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Saha S. Navigating trust and health in India: the influence of social status and neighbourhood environment. BMC Public Health 2024; 24:2680. [PMID: 39354452 PMCID: PMC11443772 DOI: 10.1186/s12889-024-19826-7] [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: 02/11/2024] [Accepted: 08/19/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND The research on the relationship between interpersonal trust and health has primarily focused on Western contexts, with scarce attention in developing contexts. Addressing this gap, the study examines the association between interpersonal trust (both generalised and particularised) and health outcomes (self-rated health /SRH, and depression) among Indian adults, considering the moderating roles of social statuses (gender and caste) and macro-level factors like district-level income inequality. METHODS The study draws on data from the World Health Organization's (WHO) Study on global AGEing and adult health (SAGE) Wave-1, collected between 2007 and 2010. This dataset provides a comprehensive overview of health outcomes, including self-rated health (SRH) and depression, socio-cultural status of adults aged 18 and above in India. Additionally, district-level data on income inequality, quantified through the Gini index, were incorporated to examine the influence of contextual socioeconomic influence on the trust-health relationship. Multilevel regression analysis with interaction effects with social statuses and income inequality at district was employed in the analysis to investigate the intricate relationship between interpersonal trust (both generalised and particularised) and health outcomes. RESULTS The study reveals that while generalised trust does not directly influence depression or SRH, particularised trust acts as a protective factor for both health outcomes. Gender-specific interaction effect shows that generalised trust reduces depression among males and improves SRH among females. Notably, caste does not significantly moderate the trust-health relationship. High district-level income inequality, however, modifies these associations: generalised trust is associated with improved SRH in areas of high inequality, whereas particularised trust correlates with increased depression in these districts. CONCLUSION The findings highlight the complex dynamics between interpersonal trust, social status, and income inequality in shaping health outcomes in India. Generalised trust emerges as a potential buffer against the health-detrimental effects of income inequality, providing crucial insights for developing targeted health interventions. These results offer valuable guidance for global health policymakers and practitioners in effectively allocating development aid to enhance health outcomes, especially among the most marginalised groups.
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Affiliation(s)
- Shrestha Saha
- Nanyang Technological University, Singapore, Singapore.
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2
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Shah PK. Can retinoblastoma treatment be carried out in smaller centers in India? Indian J Ophthalmol 2024; 72:925-926. [PMID: 38905457 PMCID: PMC11329829 DOI: 10.4103/ijo.ijo_301_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024] Open
Affiliation(s)
- Parag Kirit Shah
- Pediatric Retina and Ocular Oncology Department, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India. E-mail:
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Sheehan K, Bartell TR, Doobay-Persaud AA, Adler MD, Mangold KA. Where in the world: Mapping medical student learning using the Social and Structural Determinants of Health Curriculum Assessment Tool (SSDH CAT). MEDICAL EDUCATION ONLINE 2023; 28:2178979. [PMID: 36908060 PMCID: PMC10013438 DOI: 10.1080/10872981.2023.2178979] [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: 10/27/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Addressing the Social and Structural Determinants of Health (SSDH) is a primary strategy for attaining health equity. Teaching and learning about SSDH has increased across medical schools throughout the world; however, the published literature describing these efforts continues to be limited and many unknowns persist including what should be taught and by whom, what teaching methods and settings should be used, and how medical learners should be assessed. MATERIALS AND METHODS Based on published studies, input from experts in the field, and elements from the framework developed by the National Academy of Medicine, we created a universal Social and Structural Determinants of Health Curriculum Assessment Tool (SSDH CAT) to assist medical educators to assess existing SSDH curricular content, ascertain critical gaps, and categorize educational methods, delivery, and assessment techniques and tools that could help inform curricular enhancements to advance the goal of training a health care workforce focused on taking action to achieve health equity. To test the usefulness of the tool, we applied the SSDH CAT to map SSDH-related curriculum at a US-based medical school. RESULTS By applying the SSDH CAT to our undergraduate medical school curriculum, we recognized that our SSDH curriculum relied too heavily on lectures, emphasized knowledge without sufficient skill building, and lacked objective assessment measures. As a result of our curricular review, we added more skill-based activities such as using evidence-based tools for screening patients for social needs, and created and implemented a universal, longitudinal, experiential community health curriculum. DISCUSSION We created a universal SSDH CAT and applied it to assess and improve our medical school's SSDH curriculum. The SSDH CAT provides a starting point for other medical schools to assess their SSDH content as a strategy to improve teaching and learning about health equity, and to inspire students to act on the SSDH.
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Affiliation(s)
- Karen Sheehan
- Departments of Pediatrics, Medical Education, and Preventive Medicine, Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Tami R. Bartell
- Research Project Manager, Patrick M. Magoon Institute for Healthy Communities, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, Chicago
| | - Ashti A. Doobay-Persaud
- Departments of Medicine and Medical Education, Feinberg School of Medicine, Northwestern University
| | - Mark D. Adler
- Departments of Pediatrics and Medical Education, Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Karen A. Mangold
- Departments of Pediatrics and Medical Education, Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
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McKay FH, Bennett R, Dunn M. How, why and for whom does a basic income contribute to health and wellbeing: a systematic review. Health Promot Int 2023; 38:daad119. [PMID: 37804514 DOI: 10.1093/heapro/daad119] [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: 10/09/2023] Open
Abstract
Ensuring that people have a sufficient income to meet their basic needs and that it keeps pace with costs of living are important when considering ways to reduce health inequities. Many have argued that providing a basic income is one way to do this. The aim of this review is to provide an overview of the existing peer reviewed evidence on the health and wellbeing impacts of basic income interventions. A systematic search of ten electronic databases was conducted in June 2022. Eligible publications examined any effect on health and wellbeing from unconditional cash transfers. All study designs were included, and no limitations were placed on duration of cash transfer trials, location of study, study population or on amount of money provided through the cash transfer. Ten studies were included in this review. Studies employed a range of methods. All studies reported on a trial of Universal Basic Income in either a region or a town. Studies explored a range of health and wellbeing related outcomes including crime, quality of life, employment, subjective wellbeing, tuberculosis and hospitalization. Basic income programs can mitigate poverty in a time of economic upheaval and have the potential to become a powerful policy tool to act upon the determinants of health and reduce health inequality. This review found a small number of trials indicating a positive impact on health and wellbeing. More trials which track recipients over a longer period are needed to provide more robust evidence for the impact of basic income programs.
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Affiliation(s)
- Fiona H McKay
- School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
| | - Rebecca Bennett
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Matthew Dunn
- School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Australia
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Aimée Hartford Kvæl L, Gautun H. Social inequality in navigating the healthcare maze: Care trajectories from hospital to home via intermediate care for older people in Norway. Soc Sci Med 2023; 333:116142. [PMID: 37598619 DOI: 10.1016/j.socscimed.2023.116142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
Although health inequality is a growing concern, striking differences in health and life expectancy still exist across and within OECD countries. In Oslo, the largest city in Norway, life expectancy differs by up to 7 years between districts. Equal access to healthcare can help reduce social differences in health. However, research indicates that older people at the lower level of the social gradient have more difficulty accessing health services. Older people experience early hospital discharge and several transitions between and across care levels. In this study, using Bourdieu's theory of practice as a theoretical lens, we explore social inequality in access to universal healthcare within care trajectories for older people in Oslo. Through observation of family meetings in intermediate care (N = 14) and semi-structured interviews with older patients (N = 15), informal caregivers (N = 12) and healthcare professionals (N = 18), the study identifies 15 unique care trajectories from hospital to home via intermediate care. Informed by a critical realist perspective and moving from west to east via the urban areas, there is a prominent finding of climbing down the social gradient and, subsequently, reduced access to healthcare. An overarching theme, 'Navigating the healthcare maze', was identified along with two subthemes: 'Individuality meets system' and 'Having a feel for the game'. Navigating the healthcare maze depends on where you live, your level of education and health literacy and the ability to mobilize social networks. Furthermore, it is an advantage to fit into the professional habitus of the 'active patient' discourse. The findings will be relevant for politicians, managers, healthcare professionals and other stakeholders working in the field and in the development of services adapted to the needs of various socioeconomic groups.
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Affiliation(s)
- Linda Aimée Hartford Kvæl
- Norwegian Social Research - NOVA, Department of Ageing Research and Housing Studies, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, NO-0130, Oslo, Norway.
| | - Heidi Gautun
- Norwegian Social Research - NOVA, Department of Ageing Research and Housing Studies, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, NO-0130, Oslo, Norway
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Wang X, Dewidar O, Rizvi A, Huang J, Desai P, Doyle R, Ghogomu E, Rader T, Nicholls SG, Antequera A, Krentel A, Shea B, Hardy BJ, Chamberlain C, Wiysonge CS, Feng C, Juando-Prats C, Lawson DO, Obuku EA, Kristjansson E, von Elm E, Wang H, Ellingwood H, Waddington HS, Ramke J, Jull JE, Hatcher-Roberts J, Tufte J, Little J, Mbuagbaw L, Weeks L, Niba LL, Cuervo LG, Wolfenden L, Kasonde M, Avey MT, Sharp MK, Mahande MJ, Nkangu M, Magwood O, Craig P, Tugwell P, Funnell S, Noorduyn SG, Kredo T, Horsley T, Young T, Pantoja T, Bhutta Z, Martel A, Welch VA. A scoping review establishes need for consensus guidance on reporting health equity in observational studies. J Clin Epidemiol 2023; 160:126-140. [PMID: 37330072 DOI: 10.1016/j.jclinepi.2023.06.009] [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: 12/29/2022] [Revised: 04/30/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES To evaluate the support from the available guidance on reporting of health equity in research for our candidate items and to identify additional items for the Strengthening Reporting of Observational studies in Epidemiology-Equity extension. STUDY DESIGN AND SETTING We conducted a scoping review by searching Embase, MEDLINE, CINAHL, Cochrane Methodology Register, LILACS, and Caribbean Center on Health Sciences Information up to January 2022. We also searched reference lists and gray literature for additional resources. We included guidance and assessments (hereafter termed "resources") related to conduct and/or reporting for any type of health research with or about people experiencing health inequity. RESULTS We included 34 resources, which supported one or more candidate items or contributed to new items about health equity reporting in observational research. Each candidate item was supported by a median of six (range: 1-15) resources. In addition, 12 resources suggested 13 new items, such as "report the background of investigators". CONCLUSION Existing resources for reporting health equity in observational studies aligned with our interim checklist of candidate items. We also identified additional items that will be considered in the development of a consensus-based and evidence-based guideline for reporting health equity in observational studies.
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Affiliation(s)
- Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Omar Dewidar
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada
| | - Anita Rizvi
- School of Psychology, University of Ottawa, Faculty of Social Sciences, Ottawa, Ontario K1N 6N5, Canada
| | - Jimmy Huang
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada
| | - Payaam Desai
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada
| | - Rebecca Doyle
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada
| | | | - Tamara Rader
- Freelance Health Research Librarian, Ottawa, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario K1H 8L6, Canada
| | - Alba Antequera
- International Health Department, ISGlobal, Hospital Clínic - Universitat de Barcelona, 585, 08007 Barcelona, Spain
| | - Alison Krentel
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Beverley Shea
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Billie-Jo Hardy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5S, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, 3010 Victoria, Australia
| | - Charles S Wiysonge
- Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University, Cape Town 7505, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, 3629, South Africa; HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban 4091, South Africa
| | - Cindy Feng
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada
| | - Clara Juando-Prats
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5S, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario M5B 1T8, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Ekwaro A Obuku
- Africa Centre for Systematic Reviews & Knowledge Translation, College of Health Sciences, Makerere University, Kampala 7062, Uganda; Department of Global Health Security, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala 7062, Uganda; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London WC1E 6BT, United Kingdom
| | - Elizabeth Kristjansson
- School of Psychology, University of Ottawa, Faculty of Social Sciences, Ottawa, Ontario K1N 6N5, Canada
| | - Erik von Elm
- Cochrane Switzerland, Unisanté Lausanne, Lausanne, CH 1010, Switzerland
| | - Harry Wang
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; University of Ottawa Faculty of Medicine, Ottawa, Ontario K1N 6N5, Canada
| | - Holly Ellingwood
- Department of Psychology, Department of Law, Carleton University, Ottawa, Ontario K1S 5B6, Canada
| | - Hugh Sharma Waddington
- Environmental Health Group, Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; London International Development Centre, London, Ontario N5V 4T3, Canada
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; School of Optometry and Vision Science, University of Auckland, Auckland 1010, New Zealand
| | - Janet Elizabeth Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - Janet Hatcher-Roberts
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | | | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Lawrence Mbuagbaw
- Department of Anesthesia, McMaster University, Hamilton, Ontario L8S 4L8, Canada; Department of Pediatrics, McMaster University, Hamilton, Ontario L8S 4L8, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario L8N 4A6, Canada; Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, VGC6+C52, Yaoundé, Cameroon; Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town 7602, South Africa
| | | | - Loveline Lum Niba
- Department of Public Health, Faculty of Health Sciences, The University of Bamenda, Amphi 340, Bambili, Bamenda, Cameroon
| | | | - Luke Wolfenden
- School of medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Mwenya Kasonde
- Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Marc T Avey
- Canadian Council on Animal Care, Ottawa, Ontario K2P 2R3, Canada
| | - Melissa K Sharp
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin D02 YN77, Ireland
| | - Michael Johnson Mahande
- Department of Epidemiology & Biostatistics, Kilimanjaro Christian Medical University College, Kilimanjaro M8HH+MQ4, Tanzania
| | - Miriam Nkangu
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Olivia Magwood
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Peter Craig
- MRC/CSO Social and Public Health Science Unit, University of Glasgow, Glasgow G12 8QQ, UK
| | - Peter Tugwell
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Sarah Funnell
- Department of Family Medicine, Queen's University, Kingston, Ontario K7L 3N6, Canada; Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
| | - Stephen G Noorduyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, 3629, South Africa
| | - Tanya Horsley
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario K1S 5N8, Canada
| | - Taryn Young
- Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University, Cape Town 7505, South Africa
| | - Tomas Pantoja
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago 8331150, Chile
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada; Institute for Global Health and Development, The Aga Khan University, Karachi 74000, Pakistan
| | - Andrea Martel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5S, Canada
| | - Vivian A Welch
- Bruyère Research Institute, Ottawa, Ontario K1R 6M1, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada.
