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Gencer H, Saß AC, Prütz F. [Gender-sensitive health indicators for health reporting at the Robert Koch Institute (GBE-GI)-a pilot project as part of the Joint Action PreventNCD project]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024:10.1007/s00103-024-03959-6. [PMID: 39356345 DOI: 10.1007/s00103-024-03959-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2024] [Indexed: 10/03/2024]
Abstract
Health reporting (GBE) based on gender-sensitive indicators can provide information on gender inequalities, improve health promotion and healthcare, promote gender mainstreaming, and provide relevant information for gender equality measures. To date, there is no set of gender-sensitive health indicators for Federal Health Reporting at the Robert Koch Institute. As part of the Joint Action Prevent Non-Communicable Diseases, gender-sensitive health indicators are to be identified, evaluated, and integrated into the Robert Koch Institute's health reporting website in a pilot project. This is done in three work packages. In a scoping review, the available evidence on gender-sensitive health indicators and theoretical explanations for gender inequality in EU and OECD member states since 2014 will initially be assessed (work package 1). Building on this, identified indicators and explanatory approaches will be collated for evaluation and selection in a structured consensus process as part of a three-stage Delphi approach consisting of a focus group discussion and an online survey (work package 2). The evaluated indicator set will then be integrated into the Robert Koch Institute's health reporting website (work package 3). The results will be disseminated via scientific publications and conference presentations. An English full-text version of this article is available at SpingerLink as Supplementary Information.
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Affiliation(s)
- Hande Gencer
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Fachgebiet 24 Gesundheitsberichterstattung, Robert Koch-Institut, General-Pape-Straße 62-66, 12101, Berlin, Deutschland.
| | - Anke-Christine Saß
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Fachgebiet 24 Gesundheitsberichterstattung, Robert Koch-Institut, General-Pape-Straße 62-66, 12101, Berlin, Deutschland
| | - Franziska Prütz
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Fachgebiet 24 Gesundheitsberichterstattung, Robert Koch-Institut, General-Pape-Straße 62-66, 12101, Berlin, Deutschland
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Gencer H, Brunnett R, Staiger T, Tezcan-Güntekin H, Pöge K. Caring is not always sharing: A scoping review exploring how COVID-19 containment measures have impacted unpaid care work and mental health among women and men in Europe. PLoS One 2024; 19:e0308381. [PMID: 39213370 PMCID: PMC11364293 DOI: 10.1371/journal.pone.0308381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Unpaid care work is mainly performed by women, whose mental health is more affected by caregiving burden and work-family conflict compared to men. COVID-19 containment measures may have exacerbated existing gender inequalities in both unpaid care work and adverse mental health outcomes. This scoping review provides an overview of recent evidence on the impact of COVID-19 containment measures on unpaid care work and mental health for subgroups of caregivers at the intersection of gender and other social differences (e.g., ethnicity, age, class) in Europe. METHODS AND ANALYSIS Our study was informed and guided by Arksey and O'Malley's methodological framework. We searched six academic databases (Medline, PsycInfo, Scopus, CINAHL, Social Sciences Abstracts, Sociological Abstracts, ASSIA) and hand-searched the reference lists of selected articles to identify relevant peer-reviewed research articles published between 1 March 2020 and 7 September 2022. In addition, we conducted a grey literature search using Google Scholar and a targeted hand search on known international and European websites. We included studies that reported gender-disaggregated results on unpaid care work and mental health in the context of COVID-19 containment measures in Europe. Two reviewers independently screened all abstracts and full texts for eligibility and extracted the relevant data. The results were synthesised narratively. RESULTS AND DISCUSSION Our results suggest a greater gender gap in unpaid care work division and, to a lesser extent, in mental health, which is unfavourable towards women and mothers. Despite this, we see a break in the traditional division of childcare, with fathers taking on a greater role in family work, which makes us optimistic about the division of care work in the post-COVID-19 era. This research also shows that among European women, population groups often understudied, such as women who are single parents, disabled or of colour, have the highest increase in unpaid care work and greatest deterioration in wellbeing.
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Affiliation(s)
- Hande Gencer
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Regina Brunnett
- Department of Health Sciences, Fulda University of Applied Sciences, Fulda, Germany
| | - Tobias Staiger
- Faculty of Social Welfare, Baden-Wuerttemberg Cooperative State University (DHBW), Villingen-Schwenningen, Germany
| | - Hürrem Tezcan-Güntekin
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Berlin, Germany
| | - Kathleen Pöge
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
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Das B, Adhikary M, Singha SR, Parmar D. Who is Anaemic in India? Intersections of class, caste, and gender. J Biosoc Sci 2024; 56:731-753. [PMID: 38831724 DOI: 10.1017/s0021932024000245] [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: 06/05/2024]
Abstract
Anaemia severely impacts physical and mental abilities, raises health risks, and diminishes the quality of life and work capacity. It is a leading cause of adverse pregnancy outcomes and maternal mortality, especially in developing nations like India, where recent data on anaemia from National Family and Health Survey (NFHS-4) (2015-16) and NFHS-5 (2019-21) indicate a tremendous rise. Anaemia is a marker of poor nutrition and health, and socio-economic factors such as gender norms, race, income, and living conditions influence its impact. As a result, there are disparities in how anaemia affects different segments of society. However, existing research on health inequity and anaemia often employs a single-axis analytical framework of social power. These studies operate under the assumption that gender, economic class, ethnicity, and caste are inherently distinct and mutually exclusive categories and fail to provide a comprehensive understanding of anaemia prevalence. Therefore, the study has adopted the theoretical framework of intersectionality and analysed the NFHS-5 (2019-21) data using bivariate cross-tabulations and binary logistic regression models to understand how gender, class, caste, and place of residence are associated with the prevalence of anaemia. The results suggest that the women of Scheduled Tribes (ST) and Scheduled Castes (SC) share a disproportionate burden of anaemia. This study confirms that economic class and gender, geographical location, level of education, and body mass index significantly determine the prevalence of anaemia. The ST and SC women who are economically marginalised and reside in rural areas with high levels of poverty, exclusion, and poor nutritional status have a higher prevalence of anaemia than other population groups. Thus, the study suggests that intersections of multiple factors such as caste, class, gender, and place of residence significantly determine 'who is anaemic in India'.
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Affiliation(s)
- Bikash Das
- Department of Humanities and Social Sciences, Indian Institute of Technology Guwahati, Guwahati, Assam, India
| | - Mihir Adhikary
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Smriti Rekha Singha
- Department of Humanities and Social Sciences, Indian Institute of Technology Guwahati, Guwahati, Assam, India
| | - Daksha Parmar
- Department of Humanities and Social Sciences, Indian Institute of Technology Guwahati, Guwahati, Assam, India
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Fivian E, Harris-Fry H, Offner C, Zaman M, Shankar B, Allen E, Kadiyala S. The Extent, Range, and Nature of Quantitative Nutrition Research Engaging with Intersectional Inequalities: A Systematic Scoping Review. Adv Nutr 2024; 15:100237. [PMID: 38710327 PMCID: PMC11180316 DOI: 10.1016/j.advnut.2024.100237] [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: 12/08/2023] [Revised: 03/10/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024] Open
Abstract
Addressing malnutrition for all requires understanding inequalities in nutrition outcomes and how they intersect. Intersectionality is increasingly used as a theoretical tool for understanding how social characteristics intersect to shape inequalities in health outcomes. However, little is known about the extent, range, and nature of quantitative nutrition research engaging with intersectional inequalities. This systematic scoping review aimed to address this gap. Between 15 May 2021 and 15 May 2022, we searched 8 databases. Studies eligible for inclusion used any quantitative research methodology and aimed to investigate how social characteristics intersect to influence nutrition outcomes. In total, 55 studies were included, with 85% published since 2015. Studies spanned populations in 14 countries but were concentrated in the United States (n = 35) and India (n = 7), with just 1 in a low-income country (Mozambique). Race or ethnicity and gender were most commonly intersected (n = 20), and body mass index and overweight and/or obesity were the most common outcomes. No studies investigated indicators of infant and young child feeding or micronutrient status. Study designs were mostly cross-sectional (80%); no mixed-method or interventional research was identified. Regression with interaction terms was the most prevalent method (n = 26); 2 of 15 studies using nonlinear models took extra steps to assess interaction on the additive scale, as recommended for understanding intersectionality and assessing public health impacts. Nine studies investigated mechanisms that may explain why intersectional inequalities in nutrition outcomes exist, but intervention-relevant interpretations were mostly limited. We conclude that quantitative nutrition research engaging with intersectionality is gaining traction but is mostly limited to the United States and India. Future research must consider the intersectionality of a wider spectrum of public health nutrition challenges across diverse settings and use more robust and mixed-method research to identify specific interventions for addressing intersectional inequalities in nutrition outcomes. Data systems in nutrition must improve to facilitate this. This review was registered in PROSPERO as CRD42021253339.
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Affiliation(s)
- Emily Fivian
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Helen Harris-Fry
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia Offner
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michele Zaman
- Department of Medicine, Queen's University, Ontario, Canada
| | - Bhavani Shankar
- Department of Geography, The University of Sheffield, Sheffield, United Kingdom
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Suneetha Kadiyala
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Ssendikaddiwa JM, Goldenberg S, Berry NS, Lavergne MR. Sex, Immigration, and Patterns of Access to Primary Care in Canada. J Immigr Minor Health 2023; 25:548-559. [PMID: 36870007 DOI: 10.1007/s10903-023-01459-4] [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: 02/03/2023] [Indexed: 03/05/2023]
Abstract
Access to primary care is crucial to immigrant health and may be shaped by sex and gender, but research is limited and inconclusive. We identified measures that reflect access to primary care using 2015-2018 Canadian Community Health Survey data. We used multivariable logistic regression models to estimate adjusted odds of primary care access and to explore interaction effects between sex and immigration group (recent immigrant: < 10 years in Canada, long-term immigrant: 10 + years, non-immigrant). Recency of immigration and being male were negatively associated with access to primary care, with significantly lower odds of having a usual place for immediate care among male recent immigrants (AOR: 0.36, 95% CI 032-0.42). Interaction effects between immigration and sex were pronounced, especially for having a regular provider or place of care. Results underscore the need to examine approachability and acceptability of primary care services, especially for male recent immigrants.
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Affiliation(s)
- Joseph M Ssendikaddiwa
- Faculty of Health Sciences, Simon Fraser University, 8888, University Dr, Burnaby, BC, V5C 1S6, Canada
| | - Shira Goldenberg
- Division of Epidemiology and Biostatistics, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4162, USA.,Centre for Gender and Sexual Health Equity, University of British Columbia, Vancouver, BC, Canada
| | - Nicole S Berry
- Faculty of Health Sciences, Simon Fraser University, 8888, University Dr, Burnaby, BC, V5C 1S6, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Halifax, NS, B3J3TA, Canada.
