of perceived reasons and number of reasons with perceived discrimination. Findings Of 8464 MSM and TGNB, 4961 (58.6%) were White, 2173 (25.7%) Pardo (Brazil's official term for admixed populations), and 1024 (12.1%) Black. Black participants' scores for perceived discrimination (mean, standard deviation) were higher (10.2, 8.8) [Pardo (6.5, 6.8), White (5.2, 5.7)], and race was both the main reason for and the strongest predictor of perceived discrimination. The number of reasons participants used to interpret their discriminatory experiences was also a predictor of discrimination score among White, Pardo, and Black participants. Interpretation LGBTQIA+phobia was highly prevalent among all participants. Additionally, our results indicated that Black MSM and TGNB participants were more frequently discriminated against than other racial groups, with racial discrimination uniquely contributing these experiences. Funding Fundação Oswaldo Cruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro.
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Affiliation(s)
- Lucilene Freitas
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Rio de Janeiro, RJ 21040-360, Brazil
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Rio de Janeiro, RJ 21040-360, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Rio de Janeiro, RJ 21040-360, Brazil
| | - Mayara S.T. Silva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Rio de Janeiro, RJ 21040-360, Brazil
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Rio de Janeiro, RJ 21040-360, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Rio de Janeiro, RJ 21040-360, Brazil
| | - João L. Bastos
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A1S6 Canada
| | - Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Rio de Janeiro, RJ 21040-360, Brazil
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13
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Lee H, Kim JH, Lee G, Lee H, Huq M, Devakumar D, Kim SS. Ethnic discrimination, asking for fair treatment, and poor self-rated health: a gender stratified analysis of 13,443 Korean Chinese waged workers in South Korea. Int J Equity Health 2024; 23:82. [PMID: 38664773 PMCID: PMC11044320 DOI: 10.1186/s12939-024-02160-0] [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: 11/11/2023] [Accepted: 03/26/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND In South Korea, Korean Chinese workers experience ethnic discrimination although they share physical similarities and ethnic heritage with native-born Koreans. This study aimed to examine whether perceived ethnic discrimination is associated with poor self-rated health and whether the association differs by gender among Korean Chinese waged workers in South Korea. METHODS We conducted a pooled cross-sectional analysis using data of 13,443 Korean Chinese waged workers from the Survey on Immigrants' Living Conditions and Labor Force conducted in 2018, 2020, and 2022. Based on perceived ethnic discrimination, asking for fair treatment, and subsequent situational improvement, respondents were classified into the following four groups: "Not experienced," "Experienced, not asked for fair treatment," "Experienced, asked for fair treatment, not improved," and "Experienced, asked for fair treatment, improved." Poor self-rated health was assessed using a single question "How is your current overall health?" We applied logistic regression to examine the association between perceived ethnic discrimination and poor self-rated health, with gender-stratified analyses. RESULTS We found an association between ethnic discrimination and poor self-rated health among Korean Chinese waged workers. In the gender-stratified analysis, the "Experienced, not asked for fair treatment" group was more likely to report poor self-rated health compared to the "Not experienced" group, regardless of gender. However, gender differences were observed in the group stratified by situational improvements. For male workers, no statistically significant association was found in the "Experienced, asked for fair treatment, improved" group with poor self-rated health (odd ratios: 0.87, 95% confidence intervals: 0.30-2.53). Conversely, among female workers, a statistically significant association was observed (odd ratios: 2.63, 95% confidence intervals: 1.29-5.38). CONCLUSIONS This study is the first to find an association between perceived ethnic discrimination and poor self-rated health, along with gender differences in the association between situational improvements after asking for fair treatment and poor self-rated health among Korean Chinese waged workers in South Korea.
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Affiliation(s)
- Hayoung Lee
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Daehak-dong, Gwanak-gu, 08826, Seoul, Republic of Korea
| | - Ji-Hwan Kim
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Garin Lee
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Daehak-dong, Gwanak-gu, 08826, Seoul, Republic of Korea
| | - Hyelin Lee
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Daehak-dong, Gwanak-gu, 08826, Seoul, Republic of Korea
| | - Mita Huq
- Institute for Global Health, University College London, London, UK
| | | | - Seung-Sup Kim
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Daehak-dong, Gwanak-gu, 08826, Seoul, Republic of Korea.
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea.
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Beyrer C, Kamarulzaman A, Isbell M, Amon J, Baral S, Bassett MT, Cepeda J, Deacon H, Dean L, Fan L, Giacaman R, Gomes C, Gruskin S, Goyal R, Mon SHH, Jabbour S, Kazatchkine M, Kasoka K, Lyons C, Maleche A, Martin N, McKee M, Paiva V, Platt L, Puras D, Schooley R, Smoger G, Stackpool-Moore L, Vickerman P, Walker JG, Rubenstein L. Under threat: the International AIDS Society-Lancet Commission on Health and Human Rights. Lancet 2024; 403:1374-1418. [PMID: 38522449 DOI: 10.1016/s0140-6736(24)00302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/26/2023] [Accepted: 02/12/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
| | | | | | - Joseph Amon
- Office of Global Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Mary T Bassett
- François-Xavier Bagnoud Center for Health and Human Rights, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Harriet Deacon
- Treatied Spaces Research Group and Centre of Excellence in Data Science, Artificial Intelligence and Modelling, University of Hull, Hull, UK
| | - Lorraine Dean
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, West Bank, Palestine
| | - Carolyn Gomes
- UNAIDS HIV & Human Rights Reference Group, Kingston, Jamaica
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Ravi Goyal
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS, Nairobi, Kenya
| | - Natasha Martin
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Vera Paiva
- Institute of Psychology, University of Sao Paulo, Sao Paulo, Brazil
| | - Lucy Platt
- London School of Hygiene & Tropical Medicine, London, UK
| | - Dainius Puras
- Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Robert Schooley
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, CA, USA
| | | | | | | | | | - Leonard Rubenstein
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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15
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Guglielminotti J, LEE A, LANDAU R, SAMARI G, LI G. Structural Racism and Use of Labor Neuraxial Analgesia Among Non-Hispanic Black Birthing People. Obstet Gynecol 2024; 143:571-581. [PMID: 38301254 PMCID: PMC10957331 DOI: 10.1097/aog.0000000000005519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To assess the association between structural racism and labor neuraxial analgesia use. METHODS This cross-sectional study analyzed 2017 U.S. natality data for non-Hispanic Black and White birthing people. The exposure was a multidimensional structural racism index measured in the county of the delivery hospital. It was calculated as the mean of three Black-White inequity ratios (ratios for lower education, unemployment, and incarceration in jails) and categorized into terciles, with the third tercile corresponding to high structural racism. The outcome was the labor neuraxial analgesia rate. Adjusted odds ratios and 95% CIs of neuraxial analgesia associated with terciles of the index were estimated with multivariate logistic regression models. Black and White people were compared with the use of an interaction term between race and ethnicity and the racism index. RESULTS Of the 1,740,716 birth certificates analyzed, 396,303 (22.8%) were for Black people. The labor neuraxial analgesia rate was 77.2% for Black people in the first tercile of the racism index, 74.7% in the second tercile, and 72.4% in the third tercile. For White people, the rates were 80.4%, 78.2%, and 78.2%, respectively. For Black people, compared with the first tercile of the racism index, the second tercile was associated with 18.4% (95% CI, 16.9-19.9%) decreased adjusted odds of receiving neuraxial analgesia and the third tercile with 28.3% (95% CI, 26.9-29.6%) decreased adjusted odds. For White people, the decreases were 13.4% (95% CI, 12.5-14.4%) in the second tercile and 15.6% (95% CI, 14.7-16.5%) in the third tercile. A significant difference in the odds of neuraxial analgesia was observed between Black and White people for the second and third terciles. CONCLUSION A multidimensional index of structural racism is associated with significantly reduced odds of receiving labor neuraxial analgesia among Black people and, to a lesser extent, White people.