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Maani N, Abdalla SM, Ettman CK, Parsey L, Rhule E, Allotey P, Galea S. Global Health Equity Requires Global Equity. Health Equity 2023; 7:192-196. [PMID: 36960163 PMCID: PMC10029999 DOI: 10.1089/heq.2022.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 03/24/2023] Open
Abstract
Many global health challenges are characterized by the inequitable patterning of their health and economic consequences, which are etched along the lines of pre-existing inequalities in resources, power, and opportunity. These links require us to reconsider how we define global health equity, and what we consider as most consequential in its pursuit. In this article, we discuss the extent to which improving underlying global equity is an essential prerequisite to global health equity. We conclude that if we are to improve global health equity, there is a need to focus more on foundational—rather than proximal—causes of ill health and propose ways in which this can be achieved.
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Affiliation(s)
- Nason Maani
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
| | - Salma M. Abdalla
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, USA
| | - Catherine K. Ettman
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lily Parsey
- International Longevity Centre UK (ILC), London, United Kingdom
| | - Emma Rhule
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Pascale Allotey
- United Nations University International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Sandro Galea
- Rockefeller Foundation/Boston University Commission on Data, Determinants and Decision-making, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, USA
- Address correspondence to: Sandro Galea, MD, MPH, DrPH, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
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Hapuarachchi T, Fernando G, Weerasingha S, Ozdemir S, Teo I, Vishwanath P, Priyanthi A, Finkelstein E, Malhotra C. Disparities in end-of-life outcomes among advanced cancer patients in Sri Lanka: Results from the APPROACH study. Palliat Support Care 2022; 20:832-838. [PMID: 36942586 DOI: 10.1017/s147895152100167x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE A Universal Health Coverage goal is to provide access to affordable palliative care to reduce disparities in end-of-life (EOL) outcomes. To assess progress toward this goal in Sri Lanka, our primary aim was to systematically assess differences in patients' physical, psychological, social and spiritual outcomes, and their perceived quality of care by their socioeconomic status (SES). METHODS As part of the multi-country APPROACH (Asian Patient Perspectives Regarding Oncology Awareness, Care and Health) study, we surveyed 199 patients with a stage IV solid malignant tumor and aged >21 years from the largest government cancer hospital in Sri Lanka. We assessed their physical (physical and functional well-being, symptom burden), psychological (anxiety, depression, emotional well-being), social (social well-being), and spiritual outcomes and perceived quality of care (physician communication, nursing care, and coordination/responsiveness). RESULTS Low SES patients reported significantly lower physical and functional well-being, emotional well-being, spiritual well-being including meaning/peace and faith; and significantly higher symptom burden, anxiety and depressive symptoms compared with patients from high SES (p < 0.05 for all outcomes). SIGNIFICANCE OF RESULTS Results have implications regarding reducing barriers in access to appropriate palliative care and EOL care services to stage IV cancer patients from low SES in Sri Lanka.
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Affiliation(s)
| | - Gvmc Fernando
- National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | | | | | - Eric Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
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Feskens EJM, Bailey R, Bhutta Z, Biesalski HK, Eicher-Miller H, Krämer K, Pan WH, Griffiths JC. Women's health: optimal nutrition throughout the lifecycle. Eur J Nutr 2022; 61:1-23. [PMID: 35612668 PMCID: PMC9134728 DOI: 10.1007/s00394-022-02915-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/12/2022] [Indexed: 02/07/2023]
Abstract
Sex differences are an important consideration when researching and establishing policies for nutrition and optimal health. For women's health, there are important physiologic, neurologic, and hormonal distinctions throughout the lifecycle that impact nutritional needs. Distinct from those for men, these nutritional needs must be translated into appropriate nutrition policy that aims to not only avoid overt nutritional deficiency, but also to promote health and minimize risk for chronic disease. Through a series of webinars, scientific experts discussed the advances in the understanding of the unique nutritional needs, challenges and opportunities of the various life stages for women across the life course and identified emerging nutritional interventions that may be beneficial for women. Nevertheless, there is concern that existing nutrition policy intended for women's health is falling short with examples of programs that are focused more on delivering calories than achieving optimal nutrition. To be locally effective, targeted nutrition needs to offer different proposals for different cultural, socio-economic, and geographic communities, and needs to be applicable at all stages of growth and development. There must be adequate access to nutritious foods, and the information to understand and implement proven nutritional opportunities. Experts provided recommendations for improvement of current entitlement programs that will address accessibility and other social and environmental issues to support women properly throughout the lifecycle.
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Affiliation(s)
| | - Regan Bailey
- Institute for Advancing Health Through Agriculture, Texas A&M University System, College Station, TX, USA
| | - Zulfiqar Bhutta
- Centre for Global Child Health, Toronto, Canada
- Aga Khan University, Karachi, Pakistan
| | | | | | - Klaus Krämer
- Sight & Life, Basel, Switzerland
- Johns Hopkins University, Baltimore, MD, USA
| | | | - James C Griffiths
- Council for Responsible Nutrition-International, Washington, DC, USA.
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10
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Rizvi A, Lawson DO, Young T, Dewidar O, Nicholls S, Akl EA, Little J, Magwood O, Shamseer L, Ghogomu E, Jull JE, Rader T, Bhutta Z, Chamberlain C, Ellingwood H, Greer-Smith R, Hardy BJ, Harwood M, Kennedy M, Kredo T, Loder E, Mahande MJJ, Mbuagbaw L, Nkangu M, Okwen PM, Ramke J, Tufte J, Tugwell P, Wang X, Wiysonge CS, Welch VA. Guidance relevant to the reporting of health equity in observational research: a scoping review protocol. BMJ Open 2022; 12:e056875. [PMID: 35589369 PMCID: PMC9121499 DOI: 10.1136/bmjopen-2021-056875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Health inequities are defined as unfair and avoidable differences in health between groups within a population. Most health research is conducted through observational studies, which are able to offer real-world insights about etiology, healthcare policy/programme effectiveness and the impacts of socioeconomic factors. However, most published reports of observational studies do not address how their findings relate to health equity. Our team seeks to develop equity-relevant reporting guidance as an extension of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. This scoping review will inform the development of candidate items for the STROBE-Equity extension. We will operationalise equity-seeking populations using the PROGRESS-Plus framework of sociodemographic factors. As part of a parallel stream of the STROBE-Equity project, the relevance of candidate guideline items to Indigenous research will be led by Indigenous coinvestigators on the team. METHODS AND ANALYSIS We will follow the Joanna Briggs Institute method for conducting scoping reviews. We will evaluate the extent to which the identified guidance supports or refutes our preliminary candidate items for reporting equity in observational studies. These candidate items were developed based on items from equity-reporting guidelines for randomised trials and systematic reviews, developed by members of this team. We will consult with our knowledge users, patients/public partners and Indigenous research steering committee to invite suggestions for relevant guidance documents and interpretation of findings. If the identified guidance suggests the need for additional candidate items, they will be developed through inductive thematic analysis. ETHICS AND DISSEMINATION We will follow a principled approach that promotes ethical codevelopment with our community partners, based on principles of cultural safety, authentic partnerships, addressing colonial structures in knowledge production and the shared ownership, interpretation, and dissemination of research. All products of this research will be published as open access.
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Affiliation(s)
- Anita Rizvi
- School of Psychology, University of Ottawa Faculty of Social Sciences, Ottawa, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Taryn Young
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Stuart Nicholls
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Olivia Magwood
- CT Lamont Primary Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- Interdisciplinary School of Health Sciences University of Ottawa, Ottawa, Ontario, Canada
| | - Larissa Shamseer
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | | | - Tamara Rader
- Freelance health research librarian, (no affiliation), Ottawa, Ontario, Canada
| | - Zulfiqar Bhutta
- Centre for Global Child Health, SickKids Center for Global Child Health, Toronto, Ontario, Canada
- Institute for Global Health & Development, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Catherine Chamberlain
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Western Australia, Australia
| | - Holly Ellingwood
- Department of Psychology, Department of Law, Carleton University, Ottawa, Ontario, Canada
| | - Regina Greer-Smith
- Healthcare Research Associates, LLC/Strategically Targeting Appropriate Researchers (S.T.A.R.) Initiative, Apple Valley, California, USA
| | - Billie-Jo Hardy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Matire Harwood
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michelle Kennedy
- College of Health Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Elizabeth Loder
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Johnson J Mahande
- Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Miriam Nkangu
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Jacqueline Ramke
- London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, The University of Auckland, Auckland, Auckland, New Zealand
| | | | - Peter Tugwell
- University of Ottawa Department of Medicine, Ottawa, Ontario, Canada
| | - Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Vivian A Welch
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Quinn GE, Fielder AR, Chan RP, Chiang MF. Reply. Ophthalmology 2022; 129:e65-e66. [DOI: 10.1016/j.ophtha.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
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Western MJ, Armstrong MEG, Islam I, Morgan K, Jones UF, Kelson MJ. The effectiveness of digital interventions for increasing physical activity in individuals of low socioeconomic status: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18:148. [PMID: 34753490 PMCID: PMC8576797 DOI: 10.1186/s12966-021-01218-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 10/20/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Digital technologies such as wearables, websites and mobile applications are increasingly used in interventions targeting physical activity (PA). Increasing access to such technologies makes an attractive prospect for helping individuals of low socioeconomic status (SES) in becoming more active and healthier. However, little is known about their effectiveness in such populations. The aim of this systematic review was to explore whether digital interventions were effective in promoting PA in low SES populations, whether interventions are of equal benefit to higher SES individuals and whether the number or type of behaviour change techniques (BCTs) used in digital PA interventions was associated with intervention effects. METHODS A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library, published between January 1990 and March 2020. Randomised controlled trials, using digital technology as the primary intervention tool, and a control group that did not receive any digital technology-based intervention were included, provided they had a measure of PA as an outcome. Lastly, studies that did not have any measure of SES were excluded from the review. Risk of Bias was assessed using the Cochrane Risk of Bias tool version 2. RESULTS Of the 14,589 records initially identified, 19 studies were included in the final meta-analysis. Using random-effects models, in low SES there was a standardised mean difference (SMD (95%CI)) in PA between intervention and control groups of 0.06 (- 0.08,0.20). In high SES the SMD was 0.34 (0.22,0.45). Heterogeneity was modest in both low (I2 = 0.18) and high (I2 = 0) SES groups. The studies used a range of digital technologies and BCTs in their interventions, but the main findings were consistent across all of the sub-group analyses (digital interventions with a PA only focus, country, chronic disease, and duration of intervention) and there was no association with the number or type of BCTs. DISCUSSION Digital interventions targeting PA do not show equivalent efficacy for people of low and high SES. For people of low SES, there is no evidence that digital PA interventions are effective, irrespective of the behaviour change techniques used. In contrast, the same interventions in high SES participants do indicate effectiveness. To reduce inequalities and improve effectiveness, future development of digital interventions aimed at improving PA must make more effort to meet the needs of low SES people within the target population.
