1
|
Rhodes AP, Dwyer RE, Houle JN. Debt Collection Pressure and Mental Health: Evidence from a Cohort of U.S. Young Adults. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241268477. [PMID: 39225254 DOI: 10.1177/00221465241268477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The debt collection industry in the United States has grown in tandem with rising indebtedness. Prior research on debt and mental health mainly treats debt as a resource and liability rather than a power relationship between creditors and debtors. We study the mental health consequences of debt collection pressure using data from the National Longitudinal Survey of Youth-1997 Cohort (N = 7,236). Drawing on stress theory and health power resources theory, we posit collection pressure as a relational stressor that undermines well-being through negative interactions with debt collectors, financial strain, role strain, and stigma. We find that more than one out of every three young adults in this cohort faced debt collection pressure by around age 40, with higher rates among low-income and Black young adults. Individual fixed-effects and lagged dependent variable regression models indicate that debt collection pressure is associated with increased psychological distress, with more severe consequences among low-income young adults.
Collapse
|
2
|
Ravalihasy A, Faye A, Diallo AI, Gaye I, Ridde V. A social acceptability scale: Validation in the context of government measures to curb the COVID-19 pandemic in Senegal. Ann Epidemiol 2024; 94:49-63. [PMID: 38641214 DOI: 10.1016/j.annepidem.2024.04.004] [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: 06/19/2023] [Revised: 03/12/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION In March 2020, the government of Senegal introduced a curfew, a ban on travel between regions, the closure of markets, and a ban on attending places of worship to contain the spread of the COVID-19 pandemic. As part of research into the response to COVID-19, we developed a scale to measure the social acceptability of these measures. METHODS We used Sekhon's theoretical framework of acceptability (TFA) to formulate the content of the scale items. We assessed the homogeneity of the scale using Cronbach's Alpha and average interitem correlations. We measured the dimensional properties of the scale using rating scale models. We tested the sensitivity of the scale to sociodemographic characteristics using mixed linear regressions and rating scale models. RESULTS The final scale consisted of seven items corresponding to the constructs of acceptability. Analysis performed on data from 813 individuals showed that the scale has satisfactory statistical properties (Cronbach's α > 0.8, Loevinger's coefficient>0.3, intraclass correlation>0.4). CONCLUSION This scale was one of the first to test the TFA. The small number of items was advantageous for use under challenging data collection contexts. Measuring the acceptability of public health interventions with this tool can help in their design and implementation.
Collapse
Affiliation(s)
| | - Adama Faye
- Ised (Institute of Health and Development), Ucad (Cheikh Anta Diop University), Dakar Senegal
| | - Amadou Ibra Diallo
- Ised (Institute of Health and Development), Ucad (Cheikh Anta Diop University), Dakar Senegal
| | - Ibrahima Gaye
- Ised (Institute of Health and Development), Ucad (Cheikh Anta Diop University), Dakar Senegal
| | - Valéry Ridde
- Ceped (IRD-Université Paris Cité-Inserm ERL 1244), Paris France; Ised (Institute of Health and Development), Ucad (Cheikh Anta Diop University), Dakar Senegal
| |
Collapse
|
3
|
Graetz N, Gershenson C, Porter SR, Sandler DH, Lemmerman E, Desmond M. The impacts of rent burden and eviction on mortality in the United States, 2000-2019. Soc Sci Med 2024; 340:116398. [PMID: 38007965 PMCID: PMC10828546 DOI: 10.1016/j.socscimed.2023.116398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/28/2023]
Abstract
Investments in stable, affordable housing may be an important tool for improving population health, especially in the context of rising costs and evictions for American renters. Still, a lack of longitudinal data linking these exposures to health outcomes has limited prior research. In this study, we use linked administrative data to estimate the associations of rent burden and eviction with all-cause mortality. We constructed a novel dataset linking renters in the long-form 2000 Census (N = 6,587,000) to mortality follow-up through 2019 from the Census Numident file. To measure exposure to eviction, we further linked this dataset to 38 million eviction records between 2000 and 2016 using names and addresses. For a subsample of renters, we also measured within-individual changes in rent burden between 2000 and 2008-2012 by linking to the American Community Survey. We estimated the associations of rent burden and eviction with mortality using Cox proportional-hazards models and discrete-time hazard models adjusted for individual, household, neighborhood, and state characteristics, examining varying associations by cohort, race, gender, and eviction risk. Higher baseline rent burden, increases in rent burden during midlife, and evictions were all associated with increased mortality. Compared to a baseline rent burden of 30%, a burden of 70% was associated with 12% (95% confidence interval = 11-13%) higher mortality. A 20-point increase in rent burden between 2000 and 2008-2012 was associated with 16% (12-19%) higher mortality through 2019. An eviction filing without judgment was associated with a 19% (15-23%) increase in mortality and an eviction judgment was associated with a 40% (36-43%) increase. Associations were larger for those at lower predicted risk of eviction. These findings reveal how rising costs and evictions are shaping mortality for American renters. Policies designed to increase the supply of affordable housing and prevent eviction may lead to widespread improvements in population health.
Collapse
Affiliation(s)
- Nick Graetz
- Department of Sociology, Princeton University, Princeton, NJ, USA.
