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Svalestuen S, Sari E, Langholz PL, Vo CQ. Exploring the variation in associations between socioeconomic indicators and non-communicable diseases in the Tromsø Study: an algorithmic approach. Scand J Public Health 2024:14034948241249519. [PMID: 38860312 DOI: 10.1177/14034948241249519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
AIMS We contribute to the methodological literature on the assessment of health inequalities by applying an algorithmic approach to evaluate the capabilities of socioeconomic variables in predicting the prevalence of non-communicable diseases in a Norwegian health survey. METHODS We use data from the seventh survey of the population based Tromsø Study (2015-2016), including 11,074 women and 10,009 men aged 40 years and above. We apply the random forest algorithm to predict four non-communicable disease outcomes (heart attack, cancer, diabetes and stroke) based on information on a number of social root causes and health behaviours. We evaluate our results using the classification error, the mean decrease in accuracy, partial dependence statistics. RESULTS Results suggest that education, household income and occupation to a variable extent contribute to predicting non-communicable disease outcomes. Prediction misclassification ranges between 25.1% and 35.4% depending on the non-communicable diseases under study. Partial dependences reveal mostly expected health gradients, with some examples of complex functional relationships. Out-of-sample model validation shows that predictions translate to new data input. CONCLUSIONS Algorithmic modelling can provide additional empirical detail and metrics for evaluating heterogeneous inequalities in morbidity. The extent to which education, income and occupation contribute to predicting binary non-communicable disease outcomes depends on both non-communicable diseases and socioeconomic indicator. Partial dependences reveal that social gradients in non-communicable disease outcomes vary in shape between combinations of non-communicable disease outcome and socioeconomic status indicator. Misclassification rates highlight the extent of variation within socioeconomic groups, suggesting that future studies may improve predictive accuracy by exploring further subpopulation heterogeneity.
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Affiliation(s)
- Sigbjørn Svalestuen
- Department of Social Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Health Services and Health Economics, NORCE Norwegian Research Centre AS, Tromsø, Norway
| | - Emre Sari
- Health Services and Health Economics, NORCE Norwegian Research Centre AS, Tromsø, Norway
| | - Petja Lyn Langholz
- Department of Archaeology, History, Religiuos Studies and Theology, UiT The Arctic University of Norway, Tromsø, Norway and
| | - Chi Quynh Vo
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Åsberg K, Eldh AC, Löf M, Bendtsen M. "Simply complicated": Uncovering the processes of lifestyle behavior change among college and university students with access to a digital multiple lifestyle intervention. Digit Health 2024; 10:20552076241245905. [PMID: 38601184 PMCID: PMC11005484 DOI: 10.1177/20552076241245905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
Background One approach to promoting healthy lifestyle behaviors is to target students with digital interventions. One of these is the digital intervention Buddy. This study aimed to understand why college and university students' chose to participate in a digital multiple lifestyle behavior intervention trial (Buddy), and their subsequent experiences of the behavior-change process. Methods College and university students taking part in a trial of the Buddy intervention were individually interviewed after completing the 4-month intervention. Participants were guided to narrate their experiences and actions that followed signing up. Altogether, 50 interviews were conducted via telephone. The verbatim transcribed texts were analyzed qualitatively. Results The analysis generated seven personas, which illustrated the students' different levels of engagement with the intervention and the behavior-change process. These were: the Occupied, the Kickstarter, the Aimless, the Reflective, the Goal-oriented, the Compliant, and the Personally developed. Buddy worked best for students who had clear ideas about what they wanted to change and why, and who were aware of their needs, and those who could translate information and reflection into action and had the mental and physical energy needed to make changes. Conclusions The progress of behavior change depends on the interaction between the digital mode of delivery, the intervention materials of Buddy, the individual's expectations, needs, and skills, and their current life situation. This suggests that designing lifestyle interventions could benefit from more often considering the various personas' different intentions, knowledge, and contexts. By doing so, interventions are likely to emerge that can better match different needs in the target population.
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Affiliation(s)
- Katarina Åsberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Erzse A, Desmond C, Hofman K, Barker M, Christofides NJ. Qualitative exploration of the constraints on mothers' and pregnant women's ability to turn available services into nutrition benefits in a low-resource urban setting, South Africa. BMJ Open 2023; 13:e073716. [PMID: 37993159 PMCID: PMC10668265 DOI: 10.1136/bmjopen-2023-073716] [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: 03/15/2023] [Accepted: 10/25/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVES Despite free primary healthcare services and social protection system for mothers and children, significant nutrition inequalities occur across the globe, including in South Africa. This study aimed to explore what determines mothers' ability to access and turn available services into nutrition benefits. DESIGN An exploratory qualitative study was conducted including semistructured interviews with employees from community-based organisations and focus groups with pregnant women and mothers. Discussions focused on existing services perceived as important to nutrition, differences in mothers' ability to benefit from these services, and the underlying unmet needs contributing to these disparities. Data were analysed thematically using a novel social needs framework developed for this study where social needs are defined as the requisites that can magnify (if unmet) or reduce (if met) variation in the degree to which individuals can benefit from existing services. SETTING A resource-constrained urban township, Soweto in Johannesburg. PARTICIPANTS Thirty mothers of infants (<1 year old) and 21 pregnant women attending 5 primary healthcare facilities participated in 7 focus groups, and 18 interviews were conducted with employees from 10 community-based organisations. RESULTS Mothers identified social needs related to financial planning, personal income stability, appropriate and affordable housing, access to government services, social support and affordable healthier foods. The degree to which these needs were met determined mothers' capabilities to benefit from eight services. These were clinic-based services including nutrition advice and social work support, social grants, food aid, community savings groups, poverty alleviation projects, skills training workshops, formal employment opportunities and crèches/school feeding schemes. CONCLUSION Findings demonstrate that while current social protection mechanisms and free health services are necessary, they are not sufficient to address nutrition inequalities. Women's social needs must also be met to ensure that services are accessed and used to improve the nutrition of all mothers and their children.