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Affiliation(s)
- Max J. Western
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Miranda E. G. Armstrong
- Centre for Exercise, Nutrition and Health Science, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ UK
| | - Ishrat Islam
- PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, CF14 4YS UK
| | - Kelly Morgan
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, CF10 3BD UK
| | - Una F. Jones
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4XN UK
| | - Mark J. Kelson
- Department of Mathematics/Institute of Data Science and Artificial Intelligence, University of Exeter, Laver Building, Exeter, EX4 4QE UK
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Hu X, Wang T, Huang D, Wang Y, Li Q. Impact of social class on health: The mediating role of health self-management. PLoS One 2021; 16:e0254692. [PMID: 34270623 PMCID: PMC8284807 DOI: 10.1371/journal.pone.0254692] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background Studies have explored the relationship between social class and health for decades. However, the underlying mechanism between the two remains not fully understood. This study aimed to explore whether health self-management had a mediating role between social class and health under the framework of Socio-cultural Self Model. Methods 663 adults, randomly sampled from six communities in Southwest China, completed the survey for this study. Social class was assessed using individuals’ income, education, occupation. Health self-management was assessed through evaluation of the health self-management behavior, health self-management cognition, health self-management environment. Physical health and mental health were measured by the Chinese version of Short-Form (36-item) Health Survey, which contains Physical Functioning, Role-Physical, Role-Emotional, Vitality, Mental Health, Social Function, Bodily Pain and General Health. Pearson’s correlation was used to examine the associations between major variables. Mediation analyses were performed to explore the mediating role of health self-management. Results Social class positively predicted self-rated health. The lower the social class, the lower the self-reported physical and mental health. Health self-management partially mediated the relationship between social class and self-rated health. That is, the health self-management ability of the lower class, such as access to healthy and nutritious food and evaluate their own health status, is worse than that of the higher class, which leads to physical and mental health inequality between the high and the low classes. Conclusion Health self-management mediated the relationship between social class and health. Promoting health self-management abilities are conducive to improving both physical and mental health.
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Affiliation(s)
- Xiaoyong Hu
- Faculty of Psychology, Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, People's Republic of China
| | - Tiantian Wang
- Faculty of Psychology, Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, People's Republic of China
| | - Duan Huang
- School of Health, Wuhan Sports University, Wuhan, People's Republic of China
| | - Yanli Wang
- Faculty of Psychology, Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, People's Republic of China
| | - Qiong Li
- School of Health, Wuhan Sports University, Wuhan, People's Republic of China
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Okoi O, Bwawa T. How health inequality affect responses to the COVID-19 pandemic in Sub-Saharan Africa. WORLD DEVELOPMENT 2020; 135:105067. [PMID: 32834378 PMCID: PMC7351451 DOI: 10.1016/j.worlddev.2020.105067] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2020] [Indexed: 05/22/2023]
Abstract
The COVID-19 outbreak has infected millions of people across the world, caused hundreds of thousands of deaths, and collapsed national economies. Recognizing the importance of handwashing in preventing the spread of COVID-19, concerns have arisen about the condition of millions of Africans who lack access to hygiene facilities and clean water services. This paper compiles evidence from the WHO-UNICEF data to show the health disparities that limit the capacity of African countries to effectively address the COVID-19 disease along with recommendations for addressing the challenge.
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Affiliation(s)
- Obasesam Okoi
- Department of Justice and Peace Studies, University of St Thomas, 2115 Summit Avenue, Saint Paul, MN 55105, USA
| | - Tatenda Bwawa
- Global Public Health/eHealth Consultant, 708-916 Cloutier Drive, Winnipeg, MB R3V 1W9, Canada
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15
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Lee J, Sa J. Regional disparities in healthy eating and nutritional status in South Korea: Korea National Health and Nutrition Examination Survey 2017. Nutr Res Pract 2020; 14:679-690. [PMID: 33282128 PMCID: PMC7683206 DOI: 10.4162/nrp.2020.14.6.679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/25/2020] [Accepted: 09/14/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND/OBJECTIVES Concerns about regional disparities in heathy eating and nutritional status among South Korean adults are increasing. This study aims to identify the magnitude of regional disparities in diet and nutritional status among Korean adults who completed the 2017 Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS/METHODS The participants were a nationally representative sample of Korean adults aged 19 years and older from the 2017 KNHANES (n = 6,126). We employed the svy commands in STATA to accommodate the complex survey design. The relative concentration index (RCI), absolute concentration index (ACI) and index of disparity were used to measure regional nutritional inequalities. RESULTS Overweight and obese adults were more prevalent among the poor than among the rich in urban areas (RCI = -0.041; P < 0.05), while overweight and obese adults were more prevalent among the rich than among the poor in rural areas of South Korea (RCI = 0.084; P < 0.05). Economic inequality in fruit and vegetable intake ≥ 500 g per day was greater in rural areas than in urban areas in both relative size (RCI = 0.228 vs. 0.091, difference in equality = 0.137; P < 0.05) and absolute size (ACI = 0.055 vs. 0.023, difference in equality = 0.032; P < 0.05). CONCLUSIONS This study provides useful information identifying opposite directions in the relative concentration curves between urban and rural areas. Adult overweight/obesity was more prevalent among the poor in urban areas, while adult overweight/obesity was more prevalent among the rich in rural areas. Public health nutrition systems should be implemented to identify nutritional inequalities that should be targeted across regions in South Korea.
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Affiliation(s)
- Jounghee Lee
- Department of Food and Nutrition, Kunsan National University, Gunsan 54150, Korea
| | - Jaesin Sa
- College of Education and Health Sciences, Touro University, Vallejo, CA 94592, USA
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Malhotra C, Krishnan A, Yong JR, Teo I, Ozdemir S, Ning XH, Hapuarachchi T, Palat G, Bhatnagar S, Joad AK, Tuong PN, Ssu WM, Finkelstein E. Socio-economic inequalities in suffering at the end of life among advanced cancer patients: results from the APPROACH study in five Asian countries. Int J Equity Health 2020; 19:158. [PMID: 32912232 PMCID: PMC7488341 DOI: 10.1186/s12939-020-01274-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 09/02/2020] [Indexed: 12/16/2022] Open
Abstract
Background A systematic understanding of socio-economic inequalities in end-of-life (EOL) suffering among advanced cancer patients is required to inform efforts to reduce these inequalities as part of Universal Health Coverage goals. Aims To assess inequalities in multiple domains of EOL suffering among advanced cancer patients – physical, functional, psychological, social, and spiritual –, using two socio-economic status (SES) indicators, education and perceived economic status of the household. Methods We used cross-sectional data from surveys of stage IV cancer patients (n = 1378) from seven hospitals across five countries (China, Sri Lanka, India, Vietnam and Myanmar). We conducted separate multivariable linear regression models for each EOL suffering domain. We also tested interactions between the two SES indicators and between each SES indicator and patient age. Results Patients living in low economic status households /with fewer years of education reported greater suffering in several domains. We also found significant interaction effects between economic status of the household and years of education for all EOL suffering outcomes. Age significantly moderated the association between economic status of the household and social suffering and between years of education and psychological, social, and spiritual suffering (p < 0.05 for all). Conclusion Results highlight that SES inequalities in EOL suffering vary depending on the suffering domain, the SES indicator assessed, and by patient age. Greater palliative care resources for patients with low SES may help reduce these inequalities.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore. .,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Anirudh Krishnan
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore
| | - Jing Rong Yong
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore
| | - Irene Teo
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | - Semra Ozdemir
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Xiao Hong Ning
- Geriatric Department, Peking Union Medical College Hospital, Beijing, China
| | | | - Gayatri Palat
- Department of Palliative Medicine, MNJ Institute of Oncology and Regional Cancer Center, Hyderabad, India
| | - Sushma Bhatnagar
- Unit of Anesthesiology, Pain and Palliative Care, All India Institute of Medical Sciences, Delhi, India
| | - Anjum Khan Joad
- Department of Anesthesiology and Palliative Medicine, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, India
| | - Pham Nguyen Tuong
- Oncology Center, Hue Central Hospital, 16 Le Loi, Hue City, Hue, Vietnam
| | - Wynn Mon Ssu
- Clinical Research Division, Yangon General Hospital, Yangon, Myanmar
| | - Eric Finkelstein
- Lien Centre for Palliative Care, Duke-NUS Medical School, 8 College Road, Level 4, Singapore, 169857, Singapore.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Ding Y, Chen D, Ding X, Wang G, Wan Y, Shen Q. A bibliometric analysis of income and cardiovascular disease: Status, Hotspots, Trends and Outlook. Medicine (Baltimore) 2020; 99:e21828. [PMID: 32846827 PMCID: PMC7447358 DOI: 10.1097/md.0000000000021828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Income is 1 of the socio-economic indicators and could directly influence the health outcomes of cardiovascular disease (CVD). The relationship between income and CVD has attracted more and more scholars' attention in the past 20 years. METHODS To study the current research dynamics of this field, a bibliometric analysis was conducted to evaluate the publications from 1990 to 2018 based on the Science Citation Index Expanded database. By using the Derwent Date Analyzer software, the following aspects were explored: RESULTS:: The USA ranked first in this field, followed by UK and Canada in terms of number of publications. As for institutions, Harvard University took the leading place in the number of publications, as well as the h-index. Plos One had the most publications and "health" was the most frequent used keyword. The leading research area was "public environmental occupational health". CONCLUSIONS In conclusion, the elderly, the children and the puerpera were the main study population in this field and "disease prevention" was the main study direction. The most concerned health issues in this field were "obesity" and "diet". There might be a lack of articles that explore the associations between income and CVD with a global perspective. Articles on this content are urgently warranted.
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Affiliation(s)
- Ye Ding
- School of Public Health, Hangzhou Medical College
| | - Dingwan Chen
- School of Public Health, Hangzhou Medical College
| | - Xufen Ding
- Institute of Information Resources, Zhejiang University of Technology
- Library, Zhejiang University of Technology, Hangzhou, China
| | - Guan Wang
- School of Public Health, Hangzhou Medical College
| | - Yuehua Wan
- Institute of Information Resources, Zhejiang University of Technology
- Library, Zhejiang University of Technology, Hangzhou, China
| | - Qing Shen
- School of Public Health, Hangzhou Medical College
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Kurji J, Talbot B, Bulcha G, Bedru KH, Morankar S, Gebretsadik LA, Wordofa MA, Welch V, Labonte R, Kulkarni MA. Uncovering spatial variation in maternal healthcare service use at subnational level in Jimma Zone, Ethiopia. BMC Health Serv Res 2020; 20:703. [PMID: 32736622 PMCID: PMC7394677 DOI: 10.1186/s12913-020-05572-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Analysis of disaggregated national data suggest uneven access to essential maternal healthcare services within countries. This is of concern as it hinders equitable progress in health outcomes. Mounting an effective response requires identification of subnational areas that may be lagging behind. This paper aims to explore spatial variation in maternal healthcare service use at health centre catchment, village and household levels. Spatial correlations of service use with household wealth and women’s education levels were also assessed. Methods Using survey data from 3758 households enrolled in a cluster randomized trial geographical variation in the use of maternity waiting homes (MWH), antenatal care (ANC), delivery care and postnatal care (PNC) was investigated in three districts in Jimma Zone. Correlations of service use with education and wealth levels were also explored among 24 health centre catchment areas using choropleth maps. Global spatial autocorrelation was assessed using Moran’s I. Cluster analyses were performed at village and household levels using Getis Ord Gi* and Kulldorf spatial scan statistics to identify cluster locations. Results Significant global spatial autocorrelation was present in ANC use (Moran’s I = 0.15, p value = 0.025), delivery care (Moran’s I = 0.17, p value = 0.01) and PNC use (Moran’s I = 0.31, p value < 0.01), but not MWH use (Moran’s I = -0.005, p value = 0.94) suggesting clustering of villages with similarly high (hot spots) and/or low (cold spots) service use. Hot spots were detected in health centre catchments in Gomma district while Kersa district had cold spots. High poverty or low education catchments generally had low levels of service use, but there were exceptions. At village level, hot and cold spots were detected for ANC, delivery care and PNC use. Household-level analyses revealed a primary cluster of elevated MWH-use not detected previously. Further investigation of spatial heterogeneity is warranted. Conclusions Sub-national variation in maternal healthcare services exists in Jimma Zone. There was relatively higher poverty and lower education in areas where service use cold spots were identified. Re-directing resources to vulnerable sub-groups and locations lagging behind will be necessary to ensure equitable progress in maternal health.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Benoit Talbot
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Gebeyehu Bulcha
- Jimma Zone Health Office, Jimma Zone, Oromia Region, Jimma, Ethiopia
| | - Kunuz Haji Bedru
- Jimma Zone Health Office, Jimma Zone, Oromia Region, Jimma, Ethiopia
| | - Sudhakar Morankar
- Department of Health, Behaviour & Society, Jimma University, Jimma, Ethiopia
| | | | | | - Vivian Welch
- Centre for Global Health, Bruyere Research Institute, Ottawa, Canada
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
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Ogundele OJ, Pavlova M, Groot W. Patterns of access to reproductive health services in Ghana and Nigeria: results of a cluster analysis. BMC Public Health 2020; 20:549. [PMID: 32326928 PMCID: PMC7178999 DOI: 10.1186/s12889-020-08724-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inequalities in access to health care result in systematic health differences between social groups. Interventions to improve health do not always consider these inequalities. To examine access to reproductive health care services in Ghana and Nigeria, the patterns of use of family planning and maternal care by women in these countries are explored. METHODS We used population-level data from the Ghana and Nigeria Demographic Health Surveys of 2014 and 2013 respectively. We applied a two-step cluster analysis followed by multinomial logistic regression analysis. RESULTS The initial two-step cluster analyses related to family planning identified three clusters of women in Ghana and Nigeria: women with high, medium and poor access to family planning services. The subsequent two-step cluster analyses related to maternal care identified five distinct clusters: higher, high, medium, low and poor access to maternal health services in Ghana and Nigeria. Multinomial logistic regression showed that compared to women with secondary/higher education, women without education have higher odds of poor access to family planning services in Nigeria (OR = 2.54, 95% CI: 1.90-3.39) and in Ghana (OR = 1.257, 95% CI: 0.77-2.03). Compared to white-collar workers, women who are not working have increased odds of poor access to maternal health services in Nigeria (OR = 1.579, 95% CI: 1.081-2.307, p ≤ 0.01). This association is not observed for Ghana. Household wealth is strongly associated with access to family planning services and maternal health care services in Nigeria. Not having insurance in Ghana is associated with low access to family planning services, while this is not the case in Nigeria. In both countries, the absence of insurance is associated with poor access to maternal health services. CONCLUSIONS These differences confirm the importance of a focused context-specific approach towards reproductive health services, particularly to reduce inequality in access resulting from socio-economic status. Interventions should be focused on the categorization of services and population groups into priority classes based on needs assessment. In this way, they can help expand coverage of quality services bottom up to improve access among these vulnerable groups.
