1
|
Bridger EK. Subjective socioeconomic status and agreement that health is determined by distal and proximal factors. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2023; 58:536-544. [PMID: 37337347 DOI: 10.1002/ijop.12928] [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: 07/05/2022] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
This report examines whether a person's subjective view of their rank relative to others in society-subjective socioeconomic status (SES)-is systematically related to views on distal and proximal determinants of ill-health. This was tested using cross-sectional data from 28,718 respondents from 27 countries who took part in the International Social Survey Programme (ISSP) in 2011. Adjusting for age and gender as well as income and education, mixed logistic regression models showed that subjective SES was negatively associated with the likelihood of agreeing with distal explanations for poor health (being poor or because of work/life environment) and positively associated with the likelihood of agreeing with health-related behaviours as a cause for poor health. Subjective SES was not related to agreement that genes influence health. These analyses introduce a social psychological factor into the lay understanding of health determinants and extend models of subjective status and attributional style to health explanations.
Collapse
Affiliation(s)
- Emma K Bridger
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
2
|
Hunt L, Pettinger C, Wagstaff C. A critical exploration of the diets of UK disadvantaged communities to inform food systems transformation: a scoping review of qualitative literature using a social practice theory lens. BMC Public Health 2023; 23:1970. [PMID: 37821837 PMCID: PMC10568843 DOI: 10.1186/s12889-023-16804-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/21/2023] [Indexed: 10/13/2023] Open
Abstract
The UK food system affects social, economic and natural environments and features escalating risk of food insecurity. Yet it should provide access to safe, nutritious, affordable food for all citizens. Disadvantaged UK communities [individuals and families at risk of food and housing insecurity, often culturally diverse] have often been conceptualised in terms of individual behaviour which may lead to findings and conclusions based on the need for individual change. Such communities face public health challenges and are often treated as powerless recipients of dietary and health initiatives or as 'choiceless' consumers within food supply chains. As transforming the UK food system has become a national priority, it is important a diverse range of evidence is used to support understanding of the diets of disadvantaged communities to inform food systems transformation research.A scoping review of UK peer reviewed qualitative literature published in MEDLINE, CINAHL Plus with Full Text, EMBASE, PsycINFO and Web of Science between January 2010 and May 2021 in English. Eligibility criteria were applied, a data extraction table summarised data from included studies, and synthesis using social practice theory was undertaken.Forty-five qualitative studies were reviewed, which included the views of 2,434 community members aged between 5 and 83. Studies used different measures to define disadvantage. Synthesis using social practice theory identified themes of food and dietary practices shaped by interactions between 'material factors' (e.g. transport, housing and money), 'meanings' (e.g. autonomy and independence), and 'competencies' (e.g. strategies to maximise food intake). These concepts are analysed and critiqued in the context of the wider literature to inform food systems transformation research.This review suggests to date, qualitative research into diets of UK disadvantaged communities provides diverse findings that mainly conceptualise disadvantage at an individual level. Whilst several studies provide excellent characterisations of individual experience, links to 'macro' processes such as supply chains are largely missing. Recommendations are made for future research to embrace transdisciplinary perspectives and utilise new tools (e.g., creative methods and good practice guides), and theories (e.g., assemblage) to better facilitate food systems transformation for disadvantaged communities.
Collapse
Affiliation(s)
- Louise Hunt
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK.
| | - Clare Pettinger
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Carol Wagstaff
- Department of Food and Nutritional Sciences, University of Reading, Reading, UK
| |
Collapse
|
3
|
Stewart E, Pearce A, Given J, Gilbert R, Brophy S, Cookson R, Hardelid P, Harron KL, Leyland A, Wood R, Dundas R. Identifying opportunities for upstream evaluations relevant to child and maternal health: a UK policy-mapping review. Arch Dis Child 2023; 108:556-562. [PMID: 37001969 PMCID: PMC10314013 DOI: 10.1136/archdischild-2022-325219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/19/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Interventions to tackle the social determinants of health can improve outcomes during pregnancy and early childhood, leading to better health across the life course. Variation in content, timing and implementation of policies across the 4 UK nations allows for evaluation. We conducted a policy-mapping review (1981-2021) to identify relevant UK early years policies across the social determinants of health framework, and determine suitable candidates for evaluation using administrative data. METHODS We used open keyword and category searches of UK and devolved Government websites, and hand searched policy reviews. Policies were rated and included using five criteria: (1) Potential for policy to affect maternal and child health outcomes; (2) Implementation variation across the UK; (3) Population reach and expected effect size; (4) Ability to identify exposed/eligible group in administrative data; (5) Potential to affect health inequalities. An expert consensus workshop determined a final shortlist. RESULTS 336 policies and 306 strategy documents were identified. Policies were mainly excluded due to criteria 2-4, leaving 88. The consensus workshop identified three policy areas as suitable candidates for natural experiment evaluation using administrative data: pregnancy grants, early years education and childcare, and Universal Credit. CONCLUSION Our comprehensive policy review identifies valuable opportunities to evaluate sociostructural impacts on mother and child outcomes. However, many potentially impactful policies were excluded. This may lead to the inverse evidence law, where there is least evidence for policies believed to be most effective. This could be ameliorated by better access to administrative data, staged implementation of future policies or alternative evaluation methods.