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Gencer H, Brunnett R, Marchwacka MA, Rattay P, Staiger T, Tezcan-Güntekin H, Pöge K. Gendered impact of COVID-19 containment measures on unpaid care work and mental health in Europe: a scoping review protocol. BMJ Open 2022; 12:e060673. [PMID: 35896294 PMCID: PMC9334690 DOI: 10.1136/bmjopen-2021-060673] [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: 11/19/2022] Open
Abstract
INTRODUCTION Women are more likely than men to provide unpaid care work. Previous research has shown that lack of support for various forms of unpaid care work and work-family conflicts have negative impacts on caregivers' mental health, especially among female caregivers. COVID-19 containment measures may exacerbate existing gender inequalities both in terms of unpaid care work and adverse mental health outcomes. This scoping review protocol describes the systematic approach to review published literature from March 2020 onwards to identify empirical studies and grey literature on the mental health impact of COVID-19 containment measures on subgroups of unpaid caregivers at the intersection of gender and other categories of social difference (eg, ethnicity, age, class) in Europe. METHODS AND ANALYSIS This scoping review is informed and guided by Arksey and O'Malley's methodological framework. We will search the databases Medline, PsycINFO, Scopus, CINAHL, Social Sciences Abstracts, Sociological Abstracts as well as Applied Social Sciences Index & Abstracts (ASSIA) and hand-search reference lists of selected articles to identify relevant peer-reviewed studies. We will conduct a grey literature search using Google Scholar and targeted hand-search on known international and European websites and include reports, working papers, policy briefs and book chapters that meet the inclusion criteria. Studies that report gender-segregated findings for mental health outcomes associated with unpaid care work in the context of COVID-19 containment measures in Europe will be included. Two reviewers will independently screen all abstracts and full texts for inclusion, and extract general information, study characteristics and relevant findings. Results will be synthesized narratively. ETHICS AND DISSEMINATION This study is a review of published literature; ethics approval is not warranted. The findings of this study will inform public health research and policy. The results will be disseminated through a peer-reviewed publication and conference presentations.
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Affiliation(s)
- Hande Gencer
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Regina Brunnett
- Department of Welfare and Health Care, Ludwigshafen University of Business and Society, Ludwigshafen am Rhein, Germany
| | - Maria A Marchwacka
- Department of Health/Medical Education, University of Applied Sciences for Health (SRH), Stuttgart, Germany
| | - Petra Rattay
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Tobias Staiger
- Faculty of Social Welfare, Baden-Wuerttemberg Cooperative State University (DHBW), Villingen-Schwenningen, Germany
| | - Hürrem Tezcan-Güntekin
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Berlin, Germany
| | - Kathleen Pöge
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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8
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Diversifying Indigenous Vulnerability and Adaptation: An Intersectional Reading of Māori Women’s Experiences of Health, Wellbeing, and Climate Change. SUSTAINABILITY 2022. [DOI: 10.3390/su14095452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Despite evidence that Indigenous peoples’ multiple subjectivities engender diverse lived experiences both between and within Indigenous groups, the influence of multiple subjectivities on Indigenous peoples’ vulnerability and adaptation to climate change is largely un-explored. Drawing on ethnographic research with Indigenous Māori women in Aotearoa New Zealand, this paper provides empirical evidence that subjectivity-mediated power dynamics operating within Indigenous societies (at the individual and household scale) are important determinants of vulnerability and adaptation which should be considered in both scholarship and policy. Using an intersectional framework, I demonstrate how different Māori women and their whānau (families) live, cope with, and adapt to the embodied physical and emotional health effects of climate change in radically different ways because of their subject positionings, even though they belong to the same community, hapū (sub-tribe), or iwi (tribe). In underlining these heterogenous experiences, I provide an avenue for reconsidering how climate adaptation scholarship, policies, and practices might better engage with the complex, amorphous realities within Māori and other Indigenous communities. I argue it is possible to develop more inclusive, tailored, and sustainable adaptation that considers divergent vulnerabilities and adaptive capacities within Indigenous communities, groups, and societies and supports customised vulnerability-reduction strategies.
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Bambra C. Placing intersectional inequalities in health. Health Place 2022; 75:102761. [PMID: 35397319 DOI: 10.1016/j.healthplace.2022.102761] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/29/2022]
Abstract
Research into geographical inequalities in health has focused almost exclusively on examining the effects of area-level deprivation and has been largely framed through a compositional-contextual lens, their inter-relationship and the influence of vertical macro-economic and political/policy drivers. However, in the broader health inequalities field, intersectionality has recently emerged as a critical theoretical and methodical approach which examines the concurrent and interacting influences on health of multiple axes of inequality (such as socio-economic status, gender, race/ethnicity and sexuality or gender-identity). Simultaneously, social geography has been explicitly using intersectionality to analyse how mutually constitutive forms of social oppression interact and interrelate with place. This paper exploits the analytical space opened up by this 'intersectional turn' by outlining the benefits for research into geographical inequalities in health that can be achieved by taking a more explicit approach to intersectional inequalities. It argues that: (1) geographical research into health inequalities should more explicitly and widely apply an intersectional lens; and relatedly that, in turn, (2) place needs to be considered as an aspect of intersectionality and integrated into the wider intersectional inequalities in health literature. The paper summarises the evolution of theories of place and health inequalities and outlines intersectional theory and the work to date that has been undertaken to integrate this perspective into our understanding of health inequalities. Drawing on the social geography literature into place and intersectionality, the paper explores how this perspective is being used to enhance our understanding of place effects more generally - and how place itself can be considered as an element of intersectional inequalities. Drawing these different bodies of work together, the paper concludes by considering the implications for theories of geographical inequalities in health.
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Affiliation(s)
- Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK.
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Philibert L, Simon DJ, Lapierre J. [Intersectionality to better understand women's health issues]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2022; 67:18-21. [PMID: 35995494 DOI: 10.1016/j.soin.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Intersectionality, a theory for understanding women's health issue. Intersectionality offers the possibility of holistic analyzes to understand and act on women's health issue. It facilitates the exploration of the different dimensions of social inequalities in health, which are both at the level of institutions and of the individual experiences of people who live at the intersection of multiple dimensions of domination and power.
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Affiliation(s)
- Léonel Philibert
- Centre de recherche sur les innovations sociales du Québec, Faculté des sciences infirmières, Université Laval, 2325 rue de l'Université, Québec G1V 0A6, Canada
| | - David Jean Simon
- Centre de recherche de l'Institut de démographie de l'université de Paris, Université Paris 1 Panthéon Sorbonne, 90 rue de Tolbiac, 75013 Paris, France.
| | - Judith Lapierre
- Centre de recherche sur les innovations sociales du Québec, Faculté des sciences infirmières, Université Laval, 2325 rue de l'Université, Québec G1V 0A6, Canada
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Farooqi AS, Jiang S, Borja AJ, Detchou DKED, Dimentberg R, Shultz K, McClintock SD, Malhotra NR. Assessment of Gender Disparities in Short-Term and Long-Term Outcomes Following Posterior Fossa Tumor Resection. Cureus 2021; 13:e20000. [PMID: 34987893 PMCID: PMC8716122 DOI: 10.7759/cureus.20000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction The analysis of social determinants of health (SDOH) across different surgical populations is critical for the identification of health disparities and the development risk mitigation strategies among vulnerable patients. Research into the impact of gender on neurosurgical outcomes remains limited. The aim of the present study was to assess the effect of gender on outcomes, in a matched sample, following posterior fossa tumor resection, a high-risk neurosurgical procedure. Methods Two hundred seventy-eight consecutive patients undergoing posterior fossa tumor resection over a six-year period (June 07, 2013, to April 29, 2019) at a single academic medical system were retrospectively evaluated. Short-term outcomes included 30- and 90-day rates of emergency department (ED) visit, readmission, reoperation, and mortality. Long-term outcomes included mortality and reoperation for the duration of follow-up. Firstly, male and female patients in the entire pre-match sample were compared. Thereafter, coarsened exact matching was employed to control for confounding variables, matching male and female patients on key demographic factors - including history of prior surgery, median household income, and race, amongst others - and outcome comparison was repeated. Results In both the entire pre-match sample and matched cohort analyses, no significant differences in adverse postsurgical events were discerned between the female and male patients when evaluating 30-day or 90-day rates of ED visit, readmission, reoperation, and mortality. There were also no differences in reoperation or mortality for the duration of follow-up. Conclusion Gender does not appear to impact short- or long-term outcomes following posterior fossa tumor resection. As such, risk assessment and mitigation strategies in this population should focus on other SDOH. Further studies should assess the role of other SDOH within this population.
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Negi J, Nambiar D. Intersectional social-economic inequalities in breast cancer screening in India: analysis of the National Family Health Survey. BMC WOMENS HEALTH 2021; 21:324. [PMID: 34493267 PMCID: PMC8424809 DOI: 10.1186/s12905-021-01464-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/14/2021] [Indexed: 11/23/2022]
Abstract
Background Breast cancer incidence rates are increasing in developing countries including India. With 1.3 million new cases of cancer been diagnosed annually, breast cancer is the most common women’s cancer in India. India’s National Family Health Survey (NFHS-4) data 2015–2016 shows that only 9.8% of women between the ages of 15 and 49 had ever undergone breast examination (BE). Further, access to screening and treatment is unequally distributed, with inequalities by socio-economic status. It is unclear, however, if socio-economic inequalities in breast examination are similar across population subgroups. Methods We compared BE coverage in population sub-groups categorised by place of residence, religion, caste/tribal groups, education levels, age, marital status, and employment status in their intersection with economic status in India. We analysed data for 699,686 women aged 15–49 using the NFHS-4 data set conducted during 2015–2016. Descriptive (mean, standard errors, and confidence intervals) of women undergoing BE disaggregated by dimensions of inequality (education, caste/tribal groups, religion, place of residence) and their intersections with wealth were computed with national weights using STATA 12. Chi-square tests were performed to assess the association between socio-demographic factors and breast screening. Additionally, the World Health Organisation’s Health Equity Assessment Toolkit Plus was used to compute summary measures of inequality: Slope index for inequality (SII) and Relative Concentration Indices (RCI) for each intersecting dimension. Results BE coverage was concentrated among wealthier groups regardless of other intersecting population subgroups. Wealth-related inequalities in BE coverage were most pronounced among Christians (SII; 20.6, 95% CI: 18.5–22.7), married (SII; 14.1, 95% CI: 13.8–14.4), employed (SII: 14.6, 95%CI: 13.9, 15.3), and rural women (SII; 10.8, 95% CI: 10.5–11.1). Overall, relative summary measures (RCI) were consistent with our absolute summary measures (SII). Conclusions Breast examination coverage in India is concentrated among wealthier populations across population groups defined by place of residence, religion, age, employment, and marital status. Apart from this national analysis, subnational analyses may also help identify strategies for programme rollout and ensure equity in women’s cancer screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01464-5.