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Affiliation(s)
- Oluwasegun Jko Ogundele
- Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences; Maastricht University, PO Box 616, 6200MD, Maastricht, The Netherlands.
| | - Milena Pavlova
- Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences; Maastricht University, PO Box 616, 6200MD, Maastricht, The Netherlands
| | - Wim Groot
- Department of Health Services Research; CAPHRI, Maastricht University Medical Center; Faculty of Health, Medicine and Life Sciences; Maastricht University, PO Box 616, 6200MD, Maastricht, The Netherlands
- United Nations University-Maastricht Economic and Social Research Institute on Innovation and Technology, Maastricht, The Netherlands
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Sarker AR, Sultana M, Sheikh N, Akram R, Ali N, Mahumud RA, Alam K, Morton A. Inequality of childhood undernutrition in Bangladesh: A decomposition approach. Int J Health Plann Manage 2019; 35:441-468. [PMID: 31702080 DOI: 10.1002/hpm.2918] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 09/25/2019] [Accepted: 10/05/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Undernutrition is one of the major public health concerns in Bangladesh. This study examined the trends and patterns of childhood undernutrition, inequality, and its socioeconomic contributors in Bangladesh. METHODS Data were extracted from the last four rounds of the Bangladesh Demographic Health Survey (BDHS). A regression-based decomposition method was applied to assess the socioeconomic contributors of inequality. RESULTS Although the prevalence of childhood undernutrition has declined during the period 2004 to 2014, the rate of undernutrition is higher among the children of mothers who had lower education, live in rural areas, and are from the poorest wealth quintile. Socioeconomic status accounted for almost half of the total inequality in the prevalence of both stunting and underweight among children, whereas maternal education was ranked second among the contributors. CONCLUSIONS Findings of the study indicate that undernutrition inequalities in terms of socioeconomic aspects appear to have widened over time. Improving economic activity and maternal education will improve the nutritional status of children and as a consequence reduce inequality. Therefore, investments in education, creation of working opportunities, and empowerment of vulnerable and disadvantaged people along with nutrition-specific interventions will be important measures to eliminate this inequality at the population level.
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Affiliation(s)
- Abdur Razzaque Sarker
- Population Studies Division, Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | - Marufa Sultana
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.,School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Nurnabi Sheikh
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Raisul Akram
- Population Studies Division, Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | - Nausad Ali
- International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Rashidul Alam Mahumud
- School of Commerce, and Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Khorshed Alam
- School of Commerce, and Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Alec Morton
- Department of Management Science, University of Strathclyde, Glasgow, UK
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Steinbeis F, Gotham D, von Philipsborn P, Stratil JM. Quantifying changes in global health inequality: the Gini and Slope Inequality Indices applied to the Global Burden of Disease data, 1990-2017. BMJ Glob Health 2019; 4:e001500. [PMID: 31637024 PMCID: PMC6768361 DOI: 10.1136/bmjgh-2019-001500] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The major shifts in the global burden of disease over the past decades are well documented, but how these shifts have affected global inequalities in health remains an underexplored topic. We applied comprehensive inequality measures to data from the Global Burden of Disease (GBD) study. METHODS Between-country relative inequality was measured by the population-weighted Gini Index, between-country absolute inequality was calculated using the population-weighted Slope Inequality Index (SII). Both were applied to country-level GBD data on age-standardised disability-adjusted life years. FINDINGS Absolute global health inequality measured by the SII fell notably between 1990 (0.68) and 2017 (0.42), mainly driven by a decrease of disease burden due to communicable, maternal, neonatal and nutritional diseases (CMNN). By contrast, relative inequality remained essentially unchanged from 0.21 to 0.19 (1990-2017), with a peak of 0.23 (2000-2008). The main driver for the increase of relative inequality 1990-2008 was the HIV epidemic in Sub-Saharan Africa. Relative inequality increased 1990-2017 within each of the three main cause groups: CMNNs; non-communicable diseases (NCDs); and injuries. CONCLUSIONS Despite considerable reductions in disease burden in 1990-2017 and absolute health inequality between countries, absolute and relative international health inequality remain high. The limited reduction of relative inequality has been largely due to shifts in disease burden from CMNNs and injuries to NCDs. If progress in the reduction of health inequalities is to be sustained beyond the global epidemiological transition, the fight against CMNNs and injuries must be joined by increased efforts for NCDs.
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Affiliation(s)
- Fridolin Steinbeis
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charitité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Jan M Stratil
- Pettenkofer School of Public Health, LMU University of Munich, Munich, Germany
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23
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Coates MM, Kamanda M, Kintu A, Arikpo I, Chauque A, Mengesha MM, Price AJ, Sifuna P, Wamukoya M, Sacoor CN, Ogwang S, Assefa N, Crampin AC, Macete EV, Kyobutungi C, Meremikwu MM, Otieno W, Adjaye-Gbewonyo K, Marx A, Byass P, Sankoh O, Bukhman G. A comparison of all-cause and cause-specific mortality by household socioeconomic status across seven INDEPTH network health and demographic surveillance systems in sub-Saharan Africa. Glob Health Action 2019; 12:1608013. [PMID: 31092155 PMCID: PMC6534200 DOI: 10.1080/16549716.2019.1608013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background: Understanding socioeconomic disparities in all-cause and cause-specific mortality can help inform prevention and treatment strategies. Objectives: To quantify cause-specific mortality rates by socioeconomic status across seven health and demographic surveillance systems (HDSS) in five countries (Ethiopia, Kenya, Malawi, Mozambique, and Nigeria) in the INDEPTH Network in sub-Saharan Africa. Methods: We linked demographic residence data with household survey data containing living standards and education information we used to create a poverty index. Person-years lived and deaths between 2003 and 2016 (periods varied by HDSS) were stratified in each HDSS by age, sex, year, and number of deprivations on the poverty index (0–8). Causes of death were assigned to each death using the InterVA-4 model based on responses to verbal autopsy questionnaires. We estimated rate ratios between socioeconomic groups (2–4 and 5–8 deprivations on our poverty index compared to 0–2 deprivations) for specific causes of death and calculated life expectancy for the deprivation groups. Results: Our pooled data contained almost 3.5 million person-years of observation and 25,038 deaths. All-cause mortality rates were higher among people in households with 5–8 deprivations on our poverty index compared to 0–2 deprivations, controlling for age, sex, and year (rate ratios ranged 1.42 to 2.06 across HDSS sites). The poorest group had consistently higher death rates in communicable, maternal, neonatal, and nutritional conditions (rate ratios ranged 1.34–4.05) and for non-communicable diseases in several sites (1.14–1.93). The disparities in mortality between 5–8 deprivation groups and 0–2 deprivation groups led to lower life expectancy in the higher-deprivation groups by six years in all sites and more than 10 years in five sites. Conclusions: We show large disparities in mortality on the basis of socioeconomic status across seven HDSS in sub-Saharan Africa due to disparities in communicable disease mortality and from non-communicable diseases in some sites. Life expectancy gaps between socioeconomic groups within sites were similar to the gaps between high-income and lower-middle-income countries. Prevention and treatment efforts can benefit from understanding subpopulations facing higher mortality from specific conditions.
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Affiliation(s)
- Matthew M Coates
- a Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change , Harvard Medical School , Boston , USA
| | | | - Alexander Kintu
- c Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , USA
| | - Iwara Arikpo
- b INDEPTH Network , Accra , Ghana.,d Cross River Health & Demographic Surveillance System (CRHDSS) , University of Calabar , Calabar , Nigeria
| | - Alberto Chauque
- b INDEPTH Network , Accra , Ghana.,e Centro de Investigação em Saúde da Manhiça (CISM) , Mozambique
| | - Melkamu Merid Mengesha
- b INDEPTH Network , Accra , Ghana.,f College of Health and Medical Sciences , Haramaya University , Harar , Ethiopia
| | - Alison J Price
- b INDEPTH Network , Accra , Ghana.,g Department of Population Health , London School of Hygiene & Tropical Medicine , London , UK.,h Malawi Epidemiology and Intervention Research Unit , Lilongwe , Malawi
| | - Peter Sifuna
- b INDEPTH Network , Accra , Ghana.,i US Army Medical Research Directorate-Kenya (USAMRD-K)/Kenya Medical Research Institute (KEMRI) , Kisumu , Kenya
| | - Marylene Wamukoya
- b INDEPTH Network , Accra , Ghana.,j African Population and Health Research Center , Nairobi , Kenya
| | - Charfudin N Sacoor
- b INDEPTH Network , Accra , Ghana.,e Centro de Investigação em Saúde da Manhiça (CISM) , Mozambique
| | - Sheila Ogwang
- b INDEPTH Network , Accra , Ghana.,i US Army Medical Research Directorate-Kenya (USAMRD-K)/Kenya Medical Research Institute (KEMRI) , Kisumu , Kenya
| | - Nega Assefa
- b INDEPTH Network , Accra , Ghana.,f College of Health and Medical Sciences , Haramaya University , Harar , Ethiopia
| | - Amelia C Crampin
- b INDEPTH Network , Accra , Ghana.,g Department of Population Health , London School of Hygiene & Tropical Medicine , London , UK.,h Malawi Epidemiology and Intervention Research Unit , Lilongwe , Malawi
| | - Eusebio V Macete
- b INDEPTH Network , Accra , Ghana.,e Centro de Investigação em Saúde da Manhiça (CISM) , Mozambique
| | - Catherine Kyobutungi
- b INDEPTH Network , Accra , Ghana.,j African Population and Health Research Center , Nairobi , Kenya
| | - Martin M Meremikwu
- b INDEPTH Network , Accra , Ghana.,d Cross River Health & Demographic Surveillance System (CRHDSS) , University of Calabar , Calabar , Nigeria
| | - Walter Otieno
- b INDEPTH Network , Accra , Ghana.,i US Army Medical Research Directorate-Kenya (USAMRD-K)/Kenya Medical Research Institute (KEMRI) , Kisumu , Kenya.,k Department of Paediatrics and Child Health , Maseno University School of Medicine , Kisumu , Kenya
| | | | - Andrew Marx
- a Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change , Harvard Medical School , Boston , USA
| | - Peter Byass
- b INDEPTH Network , Accra , Ghana.,m Department of Epidemiology and Global Health , Umeå University , Umeå , Sweden.,n Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.,o Institute of Applied Health Sciences , University of Aberdeen , Aberdeen , Scotland
| | - Osman Sankoh
- b INDEPTH Network , Accra , Ghana.,p Statistics Sierra Leone , Freetown , Sierra Leone.,q College of Medicine and Allied Health Sciences , University of Sierra Leone , New England , Sierra Leone.,r School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Gene Bukhman
- a Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change , Harvard Medical School , Boston , USA.,s Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.,t Partners In Health , Boston , MA , USA
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Clithero-Eridon A, Albright D, Crandall C, Ross A. Contribution of the Nelson R. Mandela School of Medicine to a socially accountable health workforce. Afr J Prim Health Care Fam Med 2019; 11:e1-e7. [PMID: 31038340 PMCID: PMC6489146 DOI: 10.4102/phcfm.v11i1.1962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/08/2018] [Accepted: 11/09/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND A socially accountable health professional education curriculum aims to produce fit-for-purpose graduates to work in areas of need. 'Fit-for-purpose' can be assessed by monitoring graduate practice attributes. AIM The aim of this article was to identify whether graduates of 'fit-for-purpose' programmes are socially accountable. SETTING The setting for this project was all 37 district hospitals in the KwaZulu-Natal province in Durban, South Africa. METHODS We surveyed healthcare professionals working at district hospitals in the KwaZulu-Natal province. We compared four social accountability indicators identified by the Training for Health Network Framework, comparing medical doctors educated at the Nelson R. Mandela School of Medicine (NRMSM) with medical doctors educated at other South African and non-South African medical schools. In addition, we explored medical doctors' characteristics and reasons for leaving or staying at district hospitals. RESULTS The pursuit of specialisation or skills development were identified as reasons for leaving in the next 5 years. Although one-third of all medical doctors reported an intention to stay, graduates from non-South African schools remained working at a district hospital longer than graduates of NRMSM or other South African schools and they held a majority of leadership positions. Across all schools, graduates who worked at the district hospital longer than 5 years cited remaining close to family and enjoyment of the work and lifestyle as motivating factors. CONCLUSION Using a social accountability approach, this research assists in identifying areas of improvement in workforce development. Tracking what medical doctors do and where they work after graduation is important to ensure that medical schools are meeting their social accountability mandate to meet community needs.