Collapse
Affiliation(s)
- Emma Stewart
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Joanne Given
- School of Nursing and Paramedic Science, Ulster University, Coleraine, Londonderry, UK
| | - Ruth Gilbert
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Richard Cookson
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - Pia Hardelid
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Katie L Harron
- Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rachael Wood
- Public Health Scotland, Edinburgh, UK
- Usher Institute, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| |
Collapse
|
4
|
Cairney P, St.Denny E, Boswell J. Why is health improvement policy so difficult to secure? OPEN RESEARCH EUROPE 2022; 2:76. [PMID: 37645286 PMCID: PMC10445925 DOI: 10.12688/openreseurope.14841.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 08/31/2023]
Abstract
Many governments seek to improve population health, and some seek to reduce health inequalities. Yet, there remains a large gap between their policy statements and actual outcomes. Perennial questions in public health research include: why is this gap so large, why does it endure, and what can be done to close it? This essay uses political science and policy studies insights to address these questions, focusing on the distinctive issues that relate to (1) broad aims like 'prevention', (2) specific strategies for health improvement, or (3) new events. On the one hand, the idea of 'prevention' has widespread appeal, when governments think they can save money or reduce inequalities by preventing problems happening or worsening. While health protection seeks to inoculate populations against communicable diseases, health improvement strategies, including 'Health in All Policies' (HiAP), primarily address non-communicable diseases (NCDs). Further, the coronavirus disease 2019 (COVID-19) pandemic highlights the unequal spread of ill health, showing that preventive health ideas should be at the core of policy. On the other hand, there is a large gap between rhetorical and substantive commitment to prevention, a continuous HiAP implementation gap, and a tendency for COVID-19 health protection to overshadow health improvement. Explaining each problem clearly helps to identify the factors that generally undermine prevention policies and those specific to more detailed strategies like HiAP or events like COVID-19. We do not prioritise leadership or 'political will' as the policymaking problem. Instead, we identify the systemic factors that apply to even the most sincere, competent, and energetic policymakers. Health improvement policy is typically undermined by a lack of: clarity about what prevention means in practice; congruity between the prevention agenda (emphasising the need for major change to policy and policymaking) and routine government business; and, capacity to overcome obstacles to policy change.
Collapse
Affiliation(s)
- Paul Cairney
- Division of History, Heritage, and Policy, University of Stirling, Stirling, Stirling, FK94LA, UK
| | - Emily St.Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - John Boswell
- Politics and International Relations, University of Southampton, Southampton, SO17 1BJ, UK
| |
Collapse
|
5
|
Logie CH, Sokolovic N, Kazemi M, Islam S, Frank P, Gormley R, Kaida A, de Pokomandy A, Loutfy M. Does resource insecurity drive HIV-related stigma? Associations between food and housing insecurity with HIV-related stigma in cohort of women living with HIV in Canada. J Int AIDS Soc 2022; 25 Suppl 1:e25913. [PMID: 35818863 PMCID: PMC9274209 DOI: 10.1002/jia2.25913] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/28/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Women living with HIV across global contexts are disproportionately impacted by food insecurity and housing insecurity. Food and housing insecurity are resource insecurities associated with poorer health outcomes among people living with HIV. Poverty, a deeply stigmatized phenomenon, is a contributing factor towards food and housing insecurity. HIV-related stigma-the devaluation, mistreatment and constrained access to power and opportunities experienced by people living with HIV-intersects with structural inequities. Few studies, however, have examined food and housing insecurity as drivers of HIV-related stigma. This study aimed to estimate the associations between food and housing insecurity with HIV-related stigma among women living with HIV in Canada. METHODS This prospective cohort study of women living with HIV (≥16 years old) in three provinces in Canada involved three waves of surveys collected at 18-month intervals between 2013 and 2018. To understand associations between food and housing security and HIV-related stigma, we conducted linear mixed effects regression models. We adjusted for socio-demographic characteristics associated with HIV-related stigma. RESULTS AND DISCUSSION Among participants (n = 1422), more than one-third (n = 509; 36%) reported baseline food insecurity and approximately one-tenth (n = 152, 11%) housing insecurity. Mean HIV-related stigma scores were consistent across waves 1 (mean [M] = 57.2, standard deviation [SD] = 20.0, N = 1401) and 2 (M = 57.4, SD = 19.0, N = 1227) but lower at wave 3 (M = 52.8, SD = 18.7, N = 918). On average, across time, food insecure participants reported HIV-related stigma scores that were 8.6 points higher (95% confidence interval [CI]: 6.4, 10.8) compared with food secure individuals. Similarly, participants reporting insecure housing at wave 1 tended to experience greater HIV-related stigma (6.2 points, 95% CI: 2.7, 9.6) over time compared to stably housed participants. There was an interaction between time and housing insecurity, whereby baseline housing insecurity was no longer associated with higher HIV-related stigma at the third wave. CONCLUSIONS Among women living with HIV in Canada, experiencing food and housing insecurity was associated with consistently higher levels of HIV-related stigma. In addition to the urgent need to tackle food and housing insecurity among people living with HIV to optimize wellbeing, getting to the heart of HIV-related stigma requires identifying and dismantling resource insecurity-related stigma drivers.