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Affiliation(s)
- Jean Guglielminotti
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY 10032, USA
| | - Allison LEE
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY 10032, USA
| | - Ruth LANDAU
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY 10032, USA
| | - Goleen SAMARI
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
- Department of Population and Public Health Science, Keck School of Medicine, University of Southern California, 1845 North Soto Street, Los Angeles, CA 90033, USA
| | - Guohua LI
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
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16
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Yip JLY, Poduval S, de Souza-Thomas L, Carter S, Fenton K. Anti-racist interventions to reduce ethnic disparities in healthcare in the UK: an umbrella review and findings from healthcare, education and criminal justice. BMJ Open 2024; 14:e075711. [PMID: 38418232 PMCID: PMC10910548 DOI: 10.1136/bmjopen-2023-075711] [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] [Received: 05/16/2023] [Accepted: 02/07/2024] [Indexed: 03/01/2024] Open
Abstract
OBJECTIVES To assess the evidence for anti-racist interventions which aim to reduce ethnic disparities in healthcare, with a focus on implementation in the UK healthcare system. DESIGN Umbrella review. DATA SOURCES Embase, Medline, Social Policy and Practice, Social Care Online and Web of Science were searched for publications from the year 2000 up to November 2023. ELIGIBILITY CRITERIA Only systematic and scoping reviews of anti-racist interventions reported in English were included. Reviews were excluded if no interventions were reported, no comparator interventions were reported or the study was primarily descriptive. DATA EXTRACTION AND SYNTHESIS A narrative synthesis approach was used to integrate and categorise the evidence on anti-racist interventions for healthcare. Quality appraisal (including risk of bias) was assessed using the AMSTAR-2 tool. RESULTS A total of 29 reviews are included in the final review. 26 are from the healthcare sector and three are from education and criminal justice. The most promising interventions targeting individuals include group-based health education and providing culturally tailored interventions. On a community level, participation in all aspects of care pathway development that empowers ethnic minority communities may provide an effective approach to reducing ethnic health disparities. Interventions to improve quality of care for conditions with disproportionately worse outcomes in ethnic minority communities show promise. At a policy level, structural interventions including minimum wage policies and integrating non-medical interventions such as housing support in clinical care has some evidence for improving outcomes in ethnic minority communities. CONCLUSIONS Many of the included studies were low or critically low quality due to methodological or reporting limitations. For programme delivery, different types of pathway integration, and providing a more person-centred approach with fewer steps for patients to navigate can contribute to reducing disparities. For organisations, there is an overemphasis on individual behaviour change and recommendations should include a shift in focus and resources to policies and practices that seek to dismantle institutional and systemic racism through a multilevel approach.
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Affiliation(s)
| | - Shoba Poduval
- Institute of Health Informatics, University College London, London, UK
| | | | - Sophie Carter
- Office for Health Improvement and Disparities, London, UK
- Health Innovation Manchester, Manchester, UK
| | - Kevin Fenton
- Office for Health Improvement and Disparities, London, UK
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17
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Affiliation(s)
- Khaled Moustafa
- The Arabic Preprint Server/Arabic Science Archive (ArabiXiv), Paris, France
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18
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Van Landeghem E, Arbier A, Pratt CSA, Senga M, Scheerder G, Reyniers T, Hensen B, Nöstlinger C. PrEP Among Sub-Saharan African Diaspora Communities in Belgium - a Participatory Action Research Study. J Community Health 2024; 49:156-165. [PMID: 37580443 PMCID: PMC10881606 DOI: 10.1007/s10900-023-01269-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/16/2023]
Abstract
In Belgium, migrants from Sub-Saharan Africa (SSA) accounted for 45% of new heterosexual HIV infections in 2021, while only 1.5% of PrEP starters were of SSA descent. We explored the acceptance of PrEP and barriers towards PrEP uptake and use among SSA migrant and diaspora communities in Belgium using a participatory action research approach. Trained community researchers (CRs), involved in all phases of the study, co-designed and moderated group discussions (GDs) while simultaneously providing information on HIV and PrEP during workshops. Extensive summaries and field notes were analysed using reflexive thematic analysis. CRs were involved in data analysis, interpretation and reporting. We conducted seven GDs with 51 participants. We identified five major themes: (1) Participants had limited PrEP knowledge, which created feelings of surprise and annoyance about not being informed. This was partly explained by (2) the taboo and stigma that surrounds sexuality and HIV, which could shape PrEP acceptance. (3) Participants shared feelings of otherness due to experiences of racism and discrimination, also in relationship to HIV prevention. (4) PrEP was considered a high-threshold prevention tool, because of its perceived side-effects and its specialized service delivery. (5) Despite nuanced opinions about PrEP, all participants agreed that PrEP promotion should be mainstreamed, so everyone can make an informed decision. In conclusion, PrEP seemed acceptable among our participants. Our qualitative study provides insights into the intersecting barriers to accessing HIV services, showing that SSA diaspora communities are 'hardly reached' rather than 'hard to reach' by PrEP promotion messages.
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Affiliation(s)
- Ella Van Landeghem
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155 Antwerp, Antwerp, 2000, Belgium.