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Affiliation(s)
- Jyotsna Negi
- Independent Consultant, 62 Stratford Rd, Kensington, California, 94707, USA.
| | - Devaki Nambiar
- The George Institute for Global Health, New Delhi, India.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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13
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Carrilero N, Dalmau-Bueno A, García-Altés A. Socioeconomic inequalities in 29 childhood diseases: evidence from a 1,500,000 children population retrospective study. BMC Public Health 2021; 21:1150. [PMID: 34130683 PMCID: PMC8205646 DOI: 10.1186/s12889-021-11230-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Socioeconomic position (SEP) powerfully affects health status in the childhood population. However, the knowledge of which diseases are more affected by SEP and whose outcomes could be improved by having a more equitable society remains uncertain on a population basis. METHODS We measured socioeconomic and gender inequalities in the pre-COVID-19 era for 29 diseases in the entire childhood population in Catalonia to identify which diseases are most impacted by inequalities. This population-based study included 1,449,816 children under 15 years old from 2014 to 2017 (48.52% girls) and each of their registered diagnoses within the Catalonia National Health System. We calculated frequency measures by SEP and their sex ratios for each disease. We estimated four regression-based inequality measures: slope index of inequality, relative index of inequality (RII), absolute population-attributable fraction, and population-attributable fraction. RESULTS Twenty-five of the 29 diseases examined showed SEP inequalities. The diseases with the greatest inequalities in both sexes were tuberculosis, obesity, adjustment and anxiety disorders, essential hypertension, poisoning, short gestation, low birth weight, foetal growth retardation and intrauterine hypoxia and birth asphyxia and trauma (RII ≥ 2.0); only food allergy showed the opposite pattern (RII < 1.0). Overall, 80,188 (7.80%) of the disease events in boys and 74,921 (8.88%) in girls would be avoided if all children had the same disease rate as those in the medium-high SEP group, with tuberculosis, intrauterine hypoxia and birth asphyxia and trauma, obesity, and short gestation, low birth weight, foetal growth retardation being those that could be reduced the most in relative terms, and dermatitis, injuries, acute bronquitis, and being overweight those that could be reduced the most in absolute terms. Girls present higher RII than boys for respiratory allergy, asthma, dermatitis, being overweight, and obesity (p < 0.05). In contrast, boys showed higher RII compared to girls only in congenital anomalies (p < 0.05). CONCLUSIONS Socioeconomic and gender inequalities are widely present in childhood health. This indicates that SEP plays a common role in their development although it varies in magnitude according to each disease. It is also a phenomenon that comprises all SEP groups in society. Action needs to be taken to ensure a fairer start in life in terms of health.
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Affiliation(s)
- Neus Carrilero
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Carrer de Roc Boronat, 81-95, 08005 Barcelona, Spain
- Universitat Pompeu Fabra. Department of Experimental and Health Sciences (DCEXS), Barcelona, Spain
- Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Albert Dalmau-Bueno
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Carrer de Roc Boronat, 81-95, 08005 Barcelona, Spain
| | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Carrer de Roc Boronat, 81-95, 08005 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
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Ewerling F, Wehrmeister FC, Victora CG, Raj A, McDougal L, Barros AJD. Is women's empowerment associated with coverage of RMNCH interventions in low- and middle-income countries? An analysis using a survey-based empowerment indicator, the SWPER. J Glob Health 2021; 11:04015. [PMID: 33791094 PMCID: PMC7979155 DOI: 10.7189/jogh.11.04015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Women's empowerment has a strong potential to promote sustainable development. We evaluate the association between women's empowerment and the Composite Coverage Index (CCI), a weighted average of coverage of eight interventions in reproductive, maternal, newborn and child health (RMNCH). We also assess whether these effects are modified by wealth. METHODS We used Demographic and Health Survey data from 62 low- and middle-income countries. Women's empowerment was measured using the three domains (attitude to violence, social independence and decision making) of the survey-based indicator of women's empowerment (SWPER). Analyses followed an ecological design. Meta-regression models were used to account for within-country uncertainty in the CCI. We also carried out meta-regression with wealth quintiles of households as the units of analyses and tested for interaction between wealth and each empowerment domain. RESULTS We found positive associations between the three domains of SWPER and CCI at the country level. One standard deviation change in empowerment increased the CCI by 14.2 percentage points (attitude to violence), 15.3 percentage points (decision-making), and 16.3 percentage points (social independence). The association between social independence and CCI was modified by wealth: each additional standard deviation was associated with 21.8 (95% confidence interval (CI) = 14.0-29.6) and 8.7 (95% CI = 5.4-12.0) percentage points increase in the CCI among the poorest and the richest quintiles, respectively. CONCLUSIONS Our findings suggest that efforts toward the achievement of SDG5 (Achieve gender equality and empower all women and girls) may support improvements in RMNCH in low- and middle-income countries, especially among the poorest women and children.
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Affiliation(s)
- Fernanda Ewerling
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Wehrmeister
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego, San Diego, California, USA
| | - Lotus McDougal
- Center on Gender Equity and Health, University of California San Diego, San Diego, California, USA
| | - Aluisio JD Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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15
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Burger AE, Reither EN, Mamelund SE, Lim S. Black-white disparities in 2009 H1N1 vaccination among adults in the United States: A cautionary tale for the COVID-19 pandemic. Vaccine 2021; 39:943-951. [PMID: 33454136 PMCID: PMC7800135 DOI: 10.1016/j.vaccine.2020.12.069] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Prior research has highlighted racial and ethnic disparities in H1N1 vaccination in the United States. Our study adds to this literature by utilizing an intersectionality framework to examine the joint influence of race and sex on H1N1 vaccination beliefs and behaviors among non-Hispanic blacks and non-Hispanic whites (hereafter blacks and whites). METHODS Using data from the National H1N1 Flu Survey of U.S. adults, we measured differences in beliefs about the safety and efficacy of the H1N1 vaccine among black women, black men, white women, and white men. We then estimated a series of nested logistic regression models to examine how race/sex vaccination disparities were influenced by health beliefs, socioeconomic status (SES), pre-existing conditions, and healthcare. RESULTS Black respondents were more likely than white respondents to express reservations about the safety and efficacy of the H1N1 vaccine. Consistent with those beliefs, white females reported the highest rate of H1N1 vaccination (28.4%), followed by white males (26.3%), black males (21.6%), and black females (17.5%). Differences in health beliefs, SES, pre-existing conditions, and healthcare explained lower odds of H1N1 vaccination among white men and black men, relative to white women. However, black women experienced 35-45% lower odds of vaccination than white women across all models, highlighting the intersectional nature of these associations. DISCUSSION The 2009 H1N1 influenza pandemic provides a cautionary tale about the distribution of new vaccines across large populations with diverse racial, sex, and socioeconomic characteristics. Despite differences between the H1N1 and COVID-19 pandemics, our study warns that many black Americans will forego COVID-19 vaccines unless swift action is taken to address black-white disparities in access to vital resources. Public health stakeholders can also encourage widespread adoption of COVID-19 vaccines by tailoring health promotion messages for different groups of racial minorities, especially groups like black women who face intersecting disadvantages.
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Affiliation(s)
- Andrew E Burger
- Brigham Young University-Idaho, 525 S 2nd E, Rexburg, ID 83420, United States.
| | - Eric N Reither
- Utah State University, 0730 Old Main Hill, Logan, UT 84322, United States
| | - Svenn-Erik Mamelund
- OsloMet, Centre for Welfare and Labor Research, Stensberggata 26, 0170 Oslo, Norway
| | - Sojung Lim
- Utah State University, 0730 Old Main Hill, Logan, UT 84322, United States
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16
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Borras AM. Toward an Intersectional Approach to Health Justice. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:206-225. [PMID: 33356774 DOI: 10.1177/0020731420981857] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite unprecedented global wealth creation, health inequity-the unjust health inequality between classes and groups among and within countries-persists, reviving the relevance of social justice as a lens to understand and as an instrument to intervene in these issues. However, the theoretical aspects and polysemous character of social justice as applied in the field of public health are often assumed rather than explicitly explained. An intersectional justice approach to understanding health inequality, inequity, and injustice might be useful. It argues that preexisting class-, race/ethnicity-, and gender-based health injustice and the socially differentiated impacts of the COVID-19 pandemic are shaped, interconnectedly, by economic maldistribution, cultural misrecognition, and political misrepresentation. Pursuing health justice requires analyses, strategies, and interventions that integrate the economic, cultural, and political spheres of redistribution, recognition, and representation, respectively. Such an intersectional approach to health justice is even more relevant and compelling in light of the COVID-19 pandemic. This article is broadly about class, race/ethnicity, and gender political economy of public health-but with a narrower focus on maldistribution, misrecognition, and misrepresentation, shaping social and health injustices.
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Affiliation(s)
- Arnel M Borras
- School of Health Policy and Management, 56014York University, Toronto, Ontario, Canada
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17
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Ward VC, Weng Y, Bentley J, Carmichael SL, Mehta KM, Mahmood W, Pepper KT, Abdalla S, Atmavilas Y, Mahapatra T, Srikantiah S, Borkum E, Rangarajan A, Sridharan S, Rotz D, Bhattacharya D, Nanda P, Tarigopula UK, Shah H, Darmstadt GL. Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens. J Glob Health 2020. [DOI: 10.7189/jogh.10.0201011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Farooqi A, Dimentberg R, Shultz K, McClintock SD, Malhotra NR. Absence of Gender Disparity in Thirty-Day Morbidity and Mortality After Supratentorial Brain Tumor Resection. World Neurosurg 2020; 144:e361-e367. [DOI: 10.1016/j.wneu.2020.08.146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022]
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19
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Ward VC, Weng Y, Bentley J, Carmichael SL, Mehta KM, Mahmood W, Pepper KT, Abdalla S, Atmavilas Y, Mahapatra T, Srikantiah S, Borkum E, Rangarajan A, Sridharan S, Rotz D, Bhattacharya D, Nanda P, Tarigopula UK, Shah H, Darmstadt GL. Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens. J Glob Health 2020; 10:021011. [PMID: 33425335 PMCID: PMC7759017 DOI: 10.7189/jogh.10.021011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite increasing focus on health inequities in low- and middle income countries, significant disparities persist. We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India. METHODS Utilising survey-weighted logistic regression, we estimated programmatic impact using difference-in-difference estimators from Mathematica data collected at the beginning (2012, n = 10 174) and after two years of program implementation (2014, n = 9611). We also examined changes in disparities over time using eight rounds of Community-based Household Surveys (CHS) (2012-2017, n = 48 349) collected by CARE India. RESULTS At baseline for the Mathematica data, least marginalised women generally performed desired health-related behaviours more frequently than the most marginalised. After two years, most disparities persisted. Disparities increased for skilled birth attendant identification [+16.2% (most marginalised) vs +32.6% (least marginalized), P < 0.01) and skin-to-skin care (+14.8% vs +20.4%, P < 0.05), and decreased for immediate breastfeeding (+10.4 vs -4.9, P < 0.01). For the CHS data, odds ratios compared the most to the least marginalised women as referent. Results demonstrated that disparities were most significant for indicators reliant on access to care such as delivery in a facility (OR range: 0.15 to 0.48) or by a qualified doctor (OR range: 0.08 to 0.25), and seeking care for complications (OR range: 0.26 to 0.64). CONCLUSIONS Disparities observed at baseline generally persisted throughout program implementation. The most significant disparities were observed amongst behaviours dependent upon access to care. Changes in disparities largely were due to improvements for the least marginalised women without improvements for the most marginalised. Equity-based assessments of programmatic impacts, including those of universal health approaches, must be undertaken to monitor disparities and to ensure equitable and sustainable benefits for all. STUDY REGISTRATION ClinicalTrials.gov number NCT02726230.