| | - Carl Gershenson
- Department of Sociology, Princeton University, Princeton, NJ, USA
| | - Sonya R Porter
- Center for Economics Studies, United States Census Bureau, Washington D.C., USA
| | - Danielle H Sandler
- Center for Economics Studies, United States Census Bureau, Washington D.C., USA
| | - Emily Lemmerman
- Department of Sociology, Princeton University, Princeton, NJ, USA
| | - Matthew Desmond
- Department of Sociology, Princeton University, Princeton, NJ, USA
| |
Collapse
|
4
|
Guglielmin M, Shankardass K, Bayoumi A, O'campo P, Kokkinen L, Muntaner C. Tools for local health in all policies implementation: evidence from an explanatory case study of Kuopio, Finland. Scand J Public Health 2023; 51:1196-1204. [PMID: 35766538 DOI: 10.1177/14034948221090076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS This paper describes the use of three governance tools for health in all policies utilised to facilitate implementation in the municipality of Kuopio, Finland: impact assessments, a city mandate (the Kuopio strategy), and shared budgets. METHODS An explanatory case study was used. Data sources included semistructured interviews with 10 government employees and scholarly literature. Realist scientific methods were used to reveal mechanisms underlying the use of tools in health in all policies. RESULTS Strong evidence was found supporting initial and new theory/hypotheses regarding the use of each tool in achieving positive implementation outcomes. Impact assessments facilitated health in all policies by enhancing understanding of health implications. The Kuopio strategy aided in implementation by giving credence to health in all policies work via formal authority. Shared budgets promoted intersectoral discussions and understanding, and a sense of ownership, in addition to allowing time to be spent on health in all policies work and not financial deliberation. CONCLUSIONS Findings confirm the efficacious use of three governance tools in implementing health in all policies in Kuopio. Knowledge and evidence-based guidelines on local health in all policies implementation are needed as this policy approach continues to be recognised and adopted as a means to promote population health and health equity.
Collapse
Affiliation(s)
- Maria Guglielmin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ahmed Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada
| | - Patricia O'campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Carles Muntaner
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Canada
- Bloomberg School of Nursing, University of Toronto, Toronto, Canada
| |
Collapse
|
5
|
Barnish MS, Tan SY, Robinson S, Taeihagh A, Melendez-Torres GJ. A realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes. Soc Sci Med 2023; 339:116402. [PMID: 38000341 DOI: 10.1016/j.socscimed.2023.116402] [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: 01/26/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes. METHODS A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories. FINDINGS From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types. CONCLUSIONS This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes.
Collapse
Affiliation(s)
- Maxwell S Barnish
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, United Kingdom.
| | - Si Ying Tan
- Alexandra Research Centre for Healthcare in the Virtual Environment (ARCHIVE), Alexandra Hospital, National University Health System, Singapore
| | - Sophie Robinson
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, United Kingdom
| | - Araz Taeihagh
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, United Kingdom
| |
Collapse
|
6
|
Guglielmin M, Shankardass K, Bayoumi A, O’Campo P, Kokkinen L, Muntaner C. A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland. Int J Health Policy Manag 2022; 11:2651-2659. [PMID: 35247936 PMCID: PMC9818123 DOI: 10.34172/ijhpm.2022.6355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/05/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Health in All Policies (HiAP) encompasses collaboration across government and the consideration of health in various governmental sector's policies and decisions. Despite increasing advocacy, interest, and uptake in HiAP globally, empirical and evaluative studies are underrepresented in this growing literature, particularly literature on HiAP implementation at the local level. Finland has been a pioneer in and champion for HiAP. METHODS A realist explanatory case study design was used to test hypotheses about how HiAP is implemented in Kuopio, Finland. Semi-structured interviews with ten government employees from various sectors were conducted. Data from interviews and literature were analyzed with the aims of uncovering explanatory mechanisms in the form of context-strategy-mechanism-outcome (CSMO) configurations related to implementation strategies. Evidence was evaluated for quality based on triangulation of sources and strength of evidence. We hypothesized that having or creating a common goal between sectors and having committed staff and local leadership would facilitate implementation. RESULTS Strong evidence supports our hypothesis that having or creating a common goal can aid in positive implementation outcomes at the local level. Common goals can be created by the strategies of having a city mandate, engaging in cross-sectoral discussions, and/or by working together. Policy and political elite leadership led to HiAP implementation success because leaders supported HiAP work, thus providing justification for using time to work intersectorally. How and why the wellbeing committee facilitated implementation included by providing opportunities for discussion and learning, which led to understanding of how non-health decisions impact community wellbeing, and by acting as a conduit for the communication of wellbeing goals to government employees. CONCLUSION At the municipal level, having or creating a common goal, leadership from policy and political elites, and the presence of committed staff can facilitate HiAP implementation. Inclusion of not only strategies for HiAP, but also the explanatory mechanisms, aids in elucidating how and why HiAP is successfully implemented in a local setting.
Collapse
Affiliation(s)
- Maria Guglielmin
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ahmed Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Carles Muntaner
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Bloomberg School of Nursing University of Toronto, Toronto, ON, Canada
| |
Collapse
|
7
|
Graetz N, Boen CE, Esposito MH. Structural Racism and Quantitative Causal Inference: A Life Course Mediation Framework for Decomposing Racial Health Disparities. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:232-249. [PMID: 35001689 PMCID: PMC11251000 DOI: 10.1177/00221465211066108] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Quantitative studies of racial health disparities often use static measures of self-reported race and conventional regression estimators, which critics argue is inconsistent with social-constructivist theories of race, racialization, and racism. We demonstrate an alternative counterfactual approach to explain how multiple racialized systems dynamically shape health over time, examining racial inequities in cardiometabolic risk in the National Longitudinal Study of Adolescent to Adult Health. This framework accounts for the dynamics of time-varying confounding and mediation that is required in operationalizing a "race" variable as part of a social process (racism) rather than a separable, individual characteristic. We decompose the observed disparity into three types of effects: a controlled direct effect ("unobserved racism"), proportions attributable to interaction ("racial discrimination"), and pure indirect effects ("emergent discrimination"). We discuss the limitations of counterfactual approaches while highlighting how they can be combined with critical theories to quantify how interlocking systems produce racial health inequities.