| | - Alida Arbier
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155 Antwerp, Antwerp, 2000, Belgium
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christian Sydney A Pratt
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155 Antwerp, Antwerp, 2000, Belgium
| | - Mikaza Senga
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155 Antwerp, Antwerp, 2000, Belgium
| | - Gert Scheerder
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155 Antwerp, Antwerp, 2000, Belgium
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155 Antwerp, Antwerp, 2000, Belgium
| | - Bernadette Hensen
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155 Antwerp, Antwerp, 2000, Belgium
| | - Christiana Nöstlinger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155 Antwerp, Antwerp, 2000, Belgium
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19
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Kerrigan V, McGrath SY, Doig C, Herdman RM, Daly S, Puruntatameri P, Lee B, Hefler M, Ralph AP. Evaluating the impact of 'Ask the Specialist Plus': a training program for improving cultural safety and communication in hospital-based healthcare. BMC Health Serv Res 2024; 24:119. [PMID: 38254093 PMCID: PMC10804863 DOI: 10.1186/s12913-024-10565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND First Nations peoples in colonised countries often feel culturally unsafe in hospitals, leading to high self-discharge rates, psychological distress and premature death. To address racism in healthcare, institutions have promised to deliver cultural safety training but there is limited evidence on how to teach cultural safety. To that end, we created Ask the Specialist Plus: a training program that focuses on improving healthcare providers intercultural communication skills to improve cultural safety. Our aim is to describe training implementation and to evaluate the training according to participants. METHODS Inspired by cultural safety, Critical Race Theory and Freirean pedagogy, Ask the Specialist Plus was piloted at Royal Darwin Hospital in Australia's Northern Territory in 2021. The format combined listening to an episode of a podcast called Ask the Specialist with weekly, one-hour face-to-face discussions with First Nations Specialists outside the clinical environment over 7 to 8 weeks. Weekly surveys evaluated teaching domains using five-point Likert scales and via free text comments. Quantitative data were collated in Excel and comments were collated in NVivo12. Results were presented following Kirkpatrick's evaluation model. RESULTS Fifteen sessions of Ask the Specialist Plus training were delivered. 90% of participants found the training valuable. Attendees enjoyed the unique format including use of the podcast as a catalyst for discussions. Delivery over two months allowed for flexibility to accommodate clinical demands and shift work. Students through to senior staff learnt new skills, discussed institutionally racist systems and committed to behaviour change. Considering racism is commonly denied in healthcare, the receptiveness of staff to discussing racism was noteworthy. The pilot also contributed to evidence that cultural safety should be co-taught by educators who represent racial and gender differences. CONCLUSION The Ask the Specialist Plus training program provides an effective model for cultural safety training with high potential to achieve behaviour change among diverse healthcare providers. The training provided practical information on how to improve communication and fostered critical consciousness among healthcare providers. The program demonstrated that training delivered weekly over two months to clinical departments can lead to positive changes through cycles of learning, action, and reflection.
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Affiliation(s)
- Vicki Kerrigan
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.
| | - Stuart Yiwarr McGrath
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Cassandra Doig
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Rarrtjiwuy Melanie Herdman
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Shannon Daly
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Pirrawayingi Puruntatameri
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Bilawara Lee
- Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Anna P Ralph
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Royal Darwin Hospital, Darwin, NT, 0811, Australia
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20
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Bush A. Strip searching by the police: potential for abuse? Arch Dis Child 2024; 109:77. [PMID: 37989599 DOI: 10.1136/archdischild-2023-325683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Andy Bush
- Paediatric Respiratory Medicine, National Heart and Lung Institute Division of Respiratory Science, London, UK
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21
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Guglielminotti J, Samari G, Friedman AM, Landau R, Li G. State-Level Indicators of Structural Racism and Severe Adverse Maternal Outcomes During Childbirth. Matern Child Health J 2024; 28:165-176. [PMID: 37938439 PMCID: PMC11299521 DOI: 10.1007/s10995-023-03828-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Structural racism (SR) is viewed as a root cause of racial and ethnic disparities in maternal health outcomes. However, evidence linking SR to increased odds of severe adverse maternal outcomes (SAMO) is scant. This study assessed the association between state-level indicators of SR and SAMO during childbirth. METHODS Data for non-Hispanic Black and non-Hispanic white women came from the US Natality file, 2017-2018. The exposures were state-level Black-to-white inequity ratios for lower education level, unemployment, and prison incarceration. The outcome was patient-level SAMO, including eclampsia, blood transfusion, hysterectomy, or intensive care unit admission. Adjusted odds ratios (aORs) of SAMO associated with each ratio were estimated using multilevel models adjusting for patient, hospital, and state characteristics. RESULTS A total of 4,804,488 birth certificates were analyzed, with 22.5% for Black women. SAMO incidence was 106.4 per 10,000 (95% CI 104.5, 108.4) for Black women, and 72.7 per 10,000 (95% CI 71.8, 73.6) for white women. Odds of SAMO increased 35% per 1-unit increase in the unemployment ratio for Black women (aOR 1.35; 95% CI 1.04, 1.73), and 16% for white women (aOR 1.16; 95% CI 1.01, 1.33). Odds of SAMO increased 6% per 1-unit increase in the incarceration ratio for Black women (aOR 1.06; 95% CI 1.03, 1.10), and 4% for white women (aOR 1.04; 95% CI 1.02, 1.06). No significant association was observed between SAMO and the lower education level ratio. CONCLUSIONS FOR PRACTICE State-level Black-to-white inequity ratios for unemployment and incarceration are associated with significantly increased odds of SAMO.
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Affiliation(s)
- Jean Guglielminotti
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY, 10032, USA.
| | - Goleen Samari
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Alexander M Friedman
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, New York, NY, 10032, USA
| | - Ruth Landau
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY, 10032, USA
| | - Guohua Li
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH5-505, New York, NY, 10032, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
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22
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Lee B, Lee K, Hartmann B. Transformation of social relationships in COVID-19 America: Remote communication may amplify political echo chambers. SCIENCE ADVANCES 2023; 9:eadi1540. [PMID: 38117890 PMCID: PMC10732520 DOI: 10.1126/sciadv.adi1540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/16/2023] [Indexed: 12/22/2023]
Abstract
The COVID-19 pandemic, with millions of Americans compelled to stay home and work remotely, presented an opportunity to explore the dynamics of social relationships in a predominantly remote world. Using the 1972-2022 General Social Surveys, we found that the pandemic significantly disrupted the patterns of social gatherings with family, friends, and neighbors but only momentarily. Drawing from the nationwide ego-network surveys of 41,033 Americans from 2020 to 2022, we found that the size and composition of core networks remained stable, although political homophily increased among nonkin relationships compared to previous surveys between 1985 and 2016. Critically, heightened remote communication during the initial phase of the pandemic was associated with increased interaction with the same partisans, although political homophily decreased during the later phase of the pandemic when in-person contacts increased. These results underscore the crucial role of social institutions and social gatherings in promoting spontaneous encounters with diverse political backgrounds.
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Affiliation(s)
- Byungkyu Lee
- Department of Sociology, New York University, New York, NY, USA
| | - Kangsan Lee
- Social Research and Public Policy, New York University–Abu Dhabi, Abu Dhabi, UAE
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23
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Justice C, Sullivan MB, Van Demark CB, Davis CM, Erb M. Guiding Principles for the Practice of Integrative Physical Therapy. Phys Ther 2023; 103:pzad138. [PMID: 37815938 PMCID: PMC10757068 DOI: 10.1093/ptj/pzad138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 07/03/2023] [Accepted: 09/12/2023] [Indexed: 10/12/2023]
Abstract
Integrative health is an emerging specialty inside multiple disciplines within the medical community, yet the practice of integrative physical therapy remains undefined. This perspective paper suggests a set of guiding principles to support the role of physical therapy in integrative health. These guiding principles, including therapeutic partnership, whole person health, living systems, movement as an integrative experience, and salutogenesis, are described and explored in-depth as they relate to all aspects of patient care and clinician experience. These guiding principles are articulated within the context of social determinants of health and the interrelated roles that environment, trauma, stress, and lifestyle all play within an integrative physical therapy plan of care. Examples of current integrative physical therapy practices that embody these principles are described. The 5 guiding principles are designed to elicit interprofessional inquiry into how integrative health models can be applied to the art and science of physical therapy practice. The expansion of integrative health into the field of physical therapy has the potential to improve individual and population health, as integrative physical therapy can be used to address prevention, health promotion, primary care, and wellness while acknowledging the complex, dynamic, and interconnected nature of the human condition. IMPACT This perspective article presents 5 guiding principles to establish a framework to define and shape the growing application of an integrative health model to physical therapy practice. These integrative physical therapy guiding principles aim to improve the quality of whole-person, patient-centered care.