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Affiliation(s)
- Victoria C Ward
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jason Bentley
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kala M Mehta
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Wajeeha Mahmood
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Kevin T Pepper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Safa Abdalla
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | | | | | | | | | | | - Dana Rotz
- Mathematica, Princeton, New Jersey, USA
| | | | - Priya Nanda
- Bill and Melinda Gates Foundation, Delhi, India
| | | | - Hemant Shah
- Bill and Melinda Gates Foundation, Delhi, India
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, California, USA
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20
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Azad AD, Charles AG, Ding Q, Trickey AW, Wren SM. The gender gap and healthcare: associations between gender roles and factors affecting healthcare access in Central Malawi, June-August 2017. ACTA ACUST UNITED AC 2020; 78:119. [PMID: 33292511 PMCID: PMC7672876 DOI: 10.1186/s13690-020-00497-w] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/30/2020] [Indexed: 11/21/2022]
Abstract
Background Women in low and middle-income countries (LMICs) do not have equal access to resources, such as education, employment, or healthcare compared to men. We sought to explore health disparities and associations between gender prioritization, sociocultural factors, and household decision-making in Central Malawi. Methods From June–August 2017, a cross-sectional study with 200 participants was conducted in Central Malawi. We evaluated respondents’ access to care, prioritization within households, decision-making power, and gender equity which was measured using the Gender-Equitable Men (GEM) scale. Relationships between these outcomes and sociodemographic factors were analyzed using multivariable mixed-effect logistic regression. Results We found that women were less likely than men to secure community-sourced healthcare financial aid (68.6% vs. 88.8%, p < 0.001) and more likely to underutilize necessary healthcare (37.2% vs. 22.4%, p = 0.02). Both men and women revealed low GEM scores, indicating adherence to traditional gender norms, though women were significantly less equitable (W:16.77 vs. M:17.65, p = 0.03). Being a woman (Odds Ratio (OR) 0.41, 95% confidence interval (CI) 0.21–0.78) and prioritizing a woman as a decision-maker for large purchases (OR 0.38, CI 0.15–0.93) were independently associated with a lower likelihood of prioritizing women for medical treatment and being a member of the Chewa tribal group (OR 3.87, CI 1.83–8.18) and prioritizing women for education (OR 4.13, CI 2.13–8.01) was associated with a higher odds. Conclusion Women report greater barriers to healthcare and adhere to more traditional gender roles than men in this Central Malawian population. Women contribute to their own gender’s barriers to care and economic empowerment alone is not enough to correct for these socially constructed roles. We found that education and matriarchal societies may protect against gender disparities. Overall, internal and external gender discrimination contribute to a woman’s disproportionate lack of access to care. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-020-00497-w.
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Affiliation(s)
- Amee D Azad
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
| | - Anthony G Charles
- University of North Carolina Department of Surgery, Chapel Hill, NC, USA
| | - Qian Ding
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford, CA, USA
| | - Amber W Trickey
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford, CA, USA
| | - Sherry M Wren
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.,Palo Alto Veterans Healthcare System, Palo Alto, CA, USA
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21
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Shell-Duncan B, Moreau A, Smith S, Shakya H. Women's business? A social network study of the influence of men on decision-making regarding female genital mutilation/cutting in Senegal. Glob Public Health 2020; 16:856-869. [PMID: 33105089 DOI: 10.1080/17441692.2020.1826996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There exist two dominant but conflicting views on the role of men in the perpetuation female genital mutilation/cutting (FGM/C). One paints men as culprits, with FGM/C viewed as a manifestation of patriarchal oppression of women. An alternative portrays men as relatively uninvolved in a practice described as 'women's business'. These two perspectives lead to divergent predictions: if FGM/C underpins patriarchal structures, men should be expected to be ardent supporters of FGM/C as it bolsters their power and status; if FGM/C is a women's affair, men should have little involvement. We test these predictions using data from a mixed-method study of norms and social networks in two regions of Senegal. Data show that men comprise 50% of core network members, although they exert influence in different ways in each study site. In South Senegal excision is upheld by men, as well as older women, through a constellation of norms that define FGM/C as prerequisite to marriage and social inclusion. In Central Senegal these gender norms have eroded, opening possibilities for abandonment of FGM/C, and men, particularly fathers, at times successfully advocate this change. This suggests that men can play an important role in ending FGM/C, and should be involved in intervention efforts.
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Affiliation(s)
| | | | - Sarah Smith
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Holly Shakya
- Department of Medicine, University of California, San Diego, CA, USA
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22
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Gaiha SM, Gillander Gådin K. 'No time for health:' exploring couples' health promotion in Indian slums. Health Promot Int 2020; 35:70-81. [PMID: 30590523 DOI: 10.1093/heapro/day101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Joint involvement of couples is an effective strategy to increase contraceptive use and improve reproductive health of women. However, engaging couples to understand how their gender attitudes affect their personal and family health is an idea in search of practice. This mixed-methods study explores opportunities and barriers to couples' participation in health promotion in three slums of Delhi. For each couple, surveys and semi-structured interviews were conducted with husbands and wives individually to contrast self and spousal work, time, interest in health, sources of information related to health and depth of knowledge (n = 62). Urban poverty forces men to work long hours and women to enter part-time work in the informal sector. Paid work induces lack of availability at home, lack of interest in health information and in performing household chores and a self-perception of being healthy among men. These factors inhibit men's' participation in community-based health promotion activities. Women's unpaid work in the household remains unnoticed. Women were expected to be interested in and to make time to attend community-based health-related activities. Men recalled significantly less sources of health information than their spouse. Men and their wives showed similar depth of health-related knowledge, likely due to their spousal communication, with women acting as gatekeepers. Health promotion planners must recognize time constraints, reliance on informal interpersonal communication as a source of health information and the need to portray positive masculinities that address asymmetric gender relations. Innovative, continuous and collaborative approaches may support couples to proactively care about health in low-resource settings.
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Affiliation(s)
- Shivani Mathur Gaiha
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Health Communication, Public Health Foundation of India, New Delhi, India
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23
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Judd JA, Griffiths K, Bainbridge R, Ireland S, Fredericks B. Equity, gender and health: A cross road for health promotion. Health Promot J Austr 2020; 31:336-339. [PMID: 32996234 DOI: 10.1002/hpja.422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jenni A Judd
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia
| | - Kalinda Griffiths
- Faculty of Medicine, University of NSW, Menzies School of Health Research, Kensington, NSW, Australia
| | - Roxanne Bainbridge
- Research Division, Central Queensland University, Cairns, QLD, Australia
| | - Sarah Ireland
- College of Nursing and Midwifery, Charles Darwin University, Casuarina, NT, Australia
| | - Bronwyn Fredericks
- Indigenous Engagement, University of Queensland, Brisbane, QLD, Australia
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24
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Nyamande FN, Mosquera PA, San Sebastián M, Gustafsson PE. Intersectional equity in health care: assessing complex inequities in primary and secondary care utilization by gender and education in northern Sweden. Int J Equity Health 2020; 19:159. [PMID: 32917207 PMCID: PMC7488463 DOI: 10.1186/s12939-020-01272-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/01/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Knowledge remains scarce about inequities in health care utilization between groups defined, not only by single, but by multiple and intersecting social categories. This study aims to estimate intersectional horizontal inequities in health care utilization by gender and educational level in Northern Sweden, applying a novel methodological approach. METHODS Data on participants (N = 22,997) aged 16-84 years from Northern Sweden came from the 2014 Health on Equal Terms cross sectional survey. Primary (general practitioner) and secondary (specialist doctor) health care utilization and health care needs indicators were self-reported, and sociodemographic information came from registers. Four intersectional categories representing high and low educated men, and high and low educated women, were created, to estimate intersectional (joint, referent, and excess) inequalities, and needs-adjusted horizontal inequities in utilization. RESULTS Joint inequalities in primary care were large; 8.20 percentage points difference (95%CI: 6.40-9.99) higher utilization among low-educated women than high-educated men. Only the gender referent inequity remained after needs adjustment, with high- (but not low-) educated women utilizing care more frequently than high-educated men (3.66 percentage points difference (95%CI: 2.67-5.25)). In contrast, inequalities in specialist visits were dominated by referent educational inequalities, (5.69 percentage points difference (95%CI: 2.56-6.19), but with no significant horizontal inequity - by gender, education, or their combination - remaining after needs adjustment. CONCLUSION This study suggests a complex interaction of gender and educational inequities in access to care in Northern Sweden, with horizontal equity observable for secondary but not primary care. The study thereby illustrates the unique knowledge gained from an intersectional perspective to equity in health care.
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Affiliation(s)
- Fortune N Nyamande
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | - Paola A Mosquera
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | - Miguel San Sebastián
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden
| | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
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Willems B, Cullati S, Prez VD, Jolidon V, Burton-Jeangros C, Bracke P. Cancer Screening Participation and Gender Stratification in Europe. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2020; 61:377-395. [PMID: 32686508 DOI: 10.1177/0022146520938708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The current study examines whether the extent of macrolevel gender inequality affects the association between women's educational attainment and their participation in cervical and breast cancer screening and how this relationship is moderated by a country's cancer screening strategy (organized vs. opportunistic). A multilevel design with women (Ncervical = 99,794; Nbreast = 55,021) nested in 30 European countries was used to analyze data from the European Health Interview Survey (2013-2015). Results of multilevel logistic regression models demonstrate that higher macrolevel gender inequality is associated with (a) a lower overall likelihood that women have had a mammography and Pap smear and (b) a larger gap in participation between women with low and high levels of education, regardless of a country's screening strategy (i.e., no moderation by a country's screening strategy was found). We conclude that macrolevel gender stratification should not be neglected when designing cancer screening policy.