Collapse
Affiliation(s)
- Nick Graetz
- Department of Sociology, Princeton University
- Population Studies Center, University of Pennsylvania
| | - Courtney E. Boen
- Population Studies Center, University of Pennsylvania
- Department of Sociology, Population Aging Research Center, Leonard Davis Institute for Health Economics, University of Pennsylvania
| | | |
Collapse
|
8
|
Gilman SE, Aiello A, Galea S, Howe CJ, Kawachi I, Lovasi GS, Dean LT, Oakes JM, Siddiqi A, Glymour MM. Advancing the Social Epidemiology Mission of the American Journal of Epidemiology. Am J Epidemiol 2022; 191:557-560. [PMID: 34791025 DOI: 10.1093/aje/kwab277] [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: 09/22/2021] [Revised: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Social epidemiology is concerned with how social forces influence population health. Rather than focusing on a single disease (as in cancer or cardiovascular epidemiology) or a single type of exposure (e.g., nutritional epidemiology), social epidemiology encompasses all the social and economic determinants of health, both historical and contemporary. These include features of social and physical environments, the network of relationships in a society, and the institutions, politics, policies, norms and cultures that shape all of these forces. This commentary presents the perspective of several editors at the Journal with expertise in social epidemiology. We articulate our thinking to encourage submissions to the Journal that: 1) expand knowledge of emerging and underresearched social determinants of population health; 2) advance new empirical evidence on the determinants of health inequities and solutions to advance health equity; 3) generate evidence to inform the translation of research on social determinants of health into public health impact; 4) contribute to innovation in methods to improve the rigor and relevance of social epidemiology; and 5) encourage critical self-reflection on the direction, challenges, successes, and failures of the field.
Collapse
|
9
|
Abstract
In a context where epidemiologic research has been heavily influenced by a biomedical and individualistic approach, the naming of “social epidemiology” allowed explicit emphasis on the social production of disease as a powerful explanatory paradigm and as critically important for interventions to improve population health. This review briefly highlights key substantive areas of focus in social epidemiology over the past 30 years, reflects on major advances and insights, and identifies challenges and possible future directions. Future opportunities for social epidemiology include grounding research in theoretically based and systemic conceptual models of the fundamental social drivers of health; implementing a scientifically rigorous yet realistic approach to drawing conclusions about social causes; using complementary methods to generate valid explanations and identify effective actions; leveraging the power of harmonization, replication, and big data; extending interdisciplinarity and diversity; advancing emerging critical approaches to understanding the health impacts of systemic racism and its policy implications; going global; and embracing a broad approach to generating socially useful research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Collapse
Affiliation(s)
- Ana V. Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
10
|
Perry MJ, Arrington S, Freisthler MS, Ibe IN, McCray NL, Neumann LM, Tajanlangit P, Trejo Rosas BM. Pervasive structural racism in environmental epidemiology. Environ Health 2021; 20:119. [PMID: 34784917 PMCID: PMC8595076 DOI: 10.1186/s12940-021-00801-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 10/22/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND Epistemological biases in environmental epidemiology prevent the full understanding of how racism's societal impacts directly influence health outcomes. With the ability to focus on "place" and the totality of environmental exposures, environmental epidemiologists have an important opportunity to advance the field by proactively investigating the structural racist forces that drive disparities in health. OBJECTIVE This commentary illustrates how environmental epidemiology has ignored racism for too long. Some examples from environmental health and male infertility are used to illustrate how failing to address racism neglects the health of entire populations. DISCUSSION While research on environmental justice has attended to the structural sources of environmental racism, this work has not been fully integrated into the mainstream of environmental epidemiology. Epidemiology's dominant paradigm that reduces race to a mere data point avoids the social dimensions of health and thus fails to improve population health for all. Failing to include populations who are Black, Indigenous, and people of color (BIPOC) in health research means researchers actually know very little about the effect of environmental contaminants on a range of population health outcomes. This commentary offers different practical solutions, such as naming racism in research, including BIPOC in leadership positions, mandating requirements for discussing "race", conducting far more holistic analyses, increasing community participation in research, and improving racism training, to address the myriad of ways in which structural racism permeates environmental epidemiology questions, methods, results and impacts.
Collapse
Affiliation(s)
- Melissa J Perry
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA.
| | - Suzanne Arrington
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Marlaina S Freisthler
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Ifeoma N Ibe
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Nathan L McCray
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Laura M Neumann
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Patrick Tajanlangit
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - Brenda M Trejo Rosas
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| |
Collapse
|
11
|
Castañeda E, Smith B, Vetter E. Hispanic health disparities and housing: Comparing measured and self-reported health metrics among housed and homeless Latin individuals. J Migr Health 2021; 1-2:100008. [PMID: 34405163 PMCID: PMC8352211 DOI: 10.1016/j.jmh.2020.100008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022] Open
Abstract
Previous studies argue that Hispanics are healthier and less likely to experience homelessness than other populations in their same socioeconomic position. However, earlier studies have not explored the relationship between housing status and health for Latin individuals. This study examines 1) the health disparities between homeless and housed Hispanics in El Paso, Texas, and 2) the Hispanic health and homelessness paradoxes using an intersectional framework to understand health risks. A large number of Hispanic residents of El Paso (N = 1152) were surveyed. Demographic, health, and housing data were collected. We contribute to the literature by providing detailed health indicators for homeless Hispanics. To our knowledge, this is the first study to examine health disparities between housed and homeless Hispanics. Bivariate analysis, as well as data coded from interviews, indicated that homeless Hispanics were more likely to have barriers to care, less likely to have health insurance, slightly more likely than housed Hispanics to experience mental illness, alcoholism, and addiction, and more likely to be underdiagnosed for health problems, including hypertension. This study shows how certain traditional methods for collecting health data, including self-rated health and reported diagnoses, can be ineffective at revealing health disparities. This paper calls for innovative, mixed-methods approaches to understand the social and structural determinants of health for marginalized populations.