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Affiliation(s)
- Amy Clithero-Eridon
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico.
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Robert E, David PM. “Healthcare as a refuge”: building a culture of care in Montreal for refugees and asylum-seekers living with HIV. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2019. [DOI: 10.1108/ijhrh-01-2018-0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Between 2012 and 2016, the Government of Canada modified health insurance for refugees and asylum seekers. In Quebec, this resulted in refusals of care and uncertainties about publicly reimbursed services, despite guaranteed coverage for people with this status under the provincial plan. The Chronic Viral Illness Service (CVIS) at the McGill University Health Centre in Montreal continued to provide care to refugees and asylum seekers living with HIV. The purpose of this paper is to explain how and why challenges brought by this policy change could be overcome.
Design/methodology/approach
A qualitative case study was conducted using interviews with patients and staff members, observation sessions and a review of media, documents and articles. A discussion group validated the interpretation of preliminary results.
Findings
The CVIS provides patient-centered care through a multidisciplinary team. It collectively responds to medical, social and legal issues specific to refugees. Its organizational culture and expertise explain the sustained provision of care. The team’s empathetic view of patients, anchored in the service’s history, care for men who have sex with men and commitment to human rights, is key. A culture of care developed over time thanks to the commitment of exemplary figures. Because they countered the team’s values, changes in refugee healthcare coverage strengthened the service’s culture of care. However, the healthcare system reform launched in 2014 in Quebec is perceived as jeopardizing the culture of care, as it makes, refugee and asylum-seeker patients a non-lucrative venture for providers.
Originality/value
This research analyzes the origin of sustained provision of care to refugees and asylum seekers living with HIV through the lens of culture of care. It considers the historical and political contexts in which this culture developed.
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Akombi BJ, Agho KE, Renzaho AM, Hall JJ, Merom DR. Trends in socioeconomic inequalities in child undernutrition: Evidence from Nigeria Demographic and Health Survey (2003 - 2013). PLoS One 2019; 14:e0211883. [PMID: 30730946 PMCID: PMC6366715 DOI: 10.1371/journal.pone.0211883] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/23/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the trend in socioeconomic inequalities in child undernutrition in Nigeria. METHODS The study analysed cross-sectional data from the Nigeria Demographic and Health Survey (NDHS) 2003 to 2013. The outcome variables were stunting, wasting and underweight among children under-five years. The magnitude of child undernutrition in Nigeria was estimated via a concentration index, and the socioeconomic factors contributing to child undernutrition over time were determined using the decomposition method. RESULTS The concentration index showed an increase in childhood wasting and underweight in Nigeria over time. The socioeconomic factors contributing to the increase in child undernutrition were: child's age (0-23 months), maternal education (no education), household wealth index (poorest household), type of residence (rural) and geopolitical zone (North East, North West). CONCLUSIONS To address child undernutrition, there is a need to improve maternal education and adopt effective social protection policies especially in rural communities in Nigeria.
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Affiliation(s)
- Blessing J. Akombi
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - Kingsley E. Agho
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
| | - Andre M. Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
| | - John J. Hall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Dafna R. Merom
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
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Omotoso KO, Koch SF. Assessing changes in social determinants of health inequalities in South Africa : a decomposition analysis. Int J Equity Health 2018; 17:181. [PMID: 30537976 PMCID: PMC6290544 DOI: 10.1186/s12939-018-0885-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 11/01/2018] [Indexed: 11/18/2022] Open
Abstract
Background Despite various policy interventions that have targeted reductions in socio-economic inequalities in health and health care in post-Apartheid South Africa, evidence suggests that not much has really changed. In particular, health inequalities, which are strongly linked to social determinants of health (SDH), persist. This study, thus, examines how changes in the SDH have impacted health inequalities over the last decade, the second since the end of Apartheid. Methods Data come from information collected on social determinants of health (SDH) and on health status in the 2004, 2010 and 2014 questionnaires of the South African General Household Surveys (GHSs). The health indicators considered include ill-health status and disability. Concentration indices and Oaxaca-Blinder decomposition of change in a concentration index methods were employed to unravel changes in socio-economic health inequalities and their key social drivers over the studied time period. Results The results show that inequalities in ill-health are consistently explained by socio-economic inequalities relating to employment status and provincial differences, which narrowed considerably over the studied periods. Relatedly, disability inequalities are largely explained by shrinking socio-economic inequalities relating to racial groups, educational attainment and provincial differences. Conclusion The extent of employment, location and education inequalities suggests the need for improved health care management and further delivery of education and job opportunities; greater effort in this regard is likely to be more beneficial in some way.
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Affiliation(s)
- Kehinde O Omotoso
- Department of Economics, University of Pretoria, Private Bag X20, Hatfield 0028, Pretoria, South Africa.
| | - Steven F Koch
- Department of Economics, University of Pretoria, Private Bag X20, Hatfield 0028, Pretoria, South Africa
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Hero JO, Zaslavsky AM, Blendon RJ. The United States Leads Other Nations In Differences By Income In Perceptions Of Health And Health Care. Health Aff (Millwood) 2018; 36:1032-1040. [PMID: 28583961 DOI: 10.1377/hlthaff.2017.0006] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We examined income gaps in the period 2011-13 in self-assessments of personal health and health care across thirty-two middle- and high-income countries. While high-income respondents were generally more positive about their health and health care in most countries, the gap between them and low-income respondents was much bigger in some than in others. The United States has among the largest income-related differences in each of the measures we studied, which assessed both respondents' past experiences and their confidence about accessing needed health care in the future. Relatively low levels of moral discomfort over income-based health care disparities despite broad awareness of unmet need indicate more public tolerance for health care inequalities in the United States than elsewhere. Nonetheless, over half of Americans felt that income-based health care inequalities are unfair, and these respondents were significantly more likely than their compatriots to support major health system reform-differences that reflect the country's political divisions. Given the many provisions in the Affordable Care Act that seek to reduce disparities, any replacement would also require attention to disparities or risk taking a step backward in an area where the United States is in sore need of improvement.
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Affiliation(s)
- Joachim O Hero
- Joachim O. Hero is a doctoral candidate in health policy at Harvard University, in Cambridge, Massachusetts
| | - Alan M Zaslavsky
- Alan M. Zaslavsky is a professor of health care policy (statistics) in the Department of Health Care Policy, Harvard Medical School, in Boston
| | - Robert J Blendon
- Robert J. Blendon is the Richard L. Menschel Professor of Health Policy and Political Analysis in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston
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Supply-side interventions to improve health: Findings from the Salud Mesoamérica Initiative. PLoS One 2018; 13:e0195292. [PMID: 29659586 PMCID: PMC5901783 DOI: 10.1371/journal.pone.0195292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 03/20/2018] [Indexed: 12/14/2022] Open
Abstract
Background Results-based aid (RBA) is increasingly used to incentivize action in health. In Mesoamerica, the region consisting of southern Mexico and Central America, the RBA project known as the Salud Mesoamérica Initiative (SMI) was designed to target disparities in maternal and child health, focusing on the poorest 20% of the population across the region. Methods and findings Data were first collected in 365 intervention health facilities to establish a baseline of indicators. For the first follow-up measure, 18 to 24 months later, 368 facilities were evaluated in these same areas. At both stages, we measured a near-identical set of supply-side performance indicators in line with country-specific priorities in maternal and child health. All countries showed progress in performance indicators, although with different levels. El Salvador, Honduras, Nicaragua, and Panama reached their 18-month targets, while the State of Chiapas in Mexico, Guatemala, and Belize did not. A second follow-up measurement in Chiapas and Guatemala showed continued progress, as they achieved previously missed targets nine to 12 months later, after implementing a performance improvement plan. Conclusions Our findings show an initial success in the supply-side indicators of SMI. Our data suggest that the RBA approach can be a motivator to improve availability of drugs and services in poor areas. Moreover, our innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.
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Lambert RF, Wong CA, Woodmansey KF, Rowland B, Horne SO, Seymour B. A National Survey of U.S. Dental Students' Experiences with International Service Trips. J Dent Educ 2018; 82:366-372. [PMID: 29606653 DOI: 10.21815/jde.018.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/03/2017] [Indexed: 01/26/2023]
Abstract
Globalization, along with the increasing prevalence of non-communicable diseases, their risk factors, and poor oral health, demands global approaches to oral health care. Trained health care workers' providing volunteer services abroad is one model used for improving access to dental services for some communities. Currently, little is known about U.S. dental student involvement in international clinical service volunteerism. The aim of this exploratory study was to capture national survey data from predoctoral dental students about their interest in and experience with global health service trips. The survey sought to assess students' past experiences and current and future interest in programs providing dental and/or medical services in order to lay the foundation for further research. A 12-question web-based survey was distributed in May 2017 to 22,930 students enrolled in U.S. dental schools. A total of 1,555 students responded, for a response rate of 7%. Respondents were evenly distributed across the four academic years. Approximately 22% (n=342) of the respondents had already participated in a service trip experience, 83% reported interest in a service trip while in school, and 92% were interested after graduation. Reported motivations for international trips included the desire to care for the underserved and to obtain a more global view of health and disease. Concerns were expressed regarding costs and time constraints. This study provided preliminary, exploratory data on dental student engagement with international service trips. Both interest and participation in international service trips among responding students were high, reflecting current trends in both dentistry and medicine. Dental education may have an opportunity to guide student engagement in more sustainable and ethical volunteering in the U.S. and abroad.