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Affiliation(s)
- Catherine Justice
- Integrative Health and Wellness Division of the Department of Medicine, Hennepin Healthcare Systems, Minneapolis, Minnesota, USA
| | - Marlysa B Sullivan
- Empower Veterans Program, Atlanta Veterans Administration Health Care System, Atlanta, Georgia, USA
| | - Cheryl B Van Demark
- Physical Rehabilitation Services, Dignity Health Yavapai Regional Medical Center, Prescott, Arizona, USA
| | - Carol M Davis
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Matt Erb
- The Center for Mind-Body Medicine, Washington District of Columbia, USA
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Wang X, Tian B, Zhang S, Li J, Yang W, Gu L, Zhang W. Underlying mechanisms of diabetes knowledge influencing diabetes self-management behaviors among patients with type II diabetes in rural China: Based on health belief model. PATIENT EDUCATION AND COUNSELING 2023; 117:107986. [PMID: 37757607 DOI: 10.1016/j.pec.2023.107986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE To investigate the association between diabetes knowledge and diabetes self-management (DSM) behaviors and to explore the influence mechanism between them among patients with type 2 diabetes mellitus (T2DM) based on health belief model in rural China. METHODS This cross-sectional study included 483 participants with T2DM from 8 villages of 3 townships in Jiangsu Province. All participants completed a structured questionnaire, including demographic information, diabetes knowledge, DSM behaviors, health beliefs, and cognitive function. Multiple linear regression and mediation analysis were performed to analyze the association between diabetes knowledge and DSM behaviors, furthermore the mechanism between them. RESULTS Diabetes knowledge and self-efficacy positively influenced DSM behaviors. Health beliefs multiply mediated the association between diabetes knowledge and DSM behaviors. Perceived behavioral barriers mediated the relationship between diabetes knowledge and DSM behaviors, where a suppression effect existed. A chain-mediated effect was found: diabetes knowledge affected perceived benefits, followed by self-efficacy, and finally DSM behaviors. CONCLUSION Diabetes knowledge acquisition played an important role in improving DSM behaviors, and health beliefs multiply mediated the relationship between them. PRACTICE IMPLICATIONS When designing interventions, health systems and health providers should refocus on diabetes knowledge, emphasize the benefits of self-management, and consider the barriers that patients may encounter.
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Affiliation(s)
- Xiaoying Wang
- School of Social Development and Public Policy & Center for Behavioral Health, Beijing Normal University, Beijing, China
| | - Bo Tian
- School of Social Development and Public Policy & Center for Behavioral Health, Beijing Normal University, Beijing, China
| | - Shengfa Zhang
- National Population Heath Data Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jina Li
- School of Social Development and Public Policy & Center for Behavioral Health, Beijing Normal University, Beijing, China
| | - Weiping Yang
- Yancheng Dafeng People's Hospital, Jiangsu Province, China
| | - Linni Gu
- School of Health Management, Inner Mongolia Medical University, Inner Mongolia Autonomous Region, China
| | - Weijun Zhang
- School of Social Development and Public Policy & Center for Behavioral Health, Beijing Normal University, Beijing, China.
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26
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Miranda AE, Lima RCD. Syphilis as a marker of ethnoracial inequalities in Brazil. Lancet Glob Health 2023; 11:e1670-e1671. [PMID: 37858572 DOI: 10.1016/s2214-109x(23)00424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Angelica E Miranda
- Center for Health Sciences, Federal University of Espirito Santo, Vitória 29040-091, Brazil.
| | - Rita Cassia D Lima
- Center for Health Sciences, Federal University of Espirito Santo, Vitória 29040-091, Brazil
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27
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Zhang CX, Bankhead C, Quigley MA, Kwok CH, Carson C. Ethnic inequities in routine childhood vaccinations in England 2006-2021: an observational cohort study using electronic health records. EClinicalMedicine 2023; 65:102281. [PMID: 37965428 PMCID: PMC10641103 DOI: 10.1016/j.eclinm.2023.102281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 11/16/2023] Open
Abstract
Background Population groups that are underserved by England's childhood vaccination programme must be identified to address the country's declining vaccination coverage. We examined routine childhood vaccination coverage in England by maternal ethnicity between 2006 and 2021. Methods We created first, second and fifth birthday cohorts using mother-child linked electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum. After validation against the UK Health Security Agency (UKHSA) and National Health Service England (NHSE) annual statistical reports, we described vaccination coverage for each vaccine by ethnicity and year. We used modified Poisson regression to analyse the effect of ethnicity on receiving the primary and full course of each vaccine. Findings Up to 1,170,804 children born after 1 April 2006 were included in the first birthday cohort, reducing to 645,492 by the fifth birthday. Children were followed up until 31 March 2021 at the latest. Children born to mothers in 9 minority ethnic groups and those of unknown ethnicity had lower vaccination coverage (61.3-97.5%) than the White British group (79.9-97.8%) for all vaccines. Indian, Pakistani, Bangladeshi, Chinese, Any other Asian background, and White and Asian ethnic groups had similar vaccination coverage to the White British group (above 90% for most vaccines in most years). Inequities particularly affected the Caribbean group (e.g. 61% coverage for the 6/5/4-in-1 full course in 2020-21 by children's fifth birthday; RR 0.66, 95% CI 0.6-0.74 compared with the White British group) and Any other Black, African and Caribbean background (e.g. coverage 68% for the MMR primary course in 2020-21; RR 0.71, 95% CI 0.64-0.78). These inequities widened over the study period. For example, the absolute difference in coverage between the Caribbean and White British groups for the full course of MMR increased from 12% in 2011-12 to 22% in 2019-20. These inequities remained even after accounting for sociodemographic, maternal and birth related factors, and also widened from primary course to full course. Interpretation Our findings suggest that urgent policy action is needed to address the ethnic inequities throughout England's routine childhood vaccination programme, which have been worsening over time. Funding University of Oxford Clarendon Fund, St Cross College and Nuffield Department of Population Health.
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Affiliation(s)
- Claire X. Zhang
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - Maria A. Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - Chun Hei Kwok
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, United Kingdom
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
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28
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Poduval S, Kamal A, Martin S, Islam A, Kaviraj C, Gill P. Beyond Information Provision: Analysis of the Roles of Structure and Agency in COVID-19 Vaccine Confidence in Ethnic Minority Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7008. [PMID: 37947565 PMCID: PMC10650583 DOI: 10.3390/ijerph20217008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/29/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
People from Black and Asian backgrounds are more likely to die from COVID-19 but less likely to be vaccinated, threatening to exacerbate health inequalities already experienced by ethnic minority groups. The literature suggests that mistrust rooted in structural inequality (including socioeconomic position and experience of racism) may be a key barrier to COVID-19 vaccine uptake. Understanding and addressing structural inequality is likely to lead to longer-term impacts than information alone. The aim of this study is to draw on health and sociological theories of structure and agency to inform our understanding of how structural factors influence vaccine confidence. We conducted qualitative interviews and focus groups with 22 people from London and the surrounding areas from December 2021 to March 2022. Fourteen participants were members of the public from ethnic minority backgrounds, and seven were professionals working with the public to address concerns and encourage vaccine uptake. Our findings suggest that people from ethnic minority backgrounds make decisions regarding COVID-19 vaccination based on a combination of how they experience external social structures (including lack of credibility and clarity from political authority, neglect by health services, and structural racism) and internal processes (weighing up COVID-19 vaccine harms and benefits and concerns about vaccine development and deployment). We may be able to support knowledge accumulation through the provision of reliable and accessible information, particularly through primary and community care, but we recommend a number of changes to research, policy and practice that address structural inequalities. These include working with communities to improve ethnicity data collection, increasing funding allocation to health conditions where ethnic minority communities experience poorer outcomes, greater transparency and public engagement in the vaccine development process, and culturally adapted research recruitment processes.