Collapse
Affiliation(s)
- Ernesto Castañeda
- Department of Sociology, American University, 4400 Massachusetts Ave NW, Watkins 115, Washington, DC 20016, United States
- Corresponding author.
| | - Blaine Smith
- Boston University, 100 Cummington Mall, Room 260, Boston, MA 02215, United States
| | - Emma Vetter
- American University, 4400 Massachusetts Ave NW, Watkins 115, Washington, DC 20016, United States
| |
Collapse
|
12
|
Mahabir DF, O’Campo P, Lofters A, Shankardass K, Salmon C, Muntaner C. Experiences of everyday racism in Toronto's health care system: a concept mapping study. Int J Equity Health 2021; 20:74. [PMID: 33691682 PMCID: PMC7943708 DOI: 10.1186/s12939-021-01410-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/14/2021] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND In Canada, there is longstanding evidence of health inequities for racialized groups. The purpose of this study is to understand the effect of current health care policies and practices on racial/ethnic groups and in particular racialized groups at the level of the individual in Toronto's health care system. METHODS This study used a semi-qualitative study design: concept mapping. A purposive sampling strategy was used to recruit participants. Health care users and health care providers from Toronto and the Greater Toronto Area participated in all four concept mapping activities. The sample sizes varied according to the activity. For the rating activity, 41 racialized health care users, 23 non-racialized health care users and 11 health care providers completed this activity. The data analysis was completed using the concept systems software. RESULTS Participants generated 35 unique statements of ways in which patients feel disrespect or mistreatment when receiving health care. These statements were grouped into five clusters: 'Racial/ethnic and class discrimination', 'Dehumanizing the patient', 'Negligent communication', 'Professional misconduct', and 'Unequal access to health and health services'. Two distinct conceptual regions were identified: 'Viewed as inferior' and 'Unequal medical access'. From the rating activity, racialized health care users reported 'race'/ethnic based discrimination or everyday racism as largely contributing to the challenges experienced when receiving health care; statements rated high for action/change include 'when the health care provider does not complete a proper assessment', 'when the patient's symptoms are ignored or not taken seriously', 'and 'when the health care provider belittles or talks down to the patient'. CONCLUSIONS Our study identifies how racialized health care users experience everyday racism when receiving health care and this is important to consider in the development of future research and interventions aimed at addressing institutional racism in the health care setting. To support the elimination of institutional racism, anti-racist policies are needed to move beyond cultural competence polices and towards addressing the centrality of unequal power social relations and everyday racism in the health care system.
Collapse
Affiliation(s)
- Deb Finn Mahabir
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario M5T 1P8 Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, 30 Bond Street, Toronto, Ontario M5B 1W8 Canada
| | - Aisha Lofters
- Women’s College Hospital, 76 Grenville St., Toronto, M5S 1B2 Canada
| | - Ketan Shankardass
- Department of Health Sciences, Wilfrid Laurier University, 75 University Avenue West, Waterloo, Ontario N2L 3C5 Canada
| | - Christina Salmon
- Knowledge Translation Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1T8 Canada
| | - Carles Muntaner
- Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario M5T 1P8 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, Ontario M5T 3M7 Canada
| |
Collapse
|
13
|
Barnish MS, Tan SY, Taeihagh A, Tørnes M, Nelson-Horne RVH, Melendez-Torres GJ. Linking political exposures to child and maternal health outcomes: a realist review. BMC Public Health 2021; 21:127. [PMID: 33435933 PMCID: PMC7802227 DOI: 10.1186/s12889-021-10176-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conceptual and theoretical links between politics and public health are longstanding. Internationally comparative systematic review evidence has shown links between four key political exposures - the welfare state, political tradition, democracy and globalisation - on population health outcomes. However, the pathways through which these influences may operate have not been systematically appraised. Therefore, focusing on child and maternal health outcomes, we present a realist re-analysis of the dataset from a recent systematic review. METHODS The database from a recent systematic review on the political determinants of health was used as the data source for this realist review. Included studies from the systematic review were re-evaluated and those relating to child and/or maternal health outcomes were included in the realist synthesis. Initial programme theories were generated through realist engagement with the prior systematic review. These programme theories were adjudicated and refined through detailed engagement with the evidence base using a realist re-synthesis involving two independent reviewers. The revised theories that best corresponded to the evidence base formed the final programme theories. RESULTS Out of the 176 included studies from the systematic review, a total of 67 included child and/or maternal health outcomes and were included in the realist re-analysis. Sixty-three of these studies were ecological and data were collected between 1950 and 2014. Six initial programme theories were generated. Following theory adjudication, three theories in revised form were supported and formed the final programme theories. These related to a more generous welfare state leading to better child and maternal health especially in developed countries through progressive social welfare policies, left-of-centre political tradition leading to lower child mortality and low birth weight especially in developed countries through greater focus on welfare measures, and increased globalisation leading to greater child and infant mortality and youth smoking rates in LMECs through greater influence of multinational corporations and neoliberal trade organisations. CONCLUSION We present a realist re-analysis of a large systematically identified body of evidence on how four key political exposures - the welfare state, democracy, political tradition and globalisation - relate to child and maternal health outcomes. Three final programme theories were supported.
Collapse
Affiliation(s)
- Maxwell S Barnish
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Room 3.09f, South Cloisters, St Luke's Campus, Heavitree Rd, Exeter, EX1 2LU, UK. .,Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Room 3.09f, South Cloisters, St Luke's Campus, Heavitree Rd, Exeter, EX1 2LU, UK.
| | - Si Ying Tan
- Policy Systems Group (PSG), Lee Kuan Yew School of Public Policy, National University of Singapore, 16 Evans Road, Singapore, 259363, Singapore
| | - Araz Taeihagh
- Policy Systems Group (PSG), Lee Kuan Yew School of Public Policy, National University of Singapore, 16 Evans Road, Singapore, 259363, Singapore
| | - Michelle Tørnes
- Ageing, Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Room 3.09f, South Cloisters, St Luke's Campus, Heavitree Rd, Exeter, EX1 2LU, UK.,Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, Room 3.09f, South Cloisters, St Luke's Campus, Heavitree Rd, Exeter, EX1 2LU, UK
| |
Collapse
|
14
|
Tennant E, Miller E, Costantino K, De Souza D, Coupland H, Fotheringham P, Eastwood J. A critical realist evaluation of an integrated care project for vulnerable families in Sydney, Australia. BMC Health Serv Res 2020; 20:995. [PMID: 33129332 PMCID: PMC7603742 DOI: 10.1186/s12913-020-05818-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 10/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Healthy Homes and Neighbourhoods (HHAN) Integrated Care Initiative was established to improve the care of families with complex health and social needs who reside in Sydney Local Health District. HHAN seeks to provide long-term multi-disciplinary care coordination as well as enhance capacity building and promote integrated care. The critical realist study reported here is part of the longitudinal development and evaluation of complex integrated health and social care interventions in Sydney, Australia. METHODS We describe the qualitative component of a critical realist pilot case study aimed at exploring, explaining and refining emerging HHAN programme theories in relation to care coordination. Qualitative interviews were undertaken with HHAN clients (n = 12), staff and other stakeholders (n = 21). Interviews and coding used a context (C), mechanism (M) and outcome (O) framework. Inductive, deductive, retroductive and abductive modes of reasoning were used with the CMO heuristic tool to inform the developing programme theory. RESULTS The mechanisms underpinning effective engagement of clients by care coordinators included: building trust, leveraging other family, social and organisational relationships, meeting clients on their own terms, demonstrating staff effectiveness as quickly as possible, and client empowerment. Mechanisms for enhancing care integration included knowledge transfer activities and shared learning among collaborators, structural and cultural changes, enhancing mutual respect, co-location of multidisciplinary and/or interagency staff and cultivating faith in positive change among staff. CONCLUSIONS Use of a critical realism case study approach served to elucidate the varied influences of contexts and mechanisms on programme outcomes, to highlight what works for whom and in what context. Findings supported the initial programme theory that engagement and trust building with clients, alongside enhanced collaboration and integration of services, improved outcomes for vulnerable families with complex needs. Further research is needed to explore the cost-effectiveness of integrated care initiatives, in view of the long term nature of service provision and the risk of staff burnout.