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Affiliation(s)
- R Frederick Lambert
- Mr. Lambert is a DMD student, Harvard School of Dental Medicine; Ms. Wong is a DMD student, Harvard School of Dental Medicine; Dr. Woodmansey is Program Director, Center for Advanced Dental Education, Saint Louis University; Ms. Rowland is Manager of International Development and Outreach, American Dental Association Foundation; Mr. Horne is Senior Manager of Marketing Research, American Dental Association Foundation; and Dr. Seymour is Assistant Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine
| | - Chloe A Wong
- Mr. Lambert is a DMD student, Harvard School of Dental Medicine; Ms. Wong is a DMD student, Harvard School of Dental Medicine; Dr. Woodmansey is Program Director, Center for Advanced Dental Education, Saint Louis University; Ms. Rowland is Manager of International Development and Outreach, American Dental Association Foundation; Mr. Horne is Senior Manager of Marketing Research, American Dental Association Foundation; and Dr. Seymour is Assistant Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine
| | - Karl F Woodmansey
- Mr. Lambert is a DMD student, Harvard School of Dental Medicine; Ms. Wong is a DMD student, Harvard School of Dental Medicine; Dr. Woodmansey is Program Director, Center for Advanced Dental Education, Saint Louis University; Ms. Rowland is Manager of International Development and Outreach, American Dental Association Foundation; Mr. Horne is Senior Manager of Marketing Research, American Dental Association Foundation; and Dr. Seymour is Assistant Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine
| | - Brianna Rowland
- Mr. Lambert is a DMD student, Harvard School of Dental Medicine; Ms. Wong is a DMD student, Harvard School of Dental Medicine; Dr. Woodmansey is Program Director, Center for Advanced Dental Education, Saint Louis University; Ms. Rowland is Manager of International Development and Outreach, American Dental Association Foundation; Mr. Horne is Senior Manager of Marketing Research, American Dental Association Foundation; and Dr. Seymour is Assistant Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine
| | - Steven O Horne
- Mr. Lambert is a DMD student, Harvard School of Dental Medicine; Ms. Wong is a DMD student, Harvard School of Dental Medicine; Dr. Woodmansey is Program Director, Center for Advanced Dental Education, Saint Louis University; Ms. Rowland is Manager of International Development and Outreach, American Dental Association Foundation; Mr. Horne is Senior Manager of Marketing Research, American Dental Association Foundation; and Dr. Seymour is Assistant Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine
| | - Brittany Seymour
- Mr. Lambert is a DMD student, Harvard School of Dental Medicine; Ms. Wong is a DMD student, Harvard School of Dental Medicine; Dr. Woodmansey is Program Director, Center for Advanced Dental Education, Saint Louis University; Ms. Rowland is Manager of International Development and Outreach, American Dental Association Foundation; Mr. Horne is Senior Manager of Marketing Research, American Dental Association Foundation; and Dr. Seymour is Assistant Professor, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine.
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Cash-Gibson L, Rojas-Gualdrón DF, Pericàs JM, Benach J. Inequalities in global health inequalities research: A 50-year bibliometric analysis (1966-2015). PLoS One 2018; 13:e0191901. [PMID: 29385197 PMCID: PMC5792017 DOI: 10.1371/journal.pone.0191901] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/12/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Increasing evidence shows that health inequalities exist between and within countries, and emphasis has been placed on strengthening the production and use of the global health inequalities research, so as to improve capacities to act. Yet, a comprehensive overview of this evidence base is still needed, to determine what is known about the global and historical scientific production on health inequalities to date, how is it distributed in terms of country income groups and world regions, how has it changed over time, and what international collaboration dynamics exist. METHODS A comprehensive bibliometric analysis of the global scientific production on health inequalities, from 1966 to 2015, was conducted using Scopus database. The historical and global evolution of the study of health inequalities was considered, and through joinpoint regression analysis and visualisation network maps, the preceding questions were examined. FINDINGS 159 countries (via authorship affiliation) contributed to this scientific production, three times as many countries than previously found. Scientific output on health inequalities has exponentially grown over the last five decades, with several marked shift points, and a visible country-income group affiliation gradient in the initiation and consistent publication frequency. Higher income countries, especially Anglo-Saxon and European countries, disproportionately dominate first and co-authorship, and are at the core of the global collaborative research networks, with the Global South on the periphery. However, several country anomalies exist that suggest that the causes of these research inequalities, and potential underlying dependencies, run deeper than simply differences in country income and language. CONCLUSIONS Whilst the global evidence base has expanded, Global North-South research gaps exist, persist and, in some cases, are widening. Greater understanding of the structural determinants of these research inequalities and national research capacities is needed, to further strengthen the evidence base, and support the long term agenda for global health equity.
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Affiliation(s)
- Lucinda Cash-Gibson
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona (Catalonia, Spain)
- Johns Hopkins University—Pompeu Fabra University Public Policy Center, Barcelona (Catalonia, Spain)
| | - Diego F. Rojas-Gualdrón
- Faculty of Medicine, CES University, Medellín (Antioquia, Colombia)
- School of Graduate Studies, CES University, Medellín (Antioquia, Colombia)
| | - Juan M. Pericàs
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona (Catalonia, Spain)
- Johns Hopkins University—Pompeu Fabra University Public Policy Center, Barcelona (Catalonia, Spain)
| | - Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona (Catalonia, Spain)
- Johns Hopkins University—Pompeu Fabra University Public Policy Center, Barcelona (Catalonia, Spain)
- Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma Madrid, Spain
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Argent AC. Considerations for Assessing the Appropriateness of High-Cost Pediatric Care in Low-Income Regions. Front Pediatr 2018; 6:68. [PMID: 29637061 PMCID: PMC5880905 DOI: 10.3389/fped.2018.00068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/08/2018] [Indexed: 12/24/2022] Open
Abstract
It may be difficult to predict the consequences of provision of high-cost pediatric care (HCC) in low- and middle-income countries (LMICs), and these consequences may be different to those experienced in high-income countries. An evaluation of the implications of HCC in LMICs must incorporate considerations of the specific context in that country (population age profile, profile of disease, resources available), likely costs of the HCC, likely benefits that can be gained versus the costs that will be incurred. Ideally, the process that is followed in decision making around HCC should be transparent and should involve the communities that will be most affected by those decisions. It is essential that the impacts of provision of HCC are carefully monitored so that informed decisions can be made about future provision medical interventions.
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Affiliation(s)
- Andrew C Argent
- Paediatric Critical Care, Paediatrics and Child Health, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Parmar L, Sedai A, Ankita K, Dhanya R, Agarwal RK, Dhimal S, Shriniwas R, Iyer HV, Gowda A, Gujjal P, Pushpa H, Jain S, Kondaveeti S, Dasaratha Ramaiah J, Raviteja, Jali S, Tallur NR, Ramprakash S, Faulkner L. Can inequity in healthcare be bridged in LMICs – Multicentre experience from thalassemia day care centres in India. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2017. [DOI: 10.1016/j.phoj.2017.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Clermont A. The impact of eliminating within-country inequality in health coverage on maternal and child mortality: a Lives Saved Tool analysis. BMC Public Health 2017; 17:734. [PMID: 29143623 PMCID: PMC5688502 DOI: 10.1186/s12889-017-4737-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Inequality in healthcare across population groups in low-income countries is a growing topic of interest in global health. The Lives Saved Tool (LiST), which uses health intervention coverage to model maternal, neonatal, and child health outcomes such as mortality rates, can be used to analyze the impact of within-country inequality. Methods Data from nationally representative household surveys (98 surveys conducted between 1998 and 2014), disaggregated by wealth quintile, were used to create a LiST analysis that models the impact of scaling up health intervention coverage for the entire country from the national average to the rate of the top wealth quintile (richest 20% of the population). Interventions for which household survey data are available were used as proxies for other interventions that are not measured in surveys, based on co-delivery of intervention packages. Results For the 98 countries included in the analysis, 24–32% of child deaths (including 34–47% of neonatal deaths and 16–19% of post-neonatal deaths) could be prevented by scaling up national coverage of key health interventions to the level of the top wealth quintile. On average, the interventions with most unequal coverage rates across wealth quintiles were those related to childbirth in health facilities and to water and sanitation infrastructure; the most equally distributed were those delivered through community-based mass campaigns, such as vaccines, vitamin A supplementation, and bednet distribution. Conclusions LiST is a powerful tool for exploring the policy and programmatic implications of within-country inequality in low-income, high-mortality-burden countries. An “Equity Tool” app has been developed within the software to make this type of analysis easily accessible to users. Electronic supplementary material The online version of this article (10.1186/s12889-017-4737-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adrienne Clermont
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA.
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Porcherie M, Vaillant Z, Faure E, Rican S, Simos J, Cantoreggi NL, Heritage Z, Le Gall AR, Cambon L, Diallo TA, Vidales E, Pommier J. The GREENH-City interventional research protocol on health in all policies. BMC Public Health 2017; 17:820. [PMID: 29047362 PMCID: PMC5648502 DOI: 10.1186/s12889-017-4812-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper presents the research protocol of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project funded by the National Institute for Cancer (Subvention N°2017-003-INCA). In France, health inequities have tended to increase since the late 1980s. Numerous studies show the influence of social, economic, geographic and political determinants on health inequities across the life course. Exposure to environmental factors is uneven across the population and may impact on health and health inequities. In cities, green spaces contribute to creating healthy settings which may help tackle health inequities. Health in All Policies (HiAP) represents one of the key strategies for addressing social and environmental determinants of health inequities. The objective of this research is to identify the most promising interventions to operationalize the HiAP approaches at the city level to tackle health inequities through urban green spaces. It is a participatory interventional research to analyze public policy in real life setting (WHO Healthy Cities). METHOD/DESIGN It is a mixed method systemic study with a quantitative approach for the 80 cities and a comparative qualitative multiple case-studies of 6 cities. The research combines 3 different lens: 1/a political analysis of how municipalities apply HiAP to reduce social inequities of health through green space policies and interventions 2/a geographical and topological characterization of green spaces and 3/ on-site observations of the use of green spaces by the inhabitants. RESULTS City profiles will be identified regarding their HiAP approaches and the extent to which these cities address social inequities in health as part of their green space policy action. The analysis of the transferability of the results will inform policy recommendations in the rest of the Health City Network and widely for the French municipalities. DISCUSSION/CONCLUSION The study will help identify factors enabling the implementation of the HiAP approach at a municipal level, promoting the development of green spaces policies in urban areas in order to tackle the social inequities in health.
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Affiliation(s)
- Marion Porcherie
- EHESP –School of Public Health, Department of Social Sciences and Health, 15 avenue du Professeur Léon-Bernard - CS74312 -, 35043 Rennes cedex, France
- ARENES, (UMR/CNRS 6051), University of Rennes 1 Institut d’Etudes Politiques, 104 Boulevard de la Duchesse Anne, 35700 Rennes, France
| | - Zoé Vaillant
- University of Paris-Nanterre, Ladyss - UMR 7533, 200 Avenue de la République, 92000 Nanterre, France
| | - Emmannuelle Faure
- University of Paris-Nanterre, Ladyss - UMR 7533, 200 Avenue de la République, 92000 Nanterre, France
| | - Stéphane Rican
- University of Paris-Nanterre, Ladyss - UMR 7533, 200 Avenue de la République, 92000 Nanterre, France
| | - Jean Simos
- Institute of Global Health, University of Geneva, Chemin des Mines 9, CH - 1202 Genève, Switzerland
| | - Nicola Luca Cantoreggi
- Institute of Global Health, University of Geneva, Chemin des Mines 9, CH - 1202 Genève, Switzerland
| | - Zoé Heritage
- WHO French Healthy City Network, 15 avenue du Professeur Léon-Bernard - CS74312, 35043 Rennes, France
| | - Anne Roue Le Gall
- ARENES, (UMR/CNRS 6051), University of Rennes 1 Institut d’Etudes Politiques, 104 Boulevard de la Duchesse Anne, 35700 Rennes, France
- EHESP –School of Public Health, Department of environmental and occupational health and sanitary engineering, 15 avenue du Professeur Léon-Bernard - CS74312, 35043 Rennes cedex, France
| | - Linda Cambon
- ARENES, (UMR/CNRS 6051), University of Rennes 1 Institut d’Etudes Politiques, 104 Boulevard de la Duchesse Anne, 35700 Rennes, France
- EHESP –School of Public Health, INCA/EHESP Research Chaire in Cancer Prevention, Department of Social Sciences and Health, 15 avenue du Professeur Léon-Bernard - CS74312 -, 35043 Rennes cedex, France
| | - Thierno Amadou Diallo
- École supérieure d’aménagement du territoire et de développement régional– Université Laval, Pavillon Félix-Antoine-Savard, bureau FAS-1616, 2325, allée des Bibliothèques, Québec, QC G1V 0A6 Canada
| | - Eva Vidales
- WHO French Healthy City Network, 15 avenue du Professeur Léon-Bernard - CS74312, 35043 Rennes, France
| | - Jeanine Pommier
- ARENES, (UMR/CNRS 6051), University of Rennes 1 Institut d’Etudes Politiques, 104 Boulevard de la Duchesse Anne, 35700 Rennes, France
- EHESP – National School of Public Health, Department of Social Sciences and Health, 15 avenue du Professeur Léon-Bernard - CS74312, 35043 Rennes cedex, France
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Ajayi AI, Akpan W. Who benefits from free institutional delivery? evidence from a cross sectional survey of North Central and Southwestern Nigeria. BMC Health Serv Res 2017; 17:620. [PMID: 28865462 PMCID: PMC5581419 DOI: 10.1186/s12913-017-2560-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 08/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background The reasons for low utilisation of maternal health services in settings where the user-fee removal policy has been implemented continue to generate scholarly debates. Evidence of whether user-fee removal benefits the poor women in underserved settings is scanty and inconsistent. This article examines use of maternal health care services in the context of free maternal healthcare and profiles the beneficiaries of user-fee removal. Methods The study adopted a descriptive design. A three-stage cluster sampling method was used to select a representative sample of 1227 women who gave birth between 2011 and 2015. Questionnaires were administered using a face-to-face interview approach and data generated were analysed using descriptive and inferential statistics. Results The analysis shows that the use of maternal healthcare services has improved considerably in North Central and Southwestern Nigeria. While socioeconomic and geographical inequality in the use of maternal healthcare services appear to be disappearing in Southwestern Nigeria, it appears to be widening in North Central Nigeria. The findings indicate that 33.6% of women reported to have benefitted from the free child-delivery programme; however, substantial variation exists across the two regions. The proportion of beneficiaries of user-fee removal policy was highest in urban areas (35.9%), among women belonging to the middle income category (38.3%), among women who gave birth in primary health centres (63.1%) and among women who resided in communities where there was availability of health facilities (37.2%). Conclusion The study concludes that low coverage of the free maternal health programme, especially among women of low socioeconomic status residing in underserved settings is among the reasons for persistent poor maternal health outcomes in the context of free maternal healthcare. A model towards improving maternal health in underserved settings, especially in North Central Nigeria, would entail provisioning of health facilities as well as focusing on implementing equitable maternal health policies.