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Affiliation(s)
- Shoba Poduval
- UCL Research Department of Primary Care & Population Health, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Atiya Kamal
- School of Social Sciences, Birmingham City University, 4 Cardigan Street, Birmingham B4 7BD, UK;
| | - Sam Martin
- Rapid Research Evaluation and Appraisal Lab (RREAL), Department of Targeted Intervention, University College London (UCL), Charles Bell House, 43–45 Foley Street, London W1W 7TY, UK;
- Vaccines and Society Unit, Oxford Vaccine Group, Oxford University, Oxford OX3 7LE, UK
| | - Amin Islam
- Patient and Public Involvement Authors, UCL Research Department of Primary Care & Population Health, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Chandrika Kaviraj
- Patient and Public Involvement Authors, UCL Research Department of Primary Care & Population Health, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK;
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29
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Mukadam N, Marston L, Lewis G, Mathur R, Lowther E, Rait G, Livingston G. South Asian, Black and White ethnicity and the effect of potentially modifiable risk factors for dementia: A study in English electronic health records. PLoS One 2023; 18:e0289893. [PMID: 37819899 PMCID: PMC10566703 DOI: 10.1371/journal.pone.0289893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/28/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION We aimed to investigate ethnic differences in the associations of potentially modifiable risk factors with dementia. METHODS We used anonymised data from English electronic primary care records for adults aged 65 and older between 1997 and 2018. We used Cox regression to investigate main effects for each risk factor and interaction effects between each risk factor and ethnicity. RESULTS We included 865,674 people with 8,479,973 person years of follow up. Hypertension, dyslipidaemia, obesity and diabetes were more common in people from minority ethnic groups than White people. The impact of hypertension, obesity, diabetes, low HDL and sleep disorders on dementia risk was increased in South Asian people compared to White people. The impact of hypertension was greater in Black compared to White people. DISCUSSION Dementia prevention efforts should be targeted towards people from minority ethnic groups and tailored to risk factors of particular importance.
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Affiliation(s)
- Naaheed Mukadam
- Division of Psychiatry, University College London, London, United Kingdom
| | - Louise Marston
- Primary Care & Population Health, University College London, London, United Kingdom
| | - Gemma Lewis
- Division of Psychiatry, University College London, London, United Kingdom
| | - Rohini Mathur
- Wolfson Institute of Population Health, Queen Mary University London, London, United Kingdom
| | - Ed Lowther
- Advanced Research Computing Centre, University College London, London, United Kingdom
| | - Greta Rait
- Primary Care & Population Health, University College London, London, United Kingdom
| | - Gill Livingston
- Division of Psychiatry, University College London, London, United Kingdom
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30
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Banerjee AT, Tan A, Boston-Fisher N, Dubois CA, LaFontaine A, Cloos P, Vissandjee B, Adams J, Hafeez H, Bumba S, Kernisan K, Ferlatte O, Razack S, Edwards MM, Evans T. Embedding anti-racism in Schools of Public Health: a pathway to accountability for progress towards equity. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:872-877. [PMID: 37410365 PMCID: PMC10486309 DOI: 10.17269/s41997-023-00796-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
The importance of seeing race as a socially constructed idea continues to produce unfair differences between humans and establishes power relations that lead to injustice and exposure to death. Since the racial justice movement in early 2020, there has been a heightened awareness of, and increased interest in, addressing historic racial disparities across Schools of Public Health (SPH) in Canada. Steps have been taken to recognize systemic racism and increase diversity through structural reforms to advance equity and inclusion; however, addressing racism demands collectively uprooting racist institutional designs still inherent in learning, teaching, research, service, and community engagement. This commentary highlights the need for sustained commitment to establishing longitudinal benchmarks for greater racial equity among students, staff, and faculty; revising curricula to include historic and contemporary narratives of colonialism and slavery; and providing community-engaged learning opportunities as instrumental to dismantle systemic drivers of racial health inequities locally and globally. We also advocate for intersectoral collaboration, mutual learning, and sharing of resources across SPH and partner agencies to accomplish a continual collective agenda for racial health equity and inclusion that is intersectional in Canada, while being held accountable to Indigenous and racialized communities.
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Affiliation(s)
- Ananya Tina Banerjee
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada.
| | - Amy Tan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nikita Boston-Fisher
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada
| | - Carl-Ardy Dubois
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Alika LaFontaine
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Cloos
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Bilkis Vissandjee
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer Adams
- Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Hinna Hafeez
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada
| | - Stephanie Bumba
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | | | - Olivier Ferlatte
- École de Santé Publique, Université de Montréal, Montreal, Quebec, Canada
| | - Saleem Razack
- Pediatrics and Institute for Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Mairi McKenna Edwards
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Tim Evans
- School of Population & Global Health, McGill University, Montreal, Quebec, Canada
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31
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Barbour V. The MJA supports an Aboriginal and Torres Strait Islander Voice to Parliament. Med J Aust 2023; 219:257-258. [PMID: 37634242 DOI: 10.5694/mja2.52074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/29/2023]
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Agarwal S, Wade AN, Mbanya JC, Yajnik C, Thomas N, Egede LE, Campbell JA, Walker RJ, Maple-Brown L, Graham S. The role of structural racism and geographical inequity in diabetes outcomes. Lancet 2023; 402:235-249. [PMID: 37356447 PMCID: PMC11329296 DOI: 10.1016/s0140-6736(23)00909-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/27/2023]
Abstract
Diabetes is pervasive, exponentially growing in prevalence, and outpacing most diseases globally. In this Series paper, we use new theoretical frameworks and a narrative review of existing literature to show how structural inequity (structural racism and geographical inequity) has accelerated rates of diabetes disease, morbidity, and mortality globally. We discuss how structural inequity leads to large, fixed differences in key, upstream social determinants of health, which influence downstream social determinants of health and resultant diabetes outcomes in a cascade of widening inequity. We review categories of social determinants of health with known effects on diabetes outcomes, including public awareness and policy, economic development, access to high-quality care, innovations in diabetes management, and sociocultural norms. We also provide regional perspectives, grounded in our theoretical framework, to highlight prominent, real-world challenges.