Collapse
Affiliation(s)
- E. Tennant
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW 2052 Australia
| | - E. Miller
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
| | - K. Costantino
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
| | - D. De Souza
- Centre for Research in Education, Torrens University Australia, Flinders Street Campus, Melbourne, VIC 3000 Australia
| | - H. Coupland
- Drug Health Services, Royal Prince Alfred Hospital, Level 6, King George V Building Missenden Road, Camperdown, NSW 2050 Australia
- Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050 Australia
| | - P. Fotheringham
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
| | - J. Eastwood
- Healthy Homes and Neighbourhoods Integrated Care Initiative, Community Health Services, Sydney Local Health District, 24 Liverpool Road, Croydon, NSW 2132 Australia
- Population child health group, School of Women’s and Children’s Health, The University of New South Wales, Kensington, NSW 2052 Australia
- Ingham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170 Australia
- Charles Perkins Centre, Menzies Centre for Health Policy, Discipline of Child and Adolescent Health, Central Clinical School, and School of Public Health, University of Sydney, Sydney, New South Wales 2006 Australia
- Sydney Institute for Women Children and their Families, Camperdown, NSW 2050 Australia
- Community Paediatrics, Croydon Community Health Centre, 24 Liverpool Road, Croydon, NSW 2132 Australia
| |
Collapse
|
15
|
Bannister-Tyrrell M, Meiqari L. Qualitative research in epidemiology: theoretical and methodological perspectives. Ann Epidemiol 2020; 49:27-35. [PMID: 32711056 DOI: 10.1016/j.annepidem.2020.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/30/2020] [Accepted: 07/15/2020] [Indexed: 11/26/2022]
Abstract
Increasingly, modern epidemiology has adopted complex causal frameworks incorporating individual- and population-level determinants of health. Despite the growing use of qualitative methodologies in public health research generally, discussion of causal reasoning in epidemiology rarely considers evidence derived from qualitative research. This article argues for a coherent role of qualitative research within epidemiology through analysis of the principles of causal reasoning that underlie current debates about causal inference in epidemiology. It introduces two approaches to causal inference by Russo and Williamson (2009) and Reiss (2012) that emphasize the relevance of both the nature of causation and how knowledge is gained about causation in assessing evidence for a causal relation. Both theories have scope for incorporating multiple types of evidence to assess causal claims. We argue that these theories align with the empirical focus of epidemiology and allow for different types of evidence to evaluate causal claims, including evidence originating from qualitative research; such evidence can contribute to a mechanistic understanding of causal relations and to understanding the effects of context on health-related outcomes. Finally, we discuss this approach in light of previous literature on the role of qualitative research in epidemiology and implications for future epidemiologic research.
Collapse
Affiliation(s)
| | - Lana Meiqari
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
16
|
Hahn RA, Muntaner C. Why a Right to Health Makes No Sense, and What Does. Health Equity 2020; 4:249-254. [PMID: 32587938 PMCID: PMC7310297 DOI: 10.1089/heq.2019.0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 11/12/2022] Open
Abstract
There is a widely held belief in a universal right to the highest attainable standard of health. This essay shows how this right is conceptually unclear, unattainable, and a distraction from a more concrete and attainable right: a right to equitable access to available resources for health (RARH), including equitable access to the social determinants of health. It clarifies conceptual and theoretical issues in the RARH: its underlying theory rooted in historical, economic, and axiological rationales; its concept of component resources and their availability, equity, sustainability; and the redistribution of wealth and power, metrics, and ethics. The advancement of global health equity requires explicit theorizing of what underlies a right to health. The right to the highest attainable standard of health fails in this regard. The RARH provides a desirable, actionable, and measurable foundation for global health equity.
Collapse
Affiliation(s)
- Robert A Hahn
- Department of Anthropology, Emory University, Atlanta, Georgia, USA
| | - Carles Muntaner
- Dalla Lana School of Public Health, Social Equity and Health, University of Toronto, Toronto, Canada
| |
Collapse
|
17
|
Kim D. Bridging the epidemiology-policy divide: A consequential and evidence-based framework to optimize population health. Prev Med 2019; 129:105781. [PMID: 31330155 DOI: 10.1016/j.ypmed.2019.105781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/21/2019] [Accepted: 07/17/2019] [Indexed: 11/27/2022]
Abstract
Epidemiology is the scientific cornerstone of public health. Its traditional role has been to test scientific hypotheses on causal relationships of exposures with health outcomes, the results of which should in turn be synthesized and lead to evidence-based recommendations and the formation of policy. However, the messy truth is that the path from epidemiology to policy is frequently not a perfectly rational, linear one, and the choices of which scientific hypotheses are pursued and the ways in which they are tested, evaluated, and translated into policies do not occur systematically. One avenue for bridging this divide is widespread adoption and implementation of a consequential, evidence-based framework-whereby we can systematically facilitate the translation of epidemiology into policies and interventions to optimize population health. This paper describes the roadmap for a seven-step, outcomes-based consequential approach, that includes priority-setting of problems at both the federal and regional/state levels, and that proposes to strengthen alignment of public and private research funding and journals with these priorities. Over the long term, implementing this framework should help to bridge the divide between epidemiology and policy and optimize the use of increasingly constrained resources to reduce disease burden and promote the nation's health.