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Affiliation(s)
- Anthony I Ajayi
- Department of Sociology, Faculty of Social Sciences & Humanities, University of Fort Hare, East London, South Africa.
| | - Wilson Akpan
- Faculty of Social Sciences & Humanities, University of Fort Hare, East London, South Africa
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Kabudula CW, Houle B, Collinson MA, Kahn K, Gómez-Olivé FX, Tollman S, Clark SJ. Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001-13: a population surveillance analysis. Lancet Glob Health 2017; 5:e924-e935. [PMID: 28807190 PMCID: PMC5559644 DOI: 10.1016/s2214-109x(17)30297-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/27/2017] [Accepted: 07/06/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Understanding the effects of socioeconomic disparities in health outcomes is important to implement specific preventive actions. We assessed socioeconomic disparities in mortality indicators in a rural South African population over the period 2001-13. METHODS We used data from 21 villages of the Agincourt Health and socio-Demographic Surveillance System (HDSS). We calculated the probabilities of death from birth to age 5 years and from age 15 to 60 years, life expectancy at birth, and cause-specific and age-specific mortality by sex (not in children <5 years), time period, and socioeconomic status (household wealth) quintile for HIV/AIDS and tuberculosis, other communicable diseases (excluding HIV/AIDS and tuberculosis) and maternal, perinatal, and nutritional causes, non-communicable diseases, and injury. We also quantified differences with relative risk ratios and relative and slope indices of inequality. FINDINGS Between 2001 and 2013, 10 414 deaths were registered over 1 058 538 person-years of follow-up, meaning the overall crude mortality was 9·8 deaths per 1000 person-years. We found significant socioecomonic status gradients for mortality and life expectancy at birth, with outcomes improving with increasing socioeconomic status. An inverse relation was seen for HIV/AIDS and tuberculosis mortality and socioeconomic status that persisted from 2001 to 2013. Deaths from non-communicable diseases increased over time in both sexes, and injury was an important cause of death in men and boys. Neither of these causes of death, however, showed consistent significant associations with household socioeconomic status. INTERPRETATION The poorest people in the population continue to bear a high burden of HIV/AIDS and tuberculosis mortality, despite free antiretroviral therapy being made available from public health facilities. Associations between socioeconomic status and increasing burden of mortality from non-communicable diseases is likely to become prominent. Integrated strategies are needed to improve access to and uptake of HIV testing, care, and treatment, and management of non-communicable diseases in the poorest populations. FUNDING Wellcome Trust, South African Medical Research Council, and University of the Witwatersrand, South Africa.
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Affiliation(s)
- Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Brian Houle
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Demography, Australian National University, Canberra, ACT, Australia; CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA
| | - Mark A Collinson
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Department of Science and Technology/Medical Research Council, South African Population Research Infrastructure Network (SAPRIN), Acornhoek, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Francesc Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Stephen Tollman
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Samuel J Clark
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA; INDEPTH Network, Accra, Ghana; Department of Sociology, The Ohio State University, Columbus, OH, USA
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Shin H, Aliaga-Linares L, Britton M. Misconceived equity? Health care resources, contextual poverty, and child health disparities in Peru. SOCIAL SCIENCE RESEARCH 2017; 66:234-247. [PMID: 28705359 DOI: 10.1016/j.ssresearch.2017.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 11/15/2016] [Accepted: 01/05/2017] [Indexed: 06/07/2023]
Abstract
Although many studies have examined determinants of child health, fewer have explored factors explaining regional disparities in child health outcomes. In the Peruvian context, we examined the relationship between regional disparities in child malnutrition and local variation in health resources (health care resources and the socioeconomic environment). Using the Peruvian 2007-2008 Continuous Demographic and Health Survey (N = 8020) and governmental administrative data, our analyses show that 1) only selected types of health care resources (medical professionals and outpatient visits) are related to child nutritional status, 2) local poverty predicts nutritional status net of household characteristics, and, most importantly, 3) a significant portion of regional differences in child malnutrition are explained by local poverty, whereas health care resources are not associated with regional disparities. These findings suggest that the local socioeconomic environment is a key determinant of both child health outcomes and regional disparities in these outcomes.
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Affiliation(s)
- Heeju Shin
- Department of Sociology, The Catholic University of Korea, Republic of Korea.
| | | | - Marcus Britton
- Department of Sociology, University of Wisconsin-Milwaukee, United States
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Wu L, Zhang H. Health-Related Quality of Life of Low-Socioeconomic-Status Populations in Urban China. HEALTH & SOCIAL WORK 2016; 41:219-227. [PMID: 29206975 DOI: 10.1093/hsw/hlw039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/26/2015] [Indexed: 06/07/2023]
Abstract
Previous researchers had not yet examined the association between socioeconomic status (SES) and health-related quality of life (HRQOL) in urban China. The present study attempts to assess HRQOL of lower-SES populations in urban China in comparison with middle- and high-SES populations, and then to examine the mediating role of sense of control between SES and HRQOL. A national representative sample of 1,856 participants responded to the HRQOL survey using the 12-item Short Form Health Survey (SF-12), conducted by the Chinese General Social Survey research team in 2010. The results showed that lower-SES populations reported lower HRQOL than middle- and high-SES populations. Sense of control could partially mediate the association between social class and HRQOL. These findings will generate significant policy and practice implications for identifying those at particular risk for lower HRQOL and, accordingly, suggesting ways to improve their HRQOL through specific social work interventions in urban China's context.
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Affiliation(s)
- Lei Wu
- Department of Social Work, School of Sociology and Population Studies, Renmin University of China, Beijing
| | - Huiping Zhang
- Department of Social Work, School of Sociology and Population Studies, Renmin University of China, Beijing
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Bohra T, Benmarhnia T, McKinnon B, Kaufman JS. Decomposing Educational Inequalities in Child Mortality: A Temporal Trend Analysis of Access to Water and Sanitation in Peru. Am J Trop Med Hyg 2016; 96:57-64. [PMID: 27821698 DOI: 10.4269/ajtmh.15-0745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 09/23/2016] [Indexed: 11/07/2022] Open
Abstract
Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population.
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Affiliation(s)
- Tasneem Bohra
- Master of Public Health, School of Public Health, Ecole des Hautes Études en Santé Publique (EHESP), Rennes, France
| | - Tarik Benmarhnia
- Institute for Health and Social Policy, McGill University, Montreal, Canada.
| | - Britt McKinnon
- Institute for Health and Social Policy, McGill University, Montreal, Canada
| | - Jay S Kaufman
- Institute for Health and Social Policy, McGill University, Montreal, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
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Ridde V, Guichard A, Houéto D. Social inequalities in health from Ottawa to Vancouver: action for fair equality of opportunity. ACTA ACUST UNITED AC 2016; Suppl 2:12-6, 44-7. [PMID: 17685074 DOI: 10.1177/10253823070140020601x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors set out to show that the Ottawa Charter of 1986 has not been sufficiently accepted over the past twenty years, even by those who use it as a strategic tool to guide interventions for reducing social inequalities in health. Although some public health policies do emphasize the reduction of social inequalities in health, only the Ottawa Charter appears to possess the status of an international declaration on the matter. Social inequalities in health are the systematic, avoidable, and unjust differences in health that persist between individuals and sub-groups of a population. Four examples from the field of health promotion serve to show that forgetting to combat social inequalities in health is not exclusive to the domain of public health. However, taking action against social inequalities in health does not equal tackling poverty. Moreover, intervening on the principle of equality of opportunity, on the basis of an ideology of meritocracy, or for the benefit of the population as a whole, without regard to sub-groups, only tends, at best, to reproduce inequalities. Although evidence is insufficient, there are studies that show that reducing social inequalities in health is not an aporia. Three explanations are advanced as to why social inequalities in health have been ignored by health promotion professionals. The Ottawa Charter had the merit of highlighting the struggle against social inequalities in health. Now, moving beyond the declarations, from the strategic framework provided by the Ottawa Charter and in accordance with the Bangkok Charter, it is time to show proof of voluntarism. Several priorities for the future are suggested and the International Union for Health Promotion and Education (IUHPE) should be responsible for advocating for them. (Promotion & Education, 2007, Supplement (2): pp 12-16).
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Affiliation(s)
- Valéry Ridde
- International Health Unit, Faculty of Medicine, University of Montreal, Montreal, Canada.
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Socio-economic inequalities in health and health service use among older adults in India: results from the WHO Study on Global AGEing and adult health survey. Public Health 2016; 141:32-41. [PMID: 27932013 DOI: 10.1016/j.puhe.2016.08.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/29/2016] [Accepted: 08/09/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objectives of this study were to measure socio-economic inequalities in self-reported health (SRH) and healthcare visits and to identify factors contributing to health inequalities among older people aged 50-plus years. STUDY DESIGN This study is based on a population-based, cross-sectional survey. METHODS We accessed data of 7150 older adults from the World Health Organization's Study on Global AGEing and adult health Indian survey. We used multivariate logistic regression to assess the correlates of poor SRH. We estimated the concentration index to measure socio-economic inequalities in SRH and healthcare visits. Regression-based decomposition analysis was employed to explore the correlates contributing to poor SRH inequality. RESULTS About 19% (95% CI: 18%, 20%) reported poor health (n = 1368) and these individuals were significantly less wealthy. In total, 5134 (71.8%) participants made at least one health service visit. Increasing age, female gender, low social caste, rural residence, multimorbidity, absence of pension support, and health insurance were significant correlates of poor SRH. The standardized concentration index of poor SRH -0.122 (95% CI: -0.102; -0.141) and healthcare visits 0.364 (95% CI: 0.324, 0.403) indicated pro-poor and pro-rich inequality, respectively. Economic status (62.3%), pension support (11.5%), health insurance coverage (11.5%), social caste (10.7%) and place of residence (4.1%) were important contributors to inequalities in poor health. CONCLUSION Socio-economic disparities in health and health care are major concerns in India. Achievement of health equity demand strategies beyond health policies, to include pro-poor, social welfare policies among older Indians.