Collapse
Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, Canada
| | - Nina Sokolovic
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Mina Kazemi
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Shaz Islam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Alliance for South Asian AIDS Prevention, Toronto, Ontario, Canada
| | - Peggy Frank
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Alexandra de Pokomandy
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mona Loutfy
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
6
|
Dawson ER, Stennett M, Daly B, Macpherson LMD, Cannon P, Watt RG. Upstream interventions to promote oral health and reduce socioeconomic oral health inequalities: a scoping review protocol. BMJ Open 2022; 12:e059441. [PMID: 35738648 PMCID: PMC9226867 DOI: 10.1136/bmjopen-2021-059441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Improving oral health and reducing oral health inequalities is an important global health priority. 'Upstream interventions' are a vital part of the collective effort to reduce oral disease burdens, however it is a rather nebulous term. Furthermore, there is little evidence on the effectiveness, impact and sustainability of upstream interventions that have focused on oral health and wider public health measures that impact on oral health. The aim of this scoping review is to systematically map and synthesise evidence on the effectiveness, impact and sustainability of upstream interventions on population oral health and reducing socioeconomic oral health inequalities. METHODS AND ANALYSIS This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. A detailed search strategy will be used to conduct a comprehensive search of electronic databases: Scopus, Embase and MEDLINE, PsycINFO and CINAHL, ASSIA and Cochrane Database of Systematic Reviews. A search of grey literature will also be completed to identify relevant dissertations, governmental reports and evaluations of implemented policies. Identification and extraction of data will be performed by two pairs of reviewers. Oversight and feedback will be provided by an independent expert advisory group. ETHICS AND DISSEMINATION This study will review published and available grey literature and does not require an ethics review. The scoping review protocol has been registered with the Open Science Framework. The final report will be circulated and disseminated through publication and feed into the work of the ongoing Lancet Commission on Oral Health. Due to the policy relevance of this work, discussions will take place with key stakeholders regarding the implications of the findings for future policy development.
Collapse
Affiliation(s)
- Eleanor R Dawson
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Michelle Stennett
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Blánaid Daly
- Division of Public and Child Dental Health, Dublin Dental University Hospital and Dental School, Trinity College Dublin, Dublin, Ireland
| | - Lorna M D Macpherson
- Department of Dental Public Health, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Paul Cannon
- University Library, University of Glasgow, Glasgow, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| |
Collapse
|
7
|
Fairbrother H, Woodrow N, Crowder M, Holding E, Griffin N, Er V, Dodd-Reynolds C, Egan M, Lock K, Scott S, Summerbell C, McKeown R, Rigby E, Kyle P, Goyder E. ‘It All Kind of Links Really’: Young People’s Perspectives on the Relationship between Socioeconomic Circumstances and Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063679. [PMID: 35329365 PMCID: PMC8950291 DOI: 10.3390/ijerph19063679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 02/01/2023]
Abstract
Meaningful inclusion of young people’s perceptions and experiences of inequalities is argued to be critical in the development of pro-equity policies. Our study explored young people’s perceptions of what influences their opportunities to be healthy within their local area and their understandings of health inequalities. Three interlinked qualitative focus group discussions, each lasting 90 to 100 min, with the same six groups of young people (n = 42) aged 13–21, were conducted between February and June 2021. Participants were recruited from six youth groups in areas of high deprivation across three geographical locations in England (South Yorkshire, the North East and London). Our study demonstrates that young people understand that health inequalities are generated by social determinants of health, which in turn influence behaviours. They highlight a complex interweaving of pathways between social determinants and health outcomes. However, they do not tend to think in terms of the social determinants and their distribution as resulting from the power and influence of those who create and benefit from health and social inequalities. An informed understanding of the causes of health inequalities, influenced by their own unique generational experiences, is important to help young people contribute to the development of pro-equity policies of the future.