Collapse
Affiliation(s)
- Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, MA, United States of America.
| |
Collapse
|
18
|
Petteway R, Mujahid M, Allen A, Morello-Frosch R. Towards a People's Social Epidemiology: Envisioning a More Inclusive and Equitable Future for Social Epi Research and Practice in the 21st Century. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3983. [PMID: 31635327 PMCID: PMC6843593 DOI: 10.3390/ijerph16203983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/13/2019] [Accepted: 10/16/2019] [Indexed: 12/17/2022]
Abstract
Social epidemiology has made critical contributions to understanding population health. However, translation of social epidemiology science into action remains a challenge, raising concerns about the impacts of the field beyond academia. With so much focus on issues related to social position, discrimination, racism, power, and privilege, there has been surprisingly little deliberation about the extent and value of social inclusion and equity within the field itself. Indeed, the challenge of translation/action might be more readily met through re-envisioning the role of the people within the research/practice enterprise-reimagining what "social" could, or even should, mean for the future of the field. A potential path forward rests at the nexus of social epidemiology, community-based participatory research (CBPR), and information and communication technology (ICT). Here, we draw from social epidemiology, CBPR, and ICT literatures to introduce A People's Social Epi-a multi-tiered framework for guiding social epidemiology in becoming more inclusive, equitable, and actionable for 21st century practice. In presenting this framework, we suggest the value of taking participatory, collaborative approaches anchored in CBPR and ICT principles and technological affordances-especially within the context of place-based and environmental research. We believe that such approaches present opportunities to create a social epidemiology that is of, with, and by the people-not simply about them. In this spirit, we suggest 10 ICT tools to "socialize" social epidemiology and outline 10 ways to move towards A People's Social Epi in practice.
Collapse
Affiliation(s)
- Ryan Petteway
- OHSU-PSU School of Public Health, Portland State University, Portland, OR 97201, USA.
| | - Mahasin Mujahid
- School of Public Health, University of California, Berkeley, CA 94720, USA.
| | - Amani Allen
- School of Public Health, University of California, Berkeley, CA 94720, USA.
| | | |
Collapse
|
19
|
Clarke B, Ghiara V, Russo F. Time to care: why the humanities and the social sciences belong in the science of health. BMJ Open 2019; 9:e030286. [PMID: 31462483 PMCID: PMC6720150 DOI: 10.1136/bmjopen-2019-030286] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/20/2019] [Accepted: 07/19/2019] [Indexed: 11/04/2022] Open
Abstract
Health is more than the absence of disease. It is also more than a biological phenomenon. It is inherently social, psychological, cultural and historical. While this has been recognised by major health actors for decades, open questions remain as to how to build systems that reflect the complexity of health, disease and sickness, and in a context that is increasingly technologised. We argue that an urgent change of approach is necessary. Methods and concepts from the humanities and social science must be embedded in the concepts and methods of the health sciences if we are to promote sustainable interventions capable of engaging with the recognised complexity of health, disease and sickness. Our vision is one of radical interdisciplinarity, integrating aspects of biological, psychological, social and humanities approaches across areas of urgent health need. Radical interdisciplinarity, we argue, entails the practical, methodological and conceptual integration of these approaches to health.
Collapse
Affiliation(s)
- Brendan Clarke
- Department of Science & Technology Studies, University College London, London, United Kingdom
| | - Virginia Ghiara
- Department of Philosophy, University of Kent, Canterbury, Kent, UK
| | - Federica Russo
- Department of Philosophy, Universiteit van Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
20
|
Making a Realist Turn: Applying a Critical Realist Translational Social Epidemiology Methodology to the Design and Evaluation of Complex Integrated Care Interventions. Int J Integr Care 2019; 19:7. [PMID: 31367206 PMCID: PMC6659754 DOI: 10.5334/ijic.4725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
21
|
A Critical Realist Translational Social Epidemiology Protocol for Concretising and Contextualising a "Theory of Neighbourhood Context, Stress, Depression, and the Developmental Origins of Health and Disease (DOHaD)", Sydney Australia. Int J Integr Care 2019; 19:8. [PMID: 31367207 PMCID: PMC6659581 DOI: 10.5334/ijic.3962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: We will describe here a translational social epidemiology protocol for confirming a critical realist “Theory of Neighbourhood Context, Stress, Depression, and the Developmental Origins of Health and Disease (DOHaD). The approach will include the concretising and contextualising of the above causal theory into programme theories for child and adolescent interventions that aim to break intergenerational cycles of disadvantage and poor life outcomes. In undertaking this work we seek to advance realist translational methodology within the discipline of applied perinatal and paediatric social epidemiology. Theory and Methods: The research settings are in metropolitan Sydney. The design will be a longitudinal, multi-level, mixed method realist evaluation of applied programme interventions that seek to break the intergeneration cycle of social disadvantage and poor child health and developmental outcomes. The programme of research will consist of three components: 1) Operationalisation of the theory and designing of programme initiatives for implementation; 2) Evaluation of the translated programme and implementation theory using Theory of Change and critical realist evaluation; and 3) Theory Testing of realist hypotheses using both intensive and extensive critical realist research methods including realist structural modelling. Discussion: The proposed programme of research will assist in translating empirical explanatory theory building to theory driven interventions. The research will be situated in socially disadvantaged regions of Sydney where the local child and family inter-agencies will collaborate to design and implement new initiatives that address significant disparities in childhood development and adolescent outcomes attributed to neighbourhood circumstances, family stress and intergenerational cycles of disadvantage and poor mental health.