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Affiliation(s)
| | - Stéphane Cullati
- University of Geneva, Geneva, GE, Switzerland
- University of Fribourg, Switzerland
| | | | | | | | - Piet Bracke
- Ghent University, Gent, Oost-Vlaanderen, Belgium
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Gkiouleka A, Huijts T. Intersectional migration-related health inequalities in Europe: Exploring the role of migrant generation, occupational status & gender. Soc Sci Med 2020; 267:113218. [PMID: 32732096 DOI: 10.1016/j.socscimed.2020.113218] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/13/2019] [Accepted: 07/12/2020] [Indexed: 11/18/2022]
Abstract
Integrating intersectionality theory and employing a quantitative design, the current study explores how migration-related health inequalities in Europe interact with migrant generation, occupational status and gender. Multilevel logistic regression analyses are conducted using pooled data from six waves of the European Social Survey (2004-2014), from 27 countries for two subjective health measures (general self-reported health and hampering conditions). The results reveal multiple relationships of health inequality that operate simultaneously and the complexity through which the combination of social privilege and disadvantage can have a particularly negative impact on individual health. The 'healthy migrant effect' seems to apply particularly for first-generation immigrants working as manual employees, and within occupational categories, in certain cases non-migrant women are more susceptible to poor health than migrant men. This evidence highlights how the health impact of migration is subject to additional dimensions of social positioning as well as the importance of an intersectional perspective for the monitoring of health inequalities in Europe.
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Affiliation(s)
- Anna Gkiouleka
- Department of Sociology, University of York, Wentworth College, Heslington, YO10 5DD, York, UK.
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Ryan NE, El Ayadi AM. A call for a gender-responsive, intersectional approach to address COVID-19. Glob Public Health 2020; 15:1404-1412. [DOI: 10.1080/17441692.2020.1791214] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nessa E. Ryan
- Program in Public Health, University of California, Irvine, CA, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - Alison M. El Ayadi
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
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Otieno PO, Wambiya EOA, Mohamed SM, Mutua MK, Kibe PM, Mwangi B, Donfouet HPP. Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. BMC Public Health 2020; 20:981. [PMID: 32571277 PMCID: PMC7310125 DOI: 10.1186/s12889-020-09106-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. Methods The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recorded into tertiles with categories labeled as poor, moderate, and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios (AOR) and 95% confidence intervals were used to interpret the strength of associations. Results The odds of being in the highest access tertile versus the combined categories of lowest and moderate access tertile were three times higher for males than female-headed households (AOR 3.05 [95% CI 1.47–6.37]; p < .05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥USD 30 had significantly lower odds of being in the highest versus combined categories of lowest and moderate access tertile compared to those spending ≤ USD 5 (AOR 0.36 [95% CI 0.18–0.74]; p < .05). Households that sought primary care from private facilities had significantly higher odds of being in the highest versus combined categories of lowest and moderate access tertiles compared to those who sought care from public facilities (AOR 6.64 [95% CI 3.67–12.01]; p < .001). Conclusion In Nairobi slums in Kenya, living in a female-headed household, seeking care from a public facility, and paying out-of-pocket for healthcare are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize quality improvement in public health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare.
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Affiliation(s)
- Peter O Otieno
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya.
| | - Elvis O A Wambiya
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Shukri M Mohamed
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Martin Kavao Mutua
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Peter M Kibe
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Bonventure Mwangi
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Hermann Pythagore Pierre Donfouet
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
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Pedrós Barnils N, Eurenius E, Gustafsson PE. Self-rated health inequalities in the intersection of gender, social class and regional development in Spain: exploring contributions of material and psychosocial factors. Int J Equity Health 2020; 19:85. [PMID: 32503650 PMCID: PMC7275574 DOI: 10.1186/s12939-020-01202-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Inequalities in health across social class, gender and regional context in Spain are well-known; however, there is a lack of research examining how these dimensions of inequality interact. This study explores self-rated health (SRH) inequalities across intersectional positions of gender, social class and region, and the contribution of material and psychosocial factors to these inequalities. METHODS Participants were drawn from the cross-sectional 2015 National Living Conditions Survey of Spanish residents aged 19-88 years (N = 27,215; 77% response rate). Eight intersectional positions were formed by combining dichotomous variables of gender, social class and regional development. Poisson regression was used to estimate intersectional inequalities in SRH as prevalence ratios, and the contributions of material and psychosocial factors. RESULTS Results showed both cumulative and heterogeneous inequalities within and across intersectional positions. Inequalities in the intersection of social class and regional development were best explained by the joint contributions of material and psychosocial factors, while gender inequalities within non-manual social class were better explained by material factors alone. CONCLUSIONS The results illustrate the complexity of interacting inequalities in health and their underpinnings in Spain. Local and national policies taking this complexity into account are needed to broadly improve equity in health in Spain.
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Affiliation(s)
| | - Eva Eurenius
- Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden
| | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
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Choudhary S, Gupta R. Culture and Borderline Personality Disorder in India. Front Psychol 2020; 11:714. [PMID: 32373034 PMCID: PMC7186391 DOI: 10.3389/fpsyg.2020.00714] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/24/2020] [Indexed: 12/15/2022] Open
Abstract
The present paper discusses how cultural context can be used as an essential tool in the diagnosis of mental disorders as well as in segregating individuals with normal or abnormal personality functioning. Further, such information about the culture can be used to diagnose individuals specifically with borderline personality disorder (BPD). BPD is a mental illness marked by impulsivity and instability in interpersonal relationships, moods, and self-image. We discuss how culture shapes patterns of behavior in the individual with BPD. An extensive review of manifestation of BPD in eastern countries suggests that culture and social norms are the two crucial factors, which can differentiate normal and abnormal behavioral patterns in BPD. For example, the social norms shape and give directions to our interpersonal functioning, emotions are experienced within the cultural context and expressed accordingly, and self is a reflection and representation of one’s culture. Hence, these constructs of BPD (such as interpersonal functioning, emotions, and self) indicate that they are experienced differently in different cultures and vary on the continuum of normal to abnormal personality functioning. The cultural manifestation of BPD helps to understand the specific profile of the three constructs of BPD in an eastern culture like India. A synthesis of studies on prevalence, development, and symptom presentation of BPD in the Indian context is emphasized to support the personality functioning within the constructs of BPD. The literature review indicates that BPD research in India is based only on a few cases and a tiny sample of such patients. However, studies on BPD in the cultural context are minimal and incomprehensive. Hence, it suggests the importance of more empirical studies concerning the appropriate diagnosis of BPD within the cultural context of India.
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Affiliation(s)
- Shalini Choudhary
- Shaheed Rajguru College of Applied Sciences for Women, University of Delhi, New Delhi, India
| | - Rashmi Gupta
- Cognitive and Behavioral Neuroscience Laboratory, Department of Humanities and Social Sciences, Indian Institute of Technology, Mumbai, India
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Fehrenbacher AE, Patel D. Translating the theory of intersectionality into quantitative and mixed methods for empirical gender transformative research on health. CULTURE, HEALTH & SEXUALITY 2020; 22:145-160. [PMID: 31661661 PMCID: PMC7188600 DOI: 10.1080/13691058.2019.1671494] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/19/2019] [Indexed: 05/12/2023]
Abstract
Intersectionality theory has been used primarily in legal research to provide a framework for understanding the experiences of populations situated within multiple systems of oppression, particularly in relation to anti-discrimination law and gender-based violence. Gender transformative approaches to health seek to move beyond individual-level change and instead centre on restructuring the power relationships that create and maintain gender inequalities. Intersectionality theory is well-suited for the study of gender transformation on health, but there is a lack of consensus on clearly defined intersectional methodology in the field of public health, particularly for quantitative studies. Because qualitative methodologies are well-developed and employed with regularity for intersectional health research, the objective of this paper is to describe innovative quantitative and mixed methods approaches underutilised in public health and provide researchers examples of how to design a study's methodology to adequately address intersectional research questions. The proposed methods provide a toolkit for the investigation of complex interactions across multiple levels, which may offer insight into effective points of intervention to reduce disparities, strengthen larger social movements, and ultimately alter structural and policy contexts. Despite challenges posed by the theory, intersectional approaches may be the key to addressing persistent inequalities that limit gender transformation.
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Affiliation(s)
- Anne E. Fehrenbacher
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Dhara Patel
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Cohen SA, Sabik NJ, Cook SK, Azzoli AB, Mendez-Luck CA. Differences within Differences: Gender Inequalities in Caregiving Intensity Vary by Race and Ethnicity in Informal Caregivers. J Cross Cult Gerontol 2020; 34:245-263. [PMID: 31407137 DOI: 10.1007/s10823-019-09381-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Among the 50+ million informal caregivers in the US, substantial gender, racial/ethnic, and socioeconomic disparities in caregiving intensity are well-documented. However, those disparities may be more nuanced: gender disparities in caregiving intensity may vary by race/ethnicity (White, Black, and Hispanic) and socioeconomic status (SES). We used data from the 2011 National Study of Caregiving and applied generalized linear models to estimate associations between three measures of caregiver intensity (ADLs, IADLs, and hours caregiving/month) and the three sociodemographic factors with their interaction terms. Black female caregivers provided significantly higher levels of care than White females and males for both IADL caregiving and hours/month spent caregiving. Black caregivers spent an average of 28.5 more hours/month (95%CI 1.7-45.2) caregiving than White caregivers. These findings highlight the need to understand the complex disparities within population subgroups and how intersections between gender, race/ethnicity, and SES can be used to develop effective policies to reduce disparities and improve caregiver quality-of-life.
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Affiliation(s)
- Steven A Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI, USA.
| | - Natalie J Sabik
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Sarah K Cook
- Vanderbilt Institute for Clinical and Translational Research, Nashville, TN, USA
| | | | - Carolyn A Mendez-Luck
- College of Public Health and Human Sciences, Oregon State University, 401 Waldo Hall, Corvallis, OR, USA
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Feletto M, Sharkey A. The influence of gender on immunisation: using an ecological framework to examine intersecting inequities and pathways to change. BMJ Glob Health 2019; 4:e001711. [PMID: 31565415 PMCID: PMC6747884 DOI: 10.1136/bmjgh-2019-001711] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 11/11/2022] Open
Abstract
There is still a substantial knowledge gap on how gender mediates child health in general, and child immunisation outcomes in particular. Similarly, implementation of interventions to mitigate gender inequities that hinder children from being vaccinated requires additional perspectives and research. We adopt an intersectional approach to gender and delve into the social ecology of implementation, to show how gender inequities and their connection with immunisation are grounded in the interplay between individual, household, community and system factors. We show how an ecological model can be used as an overarching framework to support more precise identification of the mechanisms causing gender inequity and their structural complexity, to identify suitable change agents and interventions that target the underlying causes of marginalisation, and to ensure outcomes are relevant within specific population groups.