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Affiliation(s)
- Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jean Claude Mbanya
- Division of Endocrinology, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | - Leonard E Egede
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Endocrinology, Royal Darwin and Palmerston Hospitals, Darwin, NT, Australia
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Deivanayagam TA, English S, Hickel J, Bonifacio J, Guinto RR, Hill KX, Huq M, Issa R, Mulindwa H, Nagginda HP, de Morais Sato P, Selvarajah S, Sharma C, Devakumar D. Envisioning environmental equity: climate change, health, and racial justice. Lancet 2023; 402:64-78. [PMID: 37263280 PMCID: PMC10415673 DOI: 10.1016/s0140-6736(23)00919-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023]
Abstract
Climate change has a broad range of health impacts and tackling climate change could be the greatest opportunity for improving global health this century. Yet conversations on climate change and health are often incomplete, giving little attention to structural discrimination and the need for racial justice. Racism kills, and climate change kills. Together, racism and climate change interact and have disproportionate effects on the lives of minoritised people both within countries and between the Global North and the Global South. This paper has three main aims. First, to survey the literature on the unequal health impacts of climate change due to racism, xenophobia, and discrimination through a scoping review. We found that racially minoritised groups, migrants, and Indigenous communities face a disproportionate burden of illness and mortality due to climate change in different contexts. Second, this paper aims to highlight inequalities in responsibility for climate change and the effects thereof. A geographical visualisation of responsibility for climate change and projected mortality and disease risk attributable to climate change per 100 000 people in 2050 was conducted. These maps visualise the disproportionate burden of illness and mortality due to climate change faced by the Global South. Our third aim is to highlight the pathways through which climate change, discrimination, and health interact in most affected areas. Case studies, testimony, and policy analysis drawn from multidisciplinary perspectives are presented throughout the paper to elucidate these pathways. The health community must urgently examine and repair the structural discrimination that drives the unequal impacts of climate change to achieve rapid and equitable action.
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Affiliation(s)
- Thilagawathi Abi Deivanayagam
- Institute for Global Health, University College London, London, UK; Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Sonora English
- Institute for Global Health, University College London, London, UK
| | - Jason Hickel
- Institute for Environmental Science and Technology, Autonomous University of Barcelona, Barcelona, Spain; International Inequalities Institute, London School of Economics and Political Science, London, UK
| | - Jon Bonifacio
- Youth Advocates for Climate Action Philippines, Quezon City, Philippines
| | - Renzo R Guinto
- Planetary and Global Health Program, St Luke's Medical Center College of Medicine-William H Quasha Memorial, Quezon City, Philippines
| | - Kyle X Hill
- Department of Indigenous Health, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - Mita Huq
- Institute for Global Health, University College London, London, UK
| | - Rita Issa
- Institute for Global Health, University College London, London, UK; School of International Development, University of East Anglia, Norwich, UK
| | | | | | | | | | - Chetna Sharma
- Institute for Global Health, University College London, London, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
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Freeman T, Baum F, Musolino C, Flavel J, McKee M, Chi C, Giugliani C, Falcão MZ, De Ceukelaire W, Howden-Chapman P, Nguyen TH, Serag H, Kim S, Carlos AD, Gesesew HA, London L, Popay J, Paremoer L, Tangcharoensathien V, Sundararaman T, Nandi S, Villar E. Illustrating the impact of commercial determinants of health on the global COVID-19 pandemic: Thematic analysis of 16 country case studies. Health Policy 2023; 134:104860. [PMID: 37385156 DOI: 10.1016/j.healthpol.2023.104860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023]
Abstract
Previous research on commercial determinants of health has primarily focused on their impact on non-communicable diseases. However, they also impact on infectious diseases and on the broader preconditions for health. We describe, through case studies in 16 countries, how commercial determinants of health were visible during the COVID-19 pandemic, and how they may have influenced national responses and health outcomes. We use a comparative qualitative case study design in selected low- middle- and high-income countries that performed differently in COVID-19 health outcomes, and for which we had country experts to lead local analysis. We created a data collection framework and developed detailed case studies, including extensive grey and peer-reviewed literature. Themes were identified and explored using iterative rapid literature reviews. We found evidence of the influence of commercial determinants of health in the spread of COVID-19. This occurred through working conditions that exacerbated spread, including precarious, low-paid employment, use of migrant workers, procurement practices that limited the availability of protective goods and services such as personal protective equipment, and commercial actors lobbying against public health measures. Commercial determinants also influenced health outcomes by influencing vaccine availability and the health system response to COVID-19. Our findings contribute to determining the appropriate role of governments in governing for health, wellbeing, and equity, and regulating and addressing negative commercial determinants of health.
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Affiliation(s)
- Toby Freeman
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005 Australia.
| | - Fran Baum
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005 Australia
| | - Connie Musolino
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005 Australia
| | - Joanne Flavel
- Stretton Health Equity, University of Adelaide, Adelaide, SA, 5005 Australia
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London WC1H 9SH, United Kingdom
| | - Chunhuei Chi
- Center for Global Health, Oregon State University, Corvallis, OR 7331, USA
| | - Camila Giugliani
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcellos, 2400 CEP 90035-003, Porto Alegre, Brazil
| | - Matheus Zuliane Falcão
- University of São Paulo, Brazil, Av. Dr. Arnaldo, 715 - 211 - Cerqueira César, São Paulo - SP, 01246-904, Brazil
| | | | | | - Thanh Huong Nguyen
- Faculty of Social Science and Behavior, Hanoi University of Public Health, 1A Duc Thang Road, Duc Thang Ward, North Tu Liem District, Hanoi, Vietnam
| | - Hani Serag
- University of Texas Medical Branch (UTMB), 301 University Blvd., Galveston, Texas, 77555, USA
| | - Sun Kim
- People's Health Institute, 36 Sadang-ro 13-gil, Dongjak-gu, Seoul 07004, South Korea
| | - Alvarez Dardet Carlos
- CIBERESP, Center for Research in Epidemiology and Public Health, University of Alicante, 03560 Spain
| | - Hailay Abrha Gesesew
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, 5000 AUSTRALIA & College of Health Sciences, Mekelle University, Mekelle, 231 Ethiopia
| | - Leslie London
- School of Public Health, University of Cape Town, South Africa
| | - Jennie Popay
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, Bailrigg, Lancaster LA1 4YW, United Kingdom
| | - Lauren Paremoer
- Political Studies, University of Cape Town, Cape Town, South Africa
| | | | | | | | - Eugenio Villar
- Universidad Peruana Cayetano Heredio, San Martín de Porres 15102, Peru
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Régio L, Barros S, Ballan C, Aguiar C, Candido BDP, de Oliveira MAF. The care provided to black-skinned children and adolescents with mental health problems in the intersection between gender and race. Rev Lat Am Enfermagem 2023; 31:e3941. [PMID: 37341257 PMCID: PMC10306061 DOI: 10.1590/1518-8345.6058.3941] [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: 03/23/2022] [Accepted: 03/28/2023] [Indexed: 06/22/2023] Open
Abstract
OBJECTIVE to characterize the sociofamily profile of black-skinned children and adolescents with mental health problems and to intersectionally describe who assumes responsibility for their care. METHOD a descriptive and exploratory study with a quantitative approach, developed in the Psychosocial Care Center for Children and Adolescents from the North region of the municipality of São Paulo. The data were collected from 47 family members of black-skinned children and adolescents, using a script with predefined variables submitted to statistical analysis. RESULTS a total of 49 interviews were conducted: 95.5% women with a mean age of 39 years old, 88.6% mothers and 85.7% black-skinned. Family income comes from wages for all the male caregivers and for 59% of the women. Among the black-skinned female caregivers, 25% live in their own house, whereas this percentage is 46.2% among the brown-skinned ones. Of all the caregivers, 10% have a job, 20% live in transferred properties, 35% in houses of their own and 35% in rented places. The social support network is larger among white-skinned people (16.7%), followed by brown-skinned (3.8%), and absent among black-skinned individuals (0%). CONCLUSION those responsible for the care of black-skinned children and adolescents monitored by the CAPS-IJ are almost entirely women, black-skinned (black or brown) "mothers or grandmothers", with unequal access to education, work and housing, constitutional social rights in Brazil.