Collapse
Affiliation(s)
- Hannah Fairbrother
- Health Sciences School, University of Sheffield, Sheffield S10 2LA, UK
- Correspondence:
| | - Nicholas Woodrow
- ScHARR, University of Sheffield, Sheffield S1 4DA, UK; (N.W.); (M.C.); (E.H.); (E.G.)
| | - Mary Crowder
- ScHARR, University of Sheffield, Sheffield S1 4DA, UK; (N.W.); (M.C.); (E.H.); (E.G.)
| | - Eleanor Holding
- ScHARR, University of Sheffield, Sheffield S1 4DA, UK; (N.W.); (M.C.); (E.H.); (E.G.)
| | - Naomi Griffin
- Department of Sport and Exercise Science, Fuse|Durham University, Durham DH1 3HN, UK; (N.G.); (C.D.-R.); (C.S.); (P.K.)
| | - Vanessa Er
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (V.E.); (M.E.); (K.L.)
| | - Caroline Dodd-Reynolds
- Department of Sport and Exercise Science, Fuse|Durham University, Durham DH1 3HN, UK; (N.G.); (C.D.-R.); (C.S.); (P.K.)
| | - Matt Egan
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (V.E.); (M.E.); (K.L.)
| | - Karen Lock
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (V.E.); (M.E.); (K.L.)
| | - Steph Scott
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 4LP, UK;
| | - Carolyn Summerbell
- Department of Sport and Exercise Science, Fuse|Durham University, Durham DH1 3HN, UK; (N.G.); (C.D.-R.); (C.S.); (P.K.)
| | - Rachael McKeown
- Association for Young People’s Health, London SE1 4YR, UK; (R.M.); (E.R.)
| | - Emma Rigby
- Association for Young People’s Health, London SE1 4YR, UK; (R.M.); (E.R.)
| | - Phillippa Kyle
- Department of Sport and Exercise Science, Fuse|Durham University, Durham DH1 3HN, UK; (N.G.); (C.D.-R.); (C.S.); (P.K.)
| | - Elizabeth Goyder
- ScHARR, University of Sheffield, Sheffield S1 4DA, UK; (N.W.); (M.C.); (E.H.); (E.G.)
| |
Collapse
|
8
|
Raphael D, Bryant T, Govender P, Medvedyuk S, Mendly-Zambo Z. Desperately seeking reductions in health inequalities in Canada: Polemics and anger mobilization as the way forward? SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:130-146. [PMID: 34741772 DOI: 10.1111/1467-9566.13399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 10/08/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
Progress in reducing health inequalities through public policy action is difficult in nations identified as liberal welfare states. In Canada, as elsewhere, researchers and advocates provide governing authorities with empirical findings on the sources of health inequalities and document the lived experiences of those encountering these adverse health outcomes with the hope of provoking public policy action. However, critical analysis of the societal structures and processes that make improving the sources of health inequalities difficult-the quality and distribution of living and working conditions, that is the social determinants of health-identifies limitations in these approaches. Within this latter critical tradition, we consider-using household food insecurity in Canada as an illustration-how polemics and anger mobilization, usually absent in health inequalities research and advocacy-could force Canadian governing authorities to reduce health inequalities through public policy action. We explore the potential of using high valence terms such as structural violence, social death and social murder, which make explicit the adverse outcomes of health-threatening public policy to force government action. We conclude by outlining the potential benefits and threats posed by polemics and anger mobilization as means of promoting health equity.
Collapse
Affiliation(s)
- Dennis Raphael
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Toba Bryant
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Piara Govender
- Graduate Program in Health Policy and Equity, York University, Toronto, Ontario, Canada
| | - Stella Medvedyuk
- Graduate Program in Health Policy and Equity, York University, Toronto, Ontario, Canada
| | - Zsofia Mendly-Zambo
- Graduate Program in Health Policy and Equity, York University, Toronto, Ontario, Canada
| |
Collapse
|