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Rosário EVN, Costa D, Timóteo L, Rodrigues AA, Varanda J, Nery SV, Brito M. Main causes of death in Dande, Angola: results from Verbal Autopsies of deaths occurring during 2009-2012. BMC Public Health 2016; 16:719. [PMID: 27491865 PMCID: PMC4973533 DOI: 10.1186/s12889-016-3365-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 07/23/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The Dande Health and Demographic Surveillance System (HDSS) located in Bengo Province, Angola, covers nearly 65,500 residents living in approximately 19,800 households. This study aims to describe the main causes of deaths (CoD) occurred within the HDSS, from 2009 to 2012, and to explore associations between demographic or socioeconomic factors and broad mortality groups (Group I-Communicable diseases, maternal, perinatal and nutritional conditions; Group II-Non-communicable diseases; Group III-Injuries; IND-Indeterminate). METHODS Verbal Autopsies (VA) were performed after death identification during routine HDSS visits. Associations between broad groups of CoD and sex, age, education, socioeconomic position, place of residence and place of death, were explored using chi-square tests and fitting logistic regression models. RESULTS From a total of 1488 deaths registered, 1009 verbal autopsies were performed and 798 of these were assigned a CoD based on the 10(th) revision of the International Classification of Diseases (ICD-10). Mortality was led by CD (61.0 %), followed by IND (18.3 %), NCD (11.6 %) and INJ (9.1 %). Intestinal infectious diseases, malnutrition and acute respiratory infections were the main contributors to under-five mortality (44.2 %). Malaria was the most common CoD among children under 15 years old (38.6 %). Tuberculosis, traffic accidents and malaria led the CoD among adults aged 15-49 (13.5 %, 10.5 % and 8.0 % respectively). Among adults aged 50 or more, diseases of the circulatory system (23.2 %) were the major CoD, followed by tuberculosis (8.2 %) and malaria (7.7 %). CD were more frequent CoD among less educated people (adjusted odds ratio, 95 % confidence interval for none vs. 5 or more years of school: 1.68, 1.04-2.72). CONCLUSION Infectious diseases were the leading CoD in this region. Verbal autopsies proved useful to identify the main CoD, being an important tool in settings where vital statistics are scarce and death registration systems have limitations.
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Affiliation(s)
| | - Diogo Costa
- Health Research Centre of Angola (CISA), Caxito, Bengo Angola
- EPIUnit—Institute of Public Health, University of Porto (ISPUP), Porto, Portugal
| | | | | | - Jorge Varanda
- CRIA, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Susana Vaz Nery
- ANU College of Medicine, Biology and Environment, The Australian National University, Camberra, Australia
| | - Miguel Brito
- Health Research Centre of Angola (CISA), Caxito, Bengo Angola
- Lisbon School of Health Technology (ESTeSL), Lisboa, Portugal
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Heaton TB, Crookston B, Pierce H, Amoateng AY. Social inequality and children's health in Africa: a cross sectional study. Int J Equity Health 2016; 15:92. [PMID: 27301658 PMCID: PMC4906977 DOI: 10.1186/s12939-016-0372-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/19/2016] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND This study examines socioeconomic inequality in children's health and factors that moderate this inequality. Socioeconomic measures include household wealth, maternal education and urban/rural area of residence. Moderating factors include reproductive behavior, access to health care, time, economic development, health expenditures and foreign aid. METHODS Data are taken from Demographic and Health Surveys conducted between 2003 and 2012 in 26 African countries. RESULTS Birth spacing, skilled birth attendants, economic development and greater per capita health expenditures benefit the children of disadvantaged mothers, but the wealthy benefit more from the services of a skilled birth attendant and from higher per capita expenditure on health. CONCLUSION Some health behavior and policy changes would reduce social inequality, but the wealthy benefit more than the poor from provision of health services.
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Affiliation(s)
- Tim B Heaton
- Department of Sociology, Brigham Young University, 2033 JFSB, Provo, UT, 84602, USA.
| | | | - Hayley Pierce
- Department of Sociology, Brigham Young University, 2033 JFSB, Provo, UT, 84602, USA
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Mtenga S, Masanja IM, Mamdani M. Strengthening national capacities for researching on Social Determinants of Health (SDH) towards informing and addressing health inequities in Tanzania. Int J Equity Health 2016; 15:23. [PMID: 26860192 PMCID: PMC4746920 DOI: 10.1186/s12939-016-0308-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background Tanzania’s socio-economic development is challenged by sharp inequities between and within urban and rural areas, and among different socio-economic groups. This paper discusses the importance of strengthening SDH research, knowledge, relevant capacities and responsive systems towards addressing health inequities in Tanzania. Methods Based on a conceptual framework for building SDH research capacity, a mapping of existing research systems was undertaken between February and June 2012. It involved a review of national policies, strategies and published SDH-related research outputs from 2005 onwards, and 34 in-depth interviews with a range of stakeholders in Tanzania. Results The conceptualization of SDH varies considerably among stakeholders and their professional background, but with some consensus that it is linked to “inequities” being a consequence of poverty, poor planning, limited attention to basic humanity and citizenship rights, weak governance structures and inefficient use of available resources. Commonly perceived SDH factors include age, income, education, beliefs, cultural norms, gender, occupation, nutritional status, access to health care, access to safe water and sanitation and child bearing practices. SDH research is in its infancy but gaining momentum. In the absence of a specific “SDH portfolio”, SDH research is scattered and hidden within disease specific, poverty-related research and research on universal health coverage. Research is mainly externally funded, which has implications on the focus of context specific SDH research, national priorities and transfer to policy. This create mismatch with population and research capacity needs. Conclusion Most research analysis in the country fails to consider the context specific structural determinants of health and inequities towards a broader understanding of existing vulnerabilities. The challenge is on promoting a culture of critical inter-disciplinary research and analysis that is central to SDH research. Establishing a system to promote collaboration across sectors and strengthen collective capacities for individuals and institutions researching in SDH will augment existing SDH research initiatives and better inform appropriate intersectoral policies towards addressing prevailing health inequities across the country.
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Affiliation(s)
- Sally Mtenga
- Ifakara Health Institute, Po Box 78373, Dar es Salaam, Tanzania.
| | - Irene M Masanja
- Ifakara Health Institute, Po Box 78373, Dar es Salaam, Tanzania.
| | - Masuma Mamdani
- Ifakara Health Institute, Po Box 78373, Dar es Salaam, Tanzania.
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dos Santos JP, Paes NA. Association between life conditions and vulnerability with mortality from cardiovascular diseases in elderly men of Northeast Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 17:407-20. [PMID: 24918413 DOI: 10.1590/1809-4503201400020010eng] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 06/07/2013] [Indexed: 11/22/2022] Open
Abstract
The study aimed at identifying explanatory factors of the mortality rate of elderly men due to cardiovascular diseases in the 187 micro regions of Northeast Brazil, in 2000, based on indicators of life conditions and vulnerability of that population, using the structural equations modeling. The following methodological steps were taken: (1) using Censo 2000's microdata, 10 indicators were selected to the latent exogenous construct 'life conditions and vulnerability'. Using the Information System of Mortality from the Brazilian Ministry of Health, data about deaths from the four major basic causes of cardiovascular diseases were collected, which composed the endogenous latent construct as the outcome variable; (2) qualitative analysis of mortality data; (3) statistical analysis using the structural equation modeling through two phases: adjustment of the outcome variables measurement model and adjustment of the obtained structural model. Due to the multicollinearity observed, three indicators showed significance for the measurement model: years of study, percentage of elderly men in households with bathroom/plumbing and survival probability at 60 years of age. The structural model indicated adjustment adequacy of the model, which the measurement of standardized coefficient was considered of strong effect (SC = 0.81, p-value < 0.01) and coefficient of determination r2 = 66%. It was concluded that indicators of life conditions and vulnerability were highly associated with the mortality rate from cardiovascular diseases in elderly men from Northeast Brazil in 2000.
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Abstract
Context Health inequalities are systematic differences in health among social groups that are caused by unequal exposure to—and distributions of—the social determinants of health (SDH). They are persistent between and within countries despite action to reduce them. Advocacy is a means of promoting policies that improve health equity, but the literature on how to do so effectively is dispersed. The aim of this review is to synthesize the evidence in the academic and gray literature and to provide a body of knowledge for advocates to draw on to inform their efforts. Methods This article is a systematic review of the academic literature and a fixed-length systematic search of the gray literature. After applying our inclusion criteria, we analyzed our findings according to our predefined dimensions of advocacy for health equity. Last, we synthesized our findings and made a critical appraisal of the literature. Findings The policy world is complex, and scientific evidence is unlikely to be conclusive in making decisions. Timely qualitative, interdisciplinary, and mixed-methods research may be valuable in advocacy efforts. The potential impact of evidence can be increased by “packaging” it as part of knowledge transfer and translation. Increased contact between researchers and policymakers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, although health professionals and disadvantaged people, who have direct contact with or experience of hardship, can be particularly persuasive in advocacy efforts. Different types of advocacy messages can accompany evidence, but messages should be tailored to advocacy target. Several barriers hamper advocacy efforts. The most frequently cited in the academic literature are the current political and economic zeitgeist and related public opinion, which tend to blame disadvantaged people for their ill health, even though biomedical approaches to health and political short-termism also act as barriers. These barriers could be tackled through long-term actions to raise public awareness and understanding of the SDH and through training of health professionals in advocacy. Advocates need to take advantage of “windows of opportunity,” which open and close quickly, and demonstrate expertise and credibility. Conclusions This article brings together for the first time evidence from the academic and the gray literature and provides a building block for efforts to advocate for health equity. Evidence regarding many of the dimensions is scant, and additional research is merited, particularly concerning the applicability of findings outside the English-speaking world. Advocacy organizations have a central role in advocating for health equity, given the challenges bridging the worlds of civil society, research, and policy.
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Arcaya MC, Arcaya AL, Subramanian SV. Inequalities in health: definitions, concepts, and theories. Glob Health Action 2015; 8:27106. [PMID: 26112142 PMCID: PMC4481045 DOI: 10.3402/gha.v8.27106] [Citation(s) in RCA: 296] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/23/2015] [Accepted: 04/03/2015] [Indexed: 11/14/2022] Open
Abstract
Individuals from different backgrounds, social groups, and countries enjoy different levels of health. This article defines and distinguishes between unavoidable health inequalities and unjust and preventable health inequities. We describe the dimensions along which health inequalities are commonly examined, including across the global population, between countries or states, and within geographies, by socially relevant groupings such as race/ethnicity, gender, education, caste, income, occupation, and more. Different theories attempt to explain group-level differences in health, including psychosocial, material deprivation, health behavior, environmental, and selection explanations. Concepts of relative versus absolute; dose-response versus threshold; composition versus context; place versus space; the life course perspective on health; causal pathways to health; conditional health effects; and group-level versus individual differences are vital in understanding health inequalities. We close by reflecting on what conditions make health inequalities unjust, and to consider the merits of policies that prioritize the elimination of health disparities versus those that focus on raising the overall standard of health in a population.
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Affiliation(s)
- Mariana C Arcaya
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University in Boston, MA, USA
| | - Alyssa L Arcaya
- Region 2, United States Environmental Protection Agency, New York, NY, USA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, University in Boston, MA, USA;
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Colson KE, Dwyer-Lindgren L, Achoki T, Fullman N, Schneider M, Mulenga P, Hangoma P, Ng M, Masiye F, Gakidou E. Benchmarking health system performance across districts in Zambia: a systematic analysis of levels and trends in key maternal and child health interventions from 1990 to 2010. BMC Med 2015; 13:69. [PMID: 25889124 PMCID: PMC4382853 DOI: 10.1186/s12916-015-0308-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/02/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Achieving universal health coverage and reducing health inequalities are primary goals for an increasing number of health systems worldwide. Timely and accurate measurements of levels and trends in key health indicators at local levels are crucial to assess progress and identify drivers of success and areas that may be lagging behind. METHODS We generated estimates of 17 key maternal and child health indicators for Zambia's 72 districts from 1990 to 2010 using surveys, censuses, and administrative data. We used a three-step statistical model involving spatial-temporal smoothing and Gaussian process regression. We generated estimates at the national level for each indicator by calculating the population-weighted mean of the district values and calculated composite coverage as the average of 10 priority interventions. RESULTS National estimates masked substantial variation across districts in the levels and trends of all indicators. Overall, composite coverage increased from 46% in 1990 to 73% in 2010, and most of this gain was attributable to the scale-up of malaria control interventions, pentavalent immunization, and exclusive breastfeeding. The scale-up of these interventions was relatively equitable across districts. In contrast, progress in routine services, including polio immunization, antenatal care, and skilled birth attendance, stagnated or declined and exhibited large disparities across districts. The absolute difference in composite coverage between the highest-performing and lowest-performing districts declined from 37 to 26 percentage points between 1990 and 2010, although considerable variation in composite coverage across districts persisted. CONCLUSIONS Zambia has made marked progress in delivering maternal and child health interventions between 1990 and 2010; nevertheless, substantial variations across districts and interventions remained. Subnational benchmarking is important to identify these disparities, allowing policymakers to prioritize areas of greatest need. Analyses such as this one should be conducted regularly and feed directly into policy decisions in order to increase accountability at the local, regional, and national levels.
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Affiliation(s)
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Tom Achoki
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Ministry of Health of Botswana, Gaborone, Botswana.
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | | | | | - Peter Hangoma
- Department of Economics, University of Bergen, Bergen, Norway.
- Department of Economics, University of Zambia, Lusaka, Zambia.
| | - Marie Ng
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Felix Masiye
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Economics, University of Zambia, Lusaka, Zambia.
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
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