Collapse
|
22
|
Abstract
Introduction: Intergenerational cycles of poverty, violence and crime, poor education and employment opportunities, psychopathology, and poor lifestyle and health behaviours require innovative models of health care delivery to break them. We describe a programme of research informed service development targeting vulnerable families in inner metropolitan Sydney, Australia that is designed to build and confirm a “Theory of Neighbourhood Context, Stress, Depression, and the Developmental Origins of Health and Disease (DOHaD)”. We describe the development of an intervention design and business case that drew on earlier realist causal and programme theoretical work. Methods: Realist causal and programme theory were used to inform the collaborative design of initiatives for vulnerable families. The collaborative design process included: identification of desirable and undesirable outcomes and contextual factors, consultation forums, interagency planning, and development of a service proposal. Results: The design elements included: perinatal coordination, sustained home visiting, integrated service model development, two place-based hubs, health promotion and strengthened research and analysis capability. Conclusions: We demonstrate here the design of interventions for vulnerable families in Sydney utilising translational research from previous realist causal and program theory building to operational service design. We have identified the importance of our earlier analysis of underlying causal mechanisms and related programme mechanisms for identifying the elements for the full intervention design. The application of theory added rigour to the design of the integrated care initiatives. In applying the theory to the local situation the analysis took into account: the role of the local agencies; evidence of program effectiveness; determinants and outcomes for local children and their families; the current deployment of service resources; and insights from front-line staff and interagency partners.
Collapse
|
23
|
Whither Occupational Class Health Gradients?: Why We Need More Social Class Theory, Mechanisms, Indicators, and Scientific Realism. Epidemiology 2019; 30:445-448. [PMID: 30964815 DOI: 10.1097/ede.0000000000000994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
24
|
Muntaner C, Augustinavicius J. Intersectionality: A Scientific Realist Critique. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:39-41. [PMID: 31543026 DOI: 10.1080/15265161.2018.1557296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
25
|
Shankardass K, O'Campo P, Muntaner C, Bayoumi AM, Kokkinen L. Ideas for Extending the Approach to Evaluating Health in All Policies in South Australia Comment on "Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia". Int J Health Policy Manag 2018; 7:755-757. [PMID: 30078296 PMCID: PMC6077279 DOI: 10.15171/ijhpm.2018.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/07/2018] [Indexed: 11/09/2022] Open
Abstract
Since 2008, the government of South Australia has been using a Health in All Policies (HiAP) approach to achieve their strategic plan (South Australia Strategic Plan of 2004). In this commentary, we summarize some of the strengths and contributions of the innovative evaluation framework that was developed by an embedded team of academic researchers. To inform how the use of HiAP is evaluated more generally, we also describe several ideas for extending their approach, including: deeper integration of interdisciplinary theory (eg, public health sciences, policy and political sciences) to make use of existing knowledge and ideas about how and why HiAP works; including a focus on implementation outcomes and using developmental evaluation (DE) partnerships to strengthen the use of HiAP over time; use of systems theory to help understand the complexity of social systems and changing contexts involved in using HiAP; integrating economic considerations into HiAP evaluations to better understand the health, social and economic benefits and trade-offs of using HiAP.
Collapse
Affiliation(s)
- Ketan Shankardass
- Wilfrid Laurier University, Waterloo, ON, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada
| | - Patricia O'Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Carles Muntaner
- Bloomberg School of Nursing, University of Toronto, Toronto, ON, Canada
| | - Ahmed M Bayoumi
- Centre for Urban Health Solutions, Li Ka Shing Knowedge Institute, Toronto, ON, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lauri Kokkinen
- Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland
| |
Collapse
|
26
|
|
27
|
Muntaner C, Mahabir DF. Just Say No to the TPP: A Democratic Setback for American and Asian Public Health Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?". Int J Health Policy Manag 2017; 6:419-421. [PMID: 28812839 PMCID: PMC5505113 DOI: 10.15171/ijhpm.2016.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/31/2016] [Indexed: 11/20/2022] Open
Abstract
The article by Labonté, Schram, and Ruckert is a significant and timely analysis of the Trans-Pacific Partnership (TPP) policy and the severe threats to public health that it implies for 12 Pacific Rim populations from the Americas and Asia (Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, United States, and Vietnam). With careful and analytic precision the authors convincingly unearth many aspects of this piece of legislation that undermine the public health achievements of most countries involved in the TTP. Our comments complement their policy analysis with the aim of providing a positive heuristic tool to assist in the understanding of the TPP, and other upcoming treaties like the even more encompassing Transatlantic Trade and Investment Partnership (TTIP), and in so doing motivate the public health community to oppose the implementation of the relevant provisions of the agreements. The aims of this commentary on the study of Labonté et al are to show that an understanding of the health effects of the TPP is incomplete without a political analysis of policy formation, and that realist methods can be useful to uncover the mechanisms underlying TPP’s political and policy processes.
Collapse
Affiliation(s)
- Carles Muntaner
- Bloomberg Faculty of Nursing University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Deb Finn Mahabir
- Bloomberg Faculty of Nursing University of Toronto, Toronto, ON, Canada
| |
Collapse
|
28
|
Muntaner C, Davis O, McIsaack K, Kokkinen L, Shankardass K, O’Campo P. Retrenched Welfare Regimes Still Lessen Social Class Inequalities in Health. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2017. [DOI: 10.1177/0020731417712509] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article builds on recent work that has explored how welfare regimes moderate social class inequalities in health. It extends research to date by using longitudinal data from the EU-SILC (2003–2010) and examines how the relationship between social class and self-reported health and chronic conditions varies across 23 countries, which are split into five welfare regimes (Nordic, Anglo-Saxon, Eastern, Southern, and Continental). Our analysis finds that health across all classes was only worse in Eastern Europe (compared with the Nordic countries). In contrast, we find evidence that the social class gradient in both measures of health was significantly wider in the Anglo-Saxon and Southern regimes. We suggest that this evidence supports the notion that welfare regimes continue to explain differences in health according to social class location. We therefore argue that although downward pressures from globalization and neoliberalism have blurred welfare regime typologies, the Nordic model may continue to have an important mediating effect on class-based inequalities in health.