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Fraser S, Beeman I, Southall K, Wittich W. Stereotyping as a barrier to the social participation of older adults with low vision: a qualitative focus group study. BMJ Open 2019; 9:e029940. [PMID: 31481561 PMCID: PMC6731881 DOI: 10.1136/bmjopen-2019-029940] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE In order to better understand the barriers that limit the social participation of older people with low vision, the aim of this study was to describe and clarify the factors that shape the social participation of older adults with vision loss. METHODS As part of a study on rehabilitation access barriers, six qualitative focus groups were conducted in a private room in a hospital, with 21 individuals with low vision (aged 38-92 years) who had or had not accessed low vision services. During the focus groups, participants often spoke of the challenges they faced when interacting with people with 'normal' vision; this discussion led to a modification of the interview guide in order to capture barriers to social participation. Focus group discussions were audiotaped and transcribed, and content analysis was conducted. RESULTS Content analysis revealed that personal as well as environmental factors influenced the social participation of older adults with low vision. Four themes emerged: 1) experiencing the onset of impairment and degenerating ability, 2) the physical environment, 3) attitudes and responses from others and 4) individual internal attitude and responses during social interactions. Lived and perceived stigma from the perspective of the insider (person living with low vision) interacting with an outsider (person with 'normal' vision) and difficult environmental contexts were described as barriers to social participation and optimal functioning. CONCLUSION At a personal level, transitioning from an outsider to an insider influenced self-identity and social participation. Further, insiders experiencing stereotypes associated with older adults who are blind had a negative impact on their social participation. Findings highlight the importance of stigma and stereotyping in the lived experience of older adults with low vision. Stigma is persistent, but strategies to reduce stigma will ultimately facilitate the social participation of older adults with low vision.
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Affiliation(s)
- Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Irene Beeman
- The School of Social Work, Faculty of Arts, McGill University, Montreal, Quebec, Canada
| | - Kenneth Southall
- The School of Social Work, Faculty of Arts, McGill University, Montreal, Quebec, Canada
| | - Walter Wittich
- School of Optometry, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montreal, Quebec, Canada
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Ingleby D. Moving upstream: Changing policy scripts on migrant and ethnic minority health. Health Policy 2019; 123:809-817. [PMID: 31409514 DOI: 10.1016/j.healthpol.2019.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
This article uses the concept of 'policy scripts' to explore the aims and assumptions underlying policies on migrant and ethnic minority health. Firstly, it analyses the shift in health policies from 'downstream' approaches (emphasising health care for the sick and injured) to 'upstream' ones (emphasising health protection for the whole population). The field of migrant health has been relatively slow to move upstream. Two factors appear to have impeded this shift: (a) the reluctance of the 'social determinants of health' movement to regard migrant status and ethnicity as important causes of health inequities; and (b) the one-sided emphasis on short-term emergency health provisions for migrants arising from the recent increase in forced migration worldwide, in particular the sudden peak in mixed migration to the EU in 2015. The article contends that (a) the usual arguments against treating migration and ethnicity as health determinants do not stand up to critical examination; and (b) the overwhelming emphasis on unauthorised entrants which characterises current discussions of migration policy, including health, is out of all proportion to their volume relative to that of other migrants. Fortunately, recent policy initiatives at UN level have the potential to restore the balance between 'upstream' and 'downstream' approaches, as well as between unauthorised entry and 'routine' migration.
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Affiliation(s)
- David Ingleby
- Centre for Social Science and Global Health, University of Amsterdam, Nieuwe Achtergracht 166, 1018WV, Amsterdam, The Netherlands.
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Nunes J. The everyday political economy of health: community health workers and the response to the 2015 Zika outbreak in Brazil. REVIEW OF INTERNATIONAL POLITICAL ECONOMY 2019; 27:146-166. [PMID: 32256198 PMCID: PMC7077346 DOI: 10.1080/09692290.2019.1625800] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
How is neoliberalism implicated in concrete health vulnerabilities? How do macro-level political economy, policy and institutions translate into everyday experiences? Drawing on Marxist, feminist and International Political Economy critiques of everyday life, the article advances an everyday political economy of health focused on four key components: power, agency, intersectionality and the mutual implication of the global and the local. These components enable a nuanced investigation of concrete experiences of health and disease, and of the local implementation of health policies in the context of neoliberalism. The framework is applied to the case of the 2015 public health response to Zika in Brazil, and specifically to the role of community health workers, close-to-community healthcare providers tasked with bridging the health system and vulnerable groups. The everyday practice of these workers, and their working conditions overwhelmingly characterized by precarity and low pay, reveal the presence of global neoliberal dynamics pertaining to the reconfiguration of the Brazilian state as healthcare provider in a context of encroaching austerity, privatization and narrowly-defined cost-efficiency. These dynamics impacted detrimentally upon the effectiveness of the Zika response.
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Affiliation(s)
- João Nunes
- Department of Politics, University of York, Heslington, York, United Kingdom of Great Britain and Northern Ireland
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Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, Zewdie D. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet 2019; 393:2440-2454. [PMID: 31155275 DOI: 10.1016/s0140-6736(19)30652-x] [Citation(s) in RCA: 463] [Impact Index Per Article: 92.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 02/07/2023]
Abstract
Gender is not accurately captured by the traditional male and female dichotomy of sex. Instead, it is a complex social system that structures the life experience of all human beings. This paper, the first in a Series of five papers, investigates the relationships between gender inequality, restrictive gender norms, and health and wellbeing. Building upon past work, we offer a consolidated conceptual framework that shows how individuals born biologically male or female develop into gendered beings, and how sexism and patriarchy intersect with other forms of discrimination, such as racism, classism, and homophobia, to structure pathways to poor health. We discuss the ample evidence showing the far-reaching consequences of these pathways, including how gender inequality and restrictive gender norms impact health through differential exposures, health-related behaviours and access to care, as well as how gender-biased health research and health-care systems reinforce and reproduce gender inequalities, with serious implications for health. The cumulative consequences of structured disadvantage, mediated through discriminatory laws, policies, and institutions, as well as diet, stress, substance use, and environmental toxins, have triggered important discussions about the role of social injustice in the creation and maintenance of health inequities, especially along racial and socioeconomic lines. This Series paper raises the parallel question of whether discrimination based on gender likewise becomes embodied, with negative consequences for health. For decades, advocates have worked to eliminate gender discrimination in global health, with only modest success. A new plan and new political commitment are needed if these global health aspirations and the wider Sustainable Development Goals of the UN are to be achieved.
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Affiliation(s)
- Lori Heise
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA.
| | | | - Neisha Opper
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Maria Stavropoulou
- Programme on Gender Equality and Social Inclusion, Overseas Development Institute, London, UK
| | - Caroline Harper
- Programme on Gender Equality and Social Inclusion, Overseas Development Institute, London, UK
| | - Marcos Nascimento
- Programa de Posgraduação em Saúde da Criança e da Mulher, Instituto Fernandes Figueira-Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Debrework Zewdie
- School of Public Health and Health Policy, City University of New York, New York, NY, USA
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Ismail SA, McCullough A, Guo S, Sharkey A, Harma S, Rutter P. Gender-related differences in care-seeking behaviour for newborns: a systematic review of the evidence in South Asia. BMJ Glob Health 2019; 4:e001309. [PMID: 31179032 PMCID: PMC6528767 DOI: 10.1136/bmjgh-2018-001309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Data indicate substantial excess mortality among female neonates in South Asia compared with males. We reviewed evidence on sex and gender differences in care-seeking behaviour for neonates as a driver for this. Methods We conducted a systematic review of literature published between January 1st, 1996 and August 31st, 2016 in Pubmed, Embase, Eldis and Imsear databases, supplemented by grey literature searches. We included observational and experimental studies, and reviews. Two research team members independently screened titles, abstracts and then full texts for inclusion, with disagreements resolved by consensus. Study quality was assessed using National Institute for Health and Care Excellence (NICE) checklists and summary judgements given using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data were extracted into Microsoft Excel. Results Of 614 studies initially identified, 17 studies were included. Low quality evidence across several South Asian countries suggests that care-seeking rates for female neonates are lower than males, especially in households with older female children. Parents are more likely to pay more, and seek care from providers perceived as higher quality, for males than females. Evidence on drivers of these care-seeking behaviours is limited. Care-seeking rates are suboptimal, ranging from 20% to 76% across male and female neonates. Conclusion Higher mortality observed among female neonates in South Asia may be partly explained by differences in care-seeking behaviour, though good quality evidence on drivers for this is lacking. Further research is needed, but policy interventions to improve awareness of causes of neonatal mortality, and work with households with predominantly female children may yield population health benefits. The social, economic and cultural norms that give greater value and preference to boys over girls must also be challenged through the creation of legislation and policy that support greater gender equality, as well as context-specific strategies in partnership with local influencers to change these practices. PROSPERO registration number CRD42016052256.
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Affiliation(s)
- Sharif A Ismail
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Amy McCullough
- Portsmouth City Council, Portsmouth, UK.,Public Health Department, Southampton City Council, Southampton, UK
| | - Sufang Guo
- UNICEF Regional Office of South Asia, Kathmandu, Nepal
| | | | - Sheeba Harma
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | - Paul Rutter
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
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Moreau C. Gender performance and adolescent health trajectories. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:512-513. [PMID: 31155321 DOI: 10.1016/s2352-4642(19)30163-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Gender, Sexual and Reproductive Health, Centre for Research in Epidemiology and Population Health, Villejuif 94805, France.
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Sinharoy SS, Fanzo J. Ethical and human rights considerations related to access to anemia diagnosis. Ann N Y Acad Sci 2019; 1450:239-248. [PMID: 31141201 DOI: 10.1111/nyas.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/22/2019] [Accepted: 05/03/2019] [Indexed: 12/01/2022]
Abstract
Important disparities exist in anemia diagnosis globally. We examine individuals' and populations' access to anemia diagnosis, the accuracy of diagnostic tests, and the interpretation of test results through the lens of key ethical considerations. These include the human right to health and the Rawlsian concept of the social contract, as well as ethical principles, such as autonomy, self-liberty, beneficence, and nonmaleficence. We discuss factors that influence individuals' and communities' access to high-quality health services, including geography, gender, age, and socioeconomic status. Geographic and other differences exist in the types of diagnostic equipment and methods used to diagnose anemia, potentially leading to differential classification of anemia across individuals and populations. A diagnosis of anemia also requires follow-up to understand etiology and appropriate treatment. However, this is not done consistently, in clinical care or in population-based surveys. To better understand the problem and track countries' progress, a need exists for disaggregated, longitudinal quantitative and qualitative data on disparities related to anemia. Moving forward, it will be important for countries to improve equitable access to high-quality health services, particularly primary health care services, and to address barriers to the ability of individuals or communities to effectively enjoy the right to health.