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Affiliation(s)
- Luciane Régio
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
- Faculdade de Ciências Médicas da Santa Casa, Curso de Enfermagem, São Paulo, SP, Brasil
| | - Sônia Barros
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
- Universidade de São Paulo, Instituto de Estudos Avançados, São Paulo, SP, Brasil
| | - Caroline Ballan
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
| | - Carla Aguiar
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brasil
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Miró Ò. Race: a sometimes relevant aspect that is immensely difficult to categorize in emergency medicine. Eur J Emerg Med 2023; 30:155-156. [PMID: 36719187 DOI: 10.1097/mej.0000000000001000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
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37
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Erondu NA, Mofokeng T, Kavanagh MM, Matache M, Bosha SL. Towards anti-racist policies and strategies to reduce poor health outcomes in racialised communities: introducing the O'Neill-Lancet Commission on Racism, Structural Discrimination, and Global Health. Lancet 2023:S0140-6736(23)00910-8. [PMID: 37211023 DOI: 10.1016/s0140-6736(23)00910-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Ngozi A Erondu
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC 20001, USA; Global Institute for Disease Elimination, Abu Dhabi, United Arab Emirates.
| | - Tlaleng Mofokeng
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC 20001, USA; Office of the United Nations High Commissioner for Human Rights, Geneva, Switzerland
| | - Matthew M Kavanagh
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC 20001, USA; School of Health, Georgetown University, Washington, DC, USA
| | | | - Sarah L Bosha
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC 20001, USA
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Devakumar D, Rajagopalan S, Strong KL, Requejo J, Diaz T, Gram L, Aldridge R, Dalglish SL. Racism, xenophobia, and discrimination: data disaggregation is a complex but crucial step to improving child health. Lancet 2023; 401:1321-1323. [PMID: 37004671 DOI: 10.1016/s0140-6736(23)00618-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London WC1N 1EH, UK.
| | - Srivatsan Rajagopalan
- Children in All Policies 2030, Institute for Global Health, University College London, London, UK
| | - Kathleen L Strong
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Jennifer Requejo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Global Financing Facility, World Bank Group, Washington DC, USA
| | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Lu Gram
- Institute for Global Health, University College London, London WC1N 1EH, UK
| | - Robert Aldridge
- Institute of Health Informatics, University College London, London WC1N 1EH, UK
| | - Sarah L Dalglish
- Children in All Policies 2030, Institute for Global Health, University College London, London, UK
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39
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Ivey Henry P, Spence Beaulieu MR, Bradford A, Graves JL. Embedded racism: Inequitable niche construction as a neglected evolutionary process affecting health. Evol Med Public Health 2023; 11:112-125. [PMID: 37197590 PMCID: PMC10184440 DOI: 10.1093/emph/eoad007] [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: 10/10/2022] [Revised: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
Racial health disparities are a pervasive feature of modern experience and structural racism is increasingly recognized as a public health crisis. Yet evolutionary medicine has not adequately addressed the racialization of health and disease, particularly the systematic embedding of social biases in biological processes leading to disparate health outcomes delineated by socially defined race. In contrast to the sheer dominance of medical publications which still assume genetic 'race' and omit mention of its social construction, we present an alternative biological framework of racialized health. We explore the unifying evolutionary-ecological principle of niche construction as it offers critical insights on internal and external biological and behavioral feedback processes environments at every level of the organization. We Integrate insights of niche construction theory in the context of human evolutionary and social history and phenotype-genotype modification, exposing the extent to which racism is an evolutionary mismatch underlying inequitable disparities in disease. We then apply ecological models of niche exclusion and exploitation to institutional and interpersonal racial constructions of population and individual health and demonstrate how discriminatory processes of health and harm apply to evolutionarily relevant disease classes and life-history processes in which socially defined race is poorly understood and evaluated. Ultimately, we call for evolutionary and biomedical scholars to recognize the salience of racism as a pathogenic process biasing health outcomes studied across disciplines and to redress the neglect of focus on research and application related to this crucial issue.
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Affiliation(s)
- Paula Ivey Henry
- Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Angelle Bradford
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joseph L Graves
- Department of Biology, North Carolina A&T State University, Greensboro, NC, USA
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40
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Versluis M, Özcan H, Overeem L, Bakker M, Telkamp C, Duvivier R, de Zeeuw J. Applicability of working abroad for physicians with a specialization in Global Health and Tropical Medicine. Global Health 2023; 19:28. [PMID: 37081545 PMCID: PMC10116460 DOI: 10.1186/s12992-023-00929-6] [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: 11/25/2022] [Accepted: 04/06/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND In The Netherlands, physicians specialized in global health and tropical medicine (Ps-GHTM) are trained to work in low-resource settings (LRS) after their training program of 27 months. After working for a period of time in LRS, many Ps-GHTM continue their careers in the Dutch healthcare system. While there is limited evidence regarding the value of international health experience for medical students and residents, it is unknown to what extent this applies to Ps-GHTM and to their clinical practice in the Netherlands. METHODS In this qualitative study we conducted semi-structured interviews and focus group discussions (FGDs) with Ps-GHTM to explore the perceived applicability of their experience abroad for their subsequent return to the Netherlands. Topic guides were developed using literature about the applicability of working abroad. Findings from the interviews served as a starting point for FGDs. The interviews and FGDs were analysed using directed content analysis. RESULTS 15 themes are described relating experience abroad to healthcare delivery in The Netherlands: broad medical perspective, holistic perspective, adaptive communication skills, creativity, flexibility, cultural awareness, self-reliance, clinical competence, cost awareness, public health, leadership, open-mindedness, organization of care, self-development, and teamwork. Highlighting the variety in competencies and the complexity of the topic, not all themes were recognized by all respondents in the FGDs nor deemed equally relevant. Flexibility, cultural awareness and holistic perspective are examples of important benefits to work experience in LRS. CONCLUSION Ps-GHTM bring their competencies to LRS and return to the Netherlands with additionally developed skills and knowledge. These may contribute to healthcare delivery in the Netherlands. This reciprocal value is an important factor for the sustainable development of global health. Identifying the competencies derived from work experience in LRS could give stakeholders insight into the added value of Ps-GHTM and partly help in refining the specialization program.