Collapse
Affiliation(s)
- C. Muntaner
- Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - O. Davis
- School of Social Policy, Sociology and Social Research, University of Kent, UK
| | - K. McIsaack
- Nova Scotia Health Authority, Research Services, Nova Scotia, Canada
| | - L. Kokkinen
- Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland
| | - K. Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Centre for Urban Health Solutions, The Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - P. O’Campo
- Centre for Urban Health Solutions, The Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Muntaner C. The missing link in precariousness research. CAD SAUDE PUBLICA 2017; 32:S0102-311X2016000600506. [PMID: 27333147 DOI: 10.1590/0102-311xco060516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada, University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto , Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada, University of Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto , Canada
| |
Collapse
|
30
|
Mulinari S, Wemrell M, Rönnerstrand B, Subramanian SV, Merlo J. Categorical and anti-categorical approaches to US racial/ethnic groupings: revisiting the National 2009 H1N1 Flu Survey (NHFS). CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1316831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Shai Mulinari
- Faculty of Social Sciences, Department of Sociology, Lund University, Lund, Sweden
- Faculty of Medicine, Department of Clinical Sciences, Unit of Social Epidemiology, Lund University, Malmö, Sweden
| | - Maria Wemrell
- Faculty of Medicine, Department of Clinical Sciences, Unit of Social Epidemiology, Lund University, Malmö, Sweden
| | - Björn Rönnerstrand
- Department of Political Science, University of Gothenburg, Göteborg, Sweden
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
| | - Juan Merlo
- Faculty of Medicine, Department of Clinical Sciences, Unit of Social Epidemiology, Lund University, Malmö, Sweden
- Center for Primary Health Care Research, Region Skåne, Malmö, Sweden
| |
Collapse
|
31
|
Muntaner C. Global precarious employment and health inequalities: working conditions, social class, or precariat? CAD SAUDE PUBLICA 2017; 32:S0102-311X2016000600501. [PMID: 27333138 DOI: 10.1590/0102-311x00162215] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/15/2015] [Indexed: 11/22/2022] Open
Abstract
Changes in employment conditions since the 1980s have been referred to as precarious employment, and terms like flexible, atypical, temporary, part-time, contract, self-employed, irregular, or non-standard employment have also been used. In this essay I review some of the current critiques to the precarious employment construct and advance some potential solutions for its use in epidemiology and public health.
Collapse
Affiliation(s)
- Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada., University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto , Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada., University of Toronto, Dalla Lana School of Public Health, University of Toronto, Toronto , Canada
| |
Collapse
|
32
|
Government, politics and health policy: Ways forward from Mackenbach and McKee's study. Health Policy 2016; 120:856-9. [DOI: 10.1016/j.healthpol.2016.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/15/2016] [Indexed: 11/20/2022]
|
33
|
Schwartz S, Gatto NM, Campbell UB. Causal identification: a charge of epidemiology in danger of marginalization. Ann Epidemiol 2016; 26:669-673. [PMID: 27237595 DOI: 10.1016/j.annepidem.2016.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/21/2016] [Accepted: 03/14/2016] [Indexed: 11/16/2022]
Abstract
The requirement for framing all causal questions as well-defined interventions is being promoted in the causal inference literature within epidemiology. One can consider this perspective as an intervention on the field which requires a refocusing of epidemiologic questions and retooling of epidemiologic methods. Although this intervention has produced many positive results, we think that its underlying assumptions and the possibilities of unintended consequences warrant examination. In so doing, we argue that this approach can lead to the neglect of causal identification as a useful link between associations and the estimation of intervention effects.
Collapse
Affiliation(s)
- Sharon Schwartz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
| | - Nicolle M Gatto
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Epidemiology, Worldwide Safety and Regulatory, Pfizer Inc., New York, NY
| | - Ulka B Campbell
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Epidemiology, Worldwide Safety and Regulatory, Pfizer Inc., New York, NY
| |
Collapse
|
34
|
Counterfactual Theory in Social Epidemiology: Reconciling Analysis and Action for the Social Determinants of Health. CURR EPIDEMIOL REP 2015. [DOI: 10.1007/s40471-014-0030-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
35
|
|
36
|
Naimi AI, Moodie EEM, Auger N, Kaufman JS. Stochastic mediation contrasts in epidemiologic research: interpregnancy interval and the educational disparity in preterm delivery. Am J Epidemiol 2014; 180:436-45. [PMID: 25038216 DOI: 10.1093/aje/kwu138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Low maternal education is consistently associated with increased risk of preterm delivery (PTD). The interpregnancy interval (IPI), defined as the time between the date of a previous birth and the conception date of the index pregnancy, may mediate this relationship. We estimated controlled direct effects to assess whether hypothetical interventions designed to increase IPIs would reduce the educational disparity in PTD. We introduce a technique for estimating controlled direct effects under interventions that set only some persons in the population to a specific mediator value. We used data from 847,618 singleton livebirths occurring in Quebec, Canada, between 1989 and 2010. Compared with mothers with some university education (≥14 years), mothers with less than high school (<11 years), high school (11 years), and some college (12-13 years) had excess PTD risks of 2.6% (95% confidence interval (CI): 2.4, 2.8), 1.5% (95% CI: 1.4, 1.7), and 1.0% (95% CI: 0.9, 1.1), respectively. Risk differences under an intervention corresponding to the Healthy People 2020 objective of reducing the number of mothers with IPIs less than 18 months by 3% were no different from those for the total relationship. Our results suggest that interventions designed to increase the length of short IPIs will yield no important change in the PTD disparity by maternal educational level.
Collapse
|
37
|
A Critical Approach to Macrosocial Determinants of Population Health: Engaging Scientific Realism and Incorporating Social Conflict. CURR EPIDEMIOL REP 2014. [DOI: 10.1007/s40471-013-0002-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
38
|
|
39
|
Galea S, Link BG. Galea and Link respond to "Pathologies of social epidemiology," "Social epidemiology and scientific realism," and "Off-roading with social epidemiology". Am J Epidemiol 2013; 178:864. [PMID: 24008914 DOI: 10.1093/aje/kwt147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|