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Affiliation(s)
- Sheela S Sinharoy
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jessica Fanzo
- Berman Institute of Bioethics, Nitze School of Advanced International Studies and Bloomberg School of Public Health, Johns Hopkins University, Washington, DC
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Thummapol O, Barton S, Park T. Healthcare Access Experiences Among Indigenous Women in Northern Rural Thailand: A Focused Ethnographic Study. Cent Asian J Glob Health 2019; 7:328. [PMID: 30863666 PMCID: PMC6393055 DOI: 10.5195/cajgh.2018.328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Persistent inequities in health and access to healthcare services for indigenous women living in Thailand remain a significant challenge. This study provides narrative accounts of Indigenous women’s experiences accessing healthcare in northern and rural Thailand and explores the complexity of culture and its interaction with multiple intersecting influences on health behaviours. Methods A focused ethnographic study was conducted to understand and describe the culture of health behaviors and other cultural phenomena. We recruited 21 female participants aged 20–41 years between March and April of 2017. In-depth semi-structured interviews conducted in Thai were used to explore the experiences of the participants living in a northern rural village. Data analysis was informed and guided by Roper and Shapira’s framework for ethnographic analysis. Results Seven themes presented across three phases of experience (pre-access, making choices, and encountering difficulties) revealed an in-depth understanding of the Indigenous women’s lives, the broader sociocultural context in which they lived, and the challenges they faced when accessing healthcare. Analysis of data showed that the participants did not have equal access to healthcare and often disproportionately experienced discriminatory practices and negative attitudes of mainstream healthcare providers. Conclusions This is the only study to date that discusses healthcare access challenges experienced by Indigenous women living in a northern rural Thai village. There is an urgent need to focus on citizenship, employment, and general health conditions; gender, familial, and labor roles; specific health conditions, wellness, and cultural practices; the seeking of healthcare services; healthcare provider relationships; the ability to access needed care; and optimization of self-care. Future efforts to improve healthcare access and reduce disease burden might benefit from these findings and allow for the development of more effective strategies, programs, and policies.
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Davison KM, D'Andreamatteo C, Markham S, Holloway C, Marshall G, Smye VL. Food Security in the Context of Paternal Incarceration: Family Impact Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E776. [PMID: 30836617 PMCID: PMC6427226 DOI: 10.3390/ijerph16050776] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 12/26/2022]
Abstract
Although research about the unintended consequences of paternal incarceration for family well-being has grown in recent years, there has been minimal exploration of food insecurity. Using qualitative methods, we aimed to understand the relationships between paternal incarceration and family food insecurity in Canada. An ethnographic study (24 months) was conducted that included naturalistic observation and in-depth interviews with formerly incarcerated fathers, their partners, and societal reintegration-focused stakeholders (n = 63). Interpretive thematic analysis based on family impact and intersectional theories, indicated that family food insecurity was elucidated by pre-incarceration, economic, social, health, and relationship factors; stigma and social/structural constraints; and intersections among individual, correctional system, community, and macro-level (i.e., economic, social, policy, physical contexts) factors. Participatory approaches and collaborative action among diverse stakeholders that include practitioners, policy makers, researchers, as well as health, social, and criminal justice agencies can guide best practices in creating supportive food environments for families impacted by adversities of incarceration. In particular, interventions aimed at prescriptive ethics, social justice, and meaningful rehabilitation show promise at mitigating the collateral consequences of incarceration-related food insecurity.
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Affiliation(s)
- Karen M Davison
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
- Fulbright Canada Visiting Research Chair, College of Social Sciences, University of Hawaii at Mānoa, 2500 Campus Road, Hawaii Hall 310, Honolulu, HI 96822, USA.
- Health Science Program, Department of Biology, Kwantlen Polytechnic University, 12666 72nd Avenue, Surrey, BC V3W 2M8, Canada.
| | - Carla D'Andreamatteo
- Food and Nutritional Sciences, University of Manitoba, 209 Human Ecology Building, Winnipeg, MB R3T 2N2, Canada.
| | - Sabina Markham
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
| | - Clifford Holloway
- University of Ontario Institute of Technology, Health Science, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada.
| | - Gillian Marshall
- Department of Social Work, University of Washington, 1900 Commerce Street, Tacoma, WA 98402, USA.
| | - Victoria L Smye
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada.
- University of Ontario Institute of Technology, Health Science, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada.
- Arthur Labatt Family School of Nursing, Western University, Room 3306, FIMS & Nursing Building, London, ON N6A 3K7, Canada.
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Singh L, Goel R, Rai RK, Singh PK. Socioeconomic inequality in functional deficiencies and chronic diseases among older Indian adults: a sex-stratified cross-sectional decomposition analysis. BMJ Open 2019; 9:e022787. [PMID: 30819699 PMCID: PMC6398785 DOI: 10.1136/bmjopen-2018-022787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 01/10/2019] [Accepted: 01/31/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Older adults with adverse socioeconomic conditions suffer disproportionately from a poor quality of life. Stratified by sex, income-related inequalities have been decomposed for functional deficiencies and chronic diseases among older adults, and the degree to which social and demographic factors contribute to these inequalities was identified in this study. DESIGN Cross-sectional study. PARTICIPANTS Data used for this study were retrieved from the WHO Study on Global AGEing and Adult Health Wave 1. A total of 3753 individuals (men: 1979, and women: 1774) aged ≥60 years were found eligible for the analysis. MEASURES Instrumental Activity of Daily Living (IADL) deficiency and presence of chronic diseases. METHOD The decomposition method proposed by Adam Wagstaff and his colleagues was used. The method allows estimating how determinants of health contribute proportionally to inequality in a health variable. RESULTS Compared with men, women were disproportionately affected by both functional deficiencies and chronic diseases. The relative contribution of sociodemographic factors to IADL deficiency was highest among those with poor economic status (38.5%), followed by those who were illiterate (22.5%), which collated to 61% of the total explained inequalities. Similarly, for chronic diseases, about 93% of the relative contribution was shared by those with poor economic status (42.3%), rural residence (30.5%) and illiteracy (20.3%). Significant difference in predictors was evident between men and women in IADL deficiency and chronic illness. CONCLUSION Pro-poor intervention strategies could be designed to address functional deficiencies and chronic diseases, with special attention to women.
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Affiliation(s)
- Lucky Singh
- ICMR - National Institute of Medical Statistics, New Delhi, India
| | - Richa Goel
- Indian Council of Medical Research, New Delhi, India
| | | | - Prashant Kumar Singh
- Division of Preventive Oncology, ICMR - National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
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Kothari MK, Dalvie SS, Gupta S, Tikoo A, Singh DK. The C2 Pedicle Width, Pars Length, and Laminar Thickness in Concurrent Ipsilateral Ponticulus Posticus and High-Riding Vertebral Artery: A Radiological Computed Tomography Scan-Based Study. Asian Spine J 2018; 13:290-295. [PMID: 30521747 PMCID: PMC6454277 DOI: 10.31616/asj.2018.0057] [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: 03/11/2018] [Accepted: 08/15/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Retrospective radiological study. PURPOSE We aimed to determine the prevalence of ponticulus posticus (PP) and high-riding vertebral artery (HRVA) occurring simultaneously on the same side (PP+HRVA) and in cases of PP+HRVA, to assess C2 radio-anatomical measurements for C2 pars length, pedicle width, and laminar thickness. OVERVIEW OF LITERATURE PP and HRVA predispose individuals to vertebral artery injuries during atlantoaxial fixation. In cases of PP+HRVA, the construct options thus become limited. METHODS Consecutive computed tomography scans (n=210) were reviewed for PP and HRVA (defined as an internal height of <2 mm and an isthmus height of <5 mm). In scans with PP+HRVA, we measured the ipsilateral pedicle width, pars length, and laminar thickness and compared them with controls (those without PP or HRVA). RESULTS PP was present in 14.76% and HRVA in 20% of scans. Of the 420 sides in 210 scans, PP+HRVA was present on 13 sides (seven right and six left). In scans with PP+HRVA, the C2 pars length was shorter compared with controls (13.69 mm in PP+HRVA vs. 20.65 mm in controls, p<0.001). The mean C2 pedicle width was 2.53 mm in scans with PP+HRVA vs. 5.83 mm in controls (p<0.001). The mean laminar thickness was 4.92 and 5.48 mm in scans with PP+HRVA and controls, respectively (p=0.209). CONCLUSIONS The prevalence of PP+HRVA was approximately 3% in the present study. Our data suggest that, in such situations, C2 pedicle width and pars length create important safety limitations for a proposed screw, whereas the translaminar thickness appears safe for a proposed screw.
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Affiliation(s)
| | | | - Santosh Gupta
- Department of Radiology, P D Hinduja National Hospital & MRC, Mumbai, India
| | - Agnivesh Tikoo
- Department of Orthopaedics, P D Hinduja National Hospital & MRC, Mumbai, India
| | - Deepak Kumar Singh
- Department of Orthopaedics, P D Hinduja National Hospital & MRC, Mumbai, India
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Hendrickson ZM, Lohani S, Thapaliya Shrestha B, Underwood CR. Talking about reproduction with a migrating spouse: Women's experiences in Dhading, Nepal. Health Care Women Int 2018; 39:1234-1258. [PMID: 30513270 DOI: 10.1080/07399332.2018.1505893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Communication between Nepali women and their migrating spouses affects the transregional or transnational social fields of women "left behind" and may have implications for their reproductive health. We explored women's interactions with their absent spouses using data gathered from qualitative interviews. Conversations with migrant husbands were frequent, organized around husbands' schedules, and focused on children's needs and expenses. Couple power dynamics were challenged and reinforced in such conversations. Communication about family planning and childbearing was often delayed until the husband's return. In an increasingly mobile world, encouraging partner communication should be integral to reproductive health programs working with migrant couples.
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Affiliation(s)
- Zoé Mistrale Hendrickson
- a Department of Health Behavior & Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,b Johns Hopkins University Center for Communication Programs , Baltimore , Maryland , USA
| | - Sandhya Lohani
- c Department of Health Behavior & Society , Johns Hopkins Bloomberg School of Public Health , Kathmandu , Nepal
| | - Bibhu Thapaliya Shrestha
- c Department of Health Behavior & Society , Johns Hopkins Bloomberg School of Public Health , Kathmandu , Nepal
| | - Carol R Underwood
- a Department of Health Behavior & Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , USA.,c Department of Health Behavior & Society , Johns Hopkins Bloomberg School of Public Health , Kathmandu , Nepal
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Dey A, Hay K, Afroz B, Chandurkar D, Singh K, Dehingia N, Raj A, Silverman JG. Understanding intersections of social determinants of maternal healthcare utilization in Uttar Pradesh, India. PLoS One 2018; 13:e0204810. [PMID: 30286134 PMCID: PMC6171889 DOI: 10.1371/journal.pone.0204810] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 09/15/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To explore intersections of social determinants of maternal healthcare utilization using the Classification and Regression Trees (CART) algorithm which is a machine-learning method used to construct prediction models. METHODS Institutional review board approval for this study was granted from Public Health Service-Ethical Review Board (PHS-ERB) and from the Health Ministry Screening Committee (HMSC) facilitated by Indian Council for Medical Research (ICMR). IRB review and approval for the current analyses was obtained from University of California, San Diego. Cross-sectional data were collected from women with children aged 0-11 months (n = 5,565) from rural households in 25 districts of Uttar Pradesh, India. Participants were surveyed on maternal healthcare utilization including registration of pregnancy (model-1), receipt of antenatal care (ANC) during pregnancy (model-2), and delivery at health facilities (model -3). Social determinants of health including wealth, social group, literacy, religion, and early age at marriage were captured during the survey. The Classification and Regression Tree (CART) algorithm was used to explore intersections of social determinants of healthcare utilization. RESULTS CART analyses highlight the intersections, particularly of wealth and literacy, in maternal healthcare utilization in Uttar Pradesh. Model-1 documents that women who are poorer, illiterate and Muslim are less likely to have their pregnancies registered (71.4% vs. 86.0% in the overall sample). Model-2 documents that poorer, illiterate women had the lowest ANC coverage (37.7% vs 45% in the overall sample). Model-3, developed for deliveries at health facilities, highlighted that illiterate and poor women have the lowest representation among facility deliveries (59.6% vs. 69% in the overall sample). CONCLUSION This paper explores the interactions between determinants of maternal healthcare utilization indicators. The findings in this paper highlights that the interaction of wealth and literacy can play a very strong role in accentuating or diminishing healthcare utilization among women. The study also reveals that religion and women's age at marriage also interact with wealth and literacy to create substantial disparities in utilization. The study provides insights into the effect of intersections of determinants, and highlights the importance of using a more nuanced understanding of the impact of co-occurring forms of marginalization to effectively tackle inequities in healthcare utilization.