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Affiliation(s)
- Marco Versluis
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Hanzeplein 1, Groningen, 9713 GZ, the Netherlands.
| | - Hasan Özcan
- Radboud University, Nijmegen, The Netherlands
| | - Loes Overeem
- University of Groningen, Groningen, The Netherlands
| | - Maria Bakker
- Department of Paediatrics, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Caroline Telkamp
- Department of Obstetrics and Gynaecology, St. Walburg's Hospital, Nyangao, Tanzania
| | - Robbert Duvivier
- Department of Health Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Janine de Zeeuw
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, Groningen, The Netherlands
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41
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Deivanayagam TA, Osborne RE. Breaking free from tunnel vision for climate change and health. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001684. [PMID: 36963098 PMCID: PMC10021701 DOI: 10.1371/journal.pgph.0001684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Climate change is widely recognised as the greatest threat to public health this century, but 'climate change and health' often refers to a narrow and limited focus on emissions, and the impacts of the climate crisis, rather than a holistic assessment of economic structures and systems of oppression. This tunnel vision misses key aspects of the climate change and health intersection, such as the enforcers of planetary destruction such as the military, police, and trade, and can also lead down dangerous alleyways such as 'net' zero, overpopulation arguments and green extractivism. Tunnel vision also limits health to the absence of the disease at the individual level, rather than sickness or health within systems themselves. Conceptualising health as political, ecological, and collective is essential for tackling the root causes of health injustice. Alternative economic paradigms can offer possibilities for fairer ecological futures that prioritise health and wellbeing. Examples such as degrowth, doughnut economics and ecosocialism, and their relationship with health, are described. The importance of reparations in various forms, to repair previous and ongoing harm, are discussed. Breaking free from tunnel vision is not simply an intellectual endeavour, but a practice. Moving towards new paradigms requires movement building and cultivating radical imagination. The review highlights lessons which can be learnt from abolitionist movements and progressive political struggles across the world. This review provides ideas and examples of how to break free from tunnel vision for climate change and health by highlighting and analysing the work of multiple organisations who are working towards social and economic transformation. Key considerations for the health community are provided, including working in solidarity with others, prioritising community-led solutions, and using our voice, skills, and capacity to address the structural diagnosis-colonial capitalism.
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Affiliation(s)
- Thilagawathi Abi Deivanayagam
- Institute for Global Health, University College London, London, United Kingdom
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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42
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Devakumar D, Abubakar I, Tendayi Achiume E, Muraya K, Paradies Y, Saini A, Selvarajah S, Shannon G. Executive summary. Lancet 2022; 400:2095-2096. [PMID: 36502847 DOI: 10.1016/s0140-6736(22)02485-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London, UK.
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - E Tendayi Achiume
- Department of Law, UCLA School of Law, University of California, Los Angeles, CA, USA
| | - Kui Muraya
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC, Australia
| | | | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
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43
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Selvarajah S, Adil HS, Ekechi C. Race, ethnicity, and ill health: making the non-modifiable modifiable. Lancet 2022; 400:2008-2009. [PMID: 36502824 DOI: 10.1016/s0140-6736(22)02460-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Sujitha Selvarajah
- Race & Health, Institute for Global Health, University College London, London, UK; St George's Hospital NHS Foundation Trust, London, UK.
| | - Haleema Sadia Adil
- Race Equality Taskforce, Royal College of Obstetricians and Gynaecologists, London, UK; University College London Medical School, London, UK
| | - Christine Ekechi
- Queen Charlotte's & Chelsea Hospital, Imperial NHS Healthcare Trust, London, UK
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44
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Abubakar I, Gram L, Lasoye S, Achiume ET, Becares L, Bola GK, Dhairyawan R, Lasco G, McKee M, Paradies Y, Sabharwal NS, Selvarajah S, Shannon G, Devakumar D. Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems. Lancet 2022; 400:2137-2146. [PMID: 36502851 DOI: 10.1016/s0140-6736(22)01989-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 12/13/2022]
Abstract
Racism, xenophobia, and discrimination are key determinants of health and equity and must be addressed for improved health outcomes. We conclude that far broader, deeper, transformative action is needed compared with current measures to tackle adverse effects of racism on health. To challenge the structural drivers of racism and xenophobia, anti-racist action and other wider measures that target determinants should implement an intersectional approach to effectively address the causes and consequences of racism within a population. Structurally, legal instruments and human rights law provide a robust framework to challenge the pervasive drivers of disadvantage linked to caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour. Actions need to consider the historical, economic, and political contexts in which the effects of racism, xenophobia, and discrimination affect health. We propose several specific actions: a commission that explores how we action the approaches laid out in this paper; building a conversation and a series of events with international multilateral agency stakeholders to raise the issue and profile of racism, xenophobia, and discrimination within health; and using our multiple platforms to build coalitions, expand knowledge, highlight inequities, and advocate for change across the world.
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Affiliation(s)
- Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK.
| | - Lu Gram
- Institute for Global Health, University College London, London, UK
| | - Sarah Lasoye
- Institute for Global Health, University College London, London, UK
| | | | - Laia Becares
- Department of Social Work and Social Care, University of Sussex, Brighton, UK
| | | | | | - Gideon Lasco
- Department of Anthropology, University of the Philippines Diliman, Quezon City, Philippines
| | - Martin McKee
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC, Australia
| | - Nidhi S Sabharwal
- Centre for Policy Research in Higher Education, National Institute of Educational Planning and Administration, New Delhi, India
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
| | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
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45
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Selvarajah S, Corona Maioli S, Deivanayagam TA, de Morais Sato P, Devakumar D, Kim SS, Wells JC, Yoseph M, Abubakar I, Paradies Y. Racism, xenophobia, and discrimination: mapping pathways to health outcomes. Lancet 2022; 400:2109-2124. [PMID: 36502849 DOI: 10.1016/s0140-6736(22)02484-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 10/06/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
Despite being globally pervasive, racism, xenophobia, and discrimination are not universally recognised determinants of health. We challenge widespread beliefs related to the inevitability of increased mortality and morbidity associated with particular ethnicities and minoritised groups. In refuting that racial categories have a genetic basis and acknowledging that socioeconomic factors offer incomplete explanations in understanding these health disparities, we examine the pathways by which discrimination based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour affect health. Discrimination based on these categories, although having many unique historical and cultural contexts, operates in the same way, with overlapping pathways and health effects. We synthesise how such discrimination affects health systems, spatial determination, and communities, and how these processes manifest at the individual level, across the life course, and intergenerationally. We explore how individuals respond to and internalise these complex mechanisms psychologically, behaviourally, and physiologically. The evidence shows that racism, xenophobia, and discrimination affect a range of health outcomes across all ages around the world, and remain embedded within the universal challenges we face, from COVID-19 to the climate emergency.
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Affiliation(s)
- Sujitha Selvarajah
- Institute for Global Health, University College London, London, UK; St George's Hospital NHS Foundation Trust, London, UK.
| | | | - Thilagawathi Abi Deivanayagam
- Institute for Global Health, University College London, London, UK; Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Seung-Sup Kim
- Department of Environmental Health Sciences, Seoul National University, Seoul, South Korea
| | - Jonathan C Wells
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Marcella Yoseph
- Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK; Sir Ketumile Masire Teaching Hospital, University of Botswana, Gaborone, Botswana
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne VIC, Australia
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