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Affiliation(s)
- Arnab Dey
- Sambodhi Research and Communications Pvt. Ltd., Noida, India
- * E-mail:
| | - Katherine Hay
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Bilal Afroz
- Sambodhi Research and Communications Pvt. Ltd., Noida, India
| | | | - Kultar Singh
- Sambodhi Research and Communications Pvt. Ltd., Noida, India
| | | | - Anita Raj
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla, California, United States of America
| | - Jay G. Silverman
- Center on Gender Equity and Health, Division of Global Public Health, University of California, San Diego School of Medicine, La Jolla, California, United States of America
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Halonen JI, Koskinen A, Varje P, Kouvonen A, Hakanen JJ, Väänänen A. Mental health by gender-specific occupational groups: Profiles, risks and dominance of predictors. J Affect Disord 2018; 238:311-316. [PMID: 29902735 DOI: 10.1016/j.jad.2018.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/15/2018] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND We defined gender-specific profiles of mental ill-health for the main occupational groups using three outcomes; antidepressant use, sickness absence (SA) due to depression, and suicides. We also examined which occupational groups had the highest risk of the outcomes, and compared the importance of their predictors. METHODS From a random register cohort of Finnish working age population, individuals in the six largest occupational groups in 2004 for men and women were included (N = 414 357). We used register data to define the first antidepressant purchase (i.e. use), the first long-term SA spell for depression, and suicide between Jan 1st 2005 and Dec 31st 2014. We assessed the risk of each outcome by occupational group with logistic regression models, and used dominance analysis to compare the relative importance of predictors. RESULTS In all six occupational groups for women, the prevalence of antidepressant use and SA for depression was higher than in the men's occupational groups. The opposite was observed for suicides. The risk of antidepressant use was lower, but the risk of suicide was 2-times higher among men in low vs. high-skilled occupations. Among women, a lower skill-level was associated with a higher risk of SA due to depression. Gender was the most important predictor of all outcomes. LIMITATIONS We lacked information on history of medication use or health problems prior to follow-up. CONCLUSIONS Gendered occupational status was an underlying factor explaining distinctive mental health profiles in the working population. Occupational class-dependent behavioural patterns related to mental health existed among men.
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Affiliation(s)
- Jaana I Halonen
- Finnish Institute of Occupational Health, Helsinki/Kuopio, Finland.
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki/Kuopio, Finland
| | - Pekka Varje
- Finnish Institute of Occupational Health, Helsinki/Kuopio, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland; Administrative Data Research Centre (Northern Ireland), Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Jari J Hakanen
- Finnish Institute of Occupational Health, Helsinki/Kuopio, Finland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki/Kuopio, Finland; School of Social Policy, Sociology and Social Research, University of Kent, United Kingdom
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Kabia E, Mbau R, Muraya KW, Morgan R, Molyneux S, Barasa E. How do gender and disability influence the ability of the poor to benefit from pro-poor health financing policies in Kenya? An intersectional analysis. Int J Equity Health 2018; 17:149. [PMID: 30231887 PMCID: PMC6146517 DOI: 10.1186/s12939-018-0853-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 08/31/2018] [Indexed: 12/04/2022] Open
Abstract
Background Health inequity has mainly been linked to differences in economic status, with the poor facing greater challenges accessing healthcare than the less poor. To extend financial coverage to the poor and vulnerable, Kenya has therefore implemented several pro-poor health policy reforms. However, other social determinants of health such as gender and disability also influence health status and access to care. This study employed an intersectional approach to explore how gender disability and poverty interact to influence how poor women in Kenya benefit from pro-poor financing policies that target them. Methods We applied a qualitative cross-sectional study approach in two purposively selected counties in Kenya. We collected data using in-depth interviews with women with disabilities living in poverty who were beneficiaries of the health insurance subsidy programme and those in the lowest wealth quintiles residing in the health and demographic surveillance system. We analyzed data using a thematic approach drawing from the study’s conceptual framework. Results Women with disabilities living in poverty often opted to forgo seeking free healthcare services because of their roles as the primary household providers and caregivers. Due to limited mobility, they needed someone to accompany them to health facilities, leading to greater transport costs. The absence of someone to accompany them and unaffordability of the high transport costs, for example, made some women forgo seeking antenatal and skilled delivery services despite the existence of a free maternity programme. The layout and equipment at health facilities offering care under pro-poor health financing policies were disability-unfriendly. The latter in addition to negative healthcare worker attitudes towards women with disabilities discouraged them from seeking care. Negative stereotypes against women with disabilities in the society led to their exclusion from public participation forums thereby limiting their awareness about health services. Conclusions Intersections of gender, poverty, and disability influenced the experiences of women with disabilities living in poverty with pro-poor health financing policies in Kenya. Addressing the healthcare access barriers they face could entail ensuring availability of disability-friendly health facilities and public transport systems, building cultural competence in health service delivery, and empowering them to engage in public participation.
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Affiliation(s)
- Evelyn Kabia
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.
| | - Rahab Mbau
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Kelly W Muraya
- Health Systems & Research Ethics Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Rosemary Morgan
- John Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Sassy Molyneux
- Health Systems & Research Ethics Department, KEMRI-Wellcome Trust Research Programme, P.O. Box 230-80108, Kilifi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Sriram V, Topp SM, Schaaf M, Mishra A, Flores W, Rajasulochana SR, Scott K. 10 best resources on power in health policy and systems in low- and middle-income countries. Health Policy Plan 2018; 33:611-621. [PMID: 29471544 DOI: 10.1093/heapol/czy008] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/12/2022] Open
Abstract
Power is a critical concept to understand and transform health policy and systems. Power manifests implicitly or explicitly at multiple levels-local, national and global-and is present at each actor interface, therefore shaping all actions, processes and outcomes. Analysing and engaging with power has important potential for improving our understanding of the underlying causes of inequity, and our ability to promote transparency, accountability and fairness. However, the study and analysis of the role of power in health policy and systems, particularly in the context of low- and middle-income countries, has been lacking. In order to facilitate greater engagement with the concept of power among researchers and practitioners in the health systems and policy realm, we share a broad overview of the concept of power, and list 10 excellent resources on power in health policy and systems in low- and middle-income countries, covering exemplary frameworks, commentaries and empirical work. We undertook a two-stage process to identify these resources. First, we conducted a collaborative exercise involving crowdsourcing and participatory validation, resulting in 24 proposed articles. Second, we conducted a structured literature review in four phases, resulting in 38 articles reviewed. We present the 10 selected resources in the following categories to bring out key facets of the literature on power and health policy and systems-(1) Resources that provide an overarching conceptual exploration into how power shapes health policy and systems, and how to investigate it; and (2) examples of strong empirical work on power and health policy and systems research representing various levels of analyses, geographic regions and conceptual understandings of power. We conclude with a brief discussion of key gaps in the literature, and suggestions for additional methodological approaches to study power.
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Affiliation(s)
- Veena Sriram
- Center for Health and the Social Sciences, University of Chicago, 5841 S. Maryland Avenue, MC 1005, Suite M200, Chicago, IL 60637, USA
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Marta Schaaf
- Averting Maternal Death and Disability, Mailman School of Public Health, Columbia University, 722 West 168th St. New York, NY 10032, USA
| | - Arima Mishra
- Azim Premji University, PES Campus, Pixel Park, B Block, Electronics City, Hosur Road, Bengaluru 560100, Karnataka, India
| | - Walter Flores
- Center for the Study of Equity and Governance in Health Systems, 11 Calle 0-48 Zona 10, Edificio Diamond, Oficina 504. Guatemala City, Guatemala and
| | | | - Kerry Scott
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA
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Mathias K, Pandey A, Armstrong G, Diksha P, Kermode M. Outcomes of a brief mental health and resilience pilot intervention for young women in an urban slum in Dehradun, North India: a quasi-experimental study. Int J Ment Health Syst 2018; 12:47. [PMID: 30140307 PMCID: PMC6098661 DOI: 10.1186/s13033-018-0226-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mental illness is a leading cause of the disease burden among young people. Poor mental health is linked to childhood adversity such as gender inequality, poverty and low educational attainment. Psycho-social assets in adolescents can moderate these impacts and be strengthened. The aim of this study was to assess the effectiveness of a brief mental health and resilience intervention among disadvantaged young women in urban North India. Methods We used an uncontrolled repeated measures design to evaluate the effectiveness of the 15-module mental health and resilience curriculum among young women residing in a slum in Dehradun, Uttarakhand. Standardised psychometric assessments were done to assess outcomes of the intervention at three time-points: pre-intervention (T1), post-intervention (T2), and 8-months post-intervention (T3), covering domains of self-efficacy, resilience, anxiety, depression and gender attitudes. Results Young women completing the intervention (n = 106) had all left school before 10th class. A statistically significant improvement in all psychometric measures was found at T2. These improvements were sustained at T3 in the areas of anxiety, depression and gender equality attitudes, while the measures of resilience and self-efficacy had declined to baseline. Conclusions This intervention delivered by community-based peers among highly disadvantaged young women can lead to sustained improvements in anxiety and depression and attitudes to gender equality. While other studies in LMIC have shown increased adolescent resilience through peer-led curriculums, this study demonstrates improvements in mental health and gender attitudes can endure 8-months post-intervention. This low-cost, brief intervention can improve mental health resiliency and self-efficacy among disadvantaged young people. Further research should explore how to bring sustained improvements in resilience.
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Affiliation(s)
- K Mathias
- 1Emmanuel Hospital Association, New Delhi, India.,Present Address: Landour Community Hospital, Mussoorie, Uttarakhand 248179 India
| | - A Pandey
- 2Austin Health, Heidelberg, VIC Australia
| | - G Armstrong
- 3Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - P Diksha
- 4University of Melbourne, Melbourne, Australia
| | - M Kermode
- 5Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
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