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Affiliation(s)
- Agnes Erzse
- SAMRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Chris Desmond
- SAMRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/Centre for Health Economics and Decision Science-PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- MRC Lifecourse Epidemiology Centre, University of Southampton, Faculty of Medicine, Southampton, UK
| | - Nicola Joan Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Finkenauer C, Boer M, Spitzer J, Weinberg D, Visser K, Jonker M, Stevens GWJM. Examining the role of civic attitudes in the link between family wealth and school dropout among tertiary vocational students. NPJ SCIENCE OF LEARNING 2023; 8:38. [PMID: 37714892 PMCID: PMC10504291 DOI: 10.1038/s41539-023-00189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/31/2023] [Indexed: 09/17/2023]
Abstract
This study examined the relationship between family wealth and school dropout among vocational education students (n = 1,231; mean age=17.81). It investigated whether (1) family affluence and adolescents' own perceptions and experiences of their family wealth (i.e., perceived family wealth, financial scarcity) predict dropout, (2) adolescents' civic attitudes (i.e., system justification, institutional trust) explain the association between family wealth and school dropout, and (3) trust in teachers buffers against the risk of dropout among students with lower civic attitudes. Multivariate models revealed that financial scarcity predicted dropout. Financial scarcity showed an indirect only effect on dropout through lower institutional trust, but not through system justification. Trust in teachers was neither associated with dropout, nor a moderator. Controlling for mental health problems did not affect these results. This study helps explain how students' experienced and perceived family wealth can affect their educational attainment, by reducing their trust in social institutions.
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Affiliation(s)
- Catrin Finkenauer
- Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands.
| | - Maartje Boer
- Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands
| | - Jenna Spitzer
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Dominic Weinberg
- Clinical Child and Family Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Kirsten Visser
- Department of Human Geography and Spatial Planning, Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
| | - Merel Jonker
- Department of Law, Faculty of Law, Economics and Governance, Utrecht University, Utrecht, The Netherlands
| | - Gonneke W J M Stevens
- Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands
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Clarke-Darrington J, McDonald T, Ali P. Digital capability: An essential nursing skill for proficiency in a post-COVID-19 world. Int Nurs Rev 2023; 70:291-296. [PMID: 37000673 DOI: 10.1111/inr.12839] [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: 08/09/2022] [Accepted: 02/08/2023] [Indexed: 04/01/2023]
Abstract
AIM We explored the importance of digital technologies to health responses during the COVID-19 pandemic. The benefits, challenges and barriers to developing digital capabilities are identified, and strategies to establish enduring digital proficiency among nurses and healthcare colleagues gained during the pandemic are canvassed. BACKGROUND Since the mid-20th century, technology uptake by health practitioners has prioritised digital information and communication technology. The COVID-19 pandemic accelerated the need to adapt digital communication to dangerous clinical workplaces. Organisational policies enabled digital capabilities to replace in-person processes while preserving regulatory compliance, safety and security of patient information and staff deployment. SOURCES OF EVIDENCE All evidence was accessed from publicly available sources. DISCUSSION The COVID-19 pandemic was a catalyst for implementing Technology Enhanced Care Services. Health practitioners need appropriate digital capabilities for their roles and scope of practice. Nursing proficiency includes technological skills. Combining the Jisc Digital Capability Framework and the Health and Care Digital Capabilities Framework helps nurses achieve the technical expertise needed for clinical proficiency in contemporary healthcare environments. CONCLUSION Healthcare workforce digital capability requires policies that resource digital technologies and individual user skills in dangerous COVID-19 workplaces. All involved must be abreast of technological changes and monitor technology effectiveness in innovation in patient care, professional education and evidence-based infectious disease management of healthcare systems. IMPLICATIONS FOR NURSING PRACTICE AND POLICY Nurses and other practitioners in COVID-19-compromised settings must be able to use the embedded digital technologies in patient care, clinical management and education. Policies securing resources for nurses to learn to use digital technologies will ensure that digital systems are regularly upgraded and that nurses develop proficiency in using technology in their clinical practice. Work and workplace redesign needs compatible computer systems and software to support nursing innovation and digital proficiency.
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Affiliation(s)
| | | | - Parveen Ali
- Professor of Nursing and Gender Based Violence, University of Sheffield, Sheffield, UK
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Jester DJ, Thomas ML, Sturm ET, Harvey PD, Keshavan M, Davis BJ, Saxena S, Tampi R, Leutwyler H, Compton MT, Palmer BW, Jeste DV. Review of Major Social Determinants of Health in Schizophrenia-Spectrum Psychotic Disorders: I. Clinical Outcomes. Schizophr Bull 2023; 49:837-850. [PMID: 37022779 PMCID: PMC10318890 DOI: 10.1093/schbul/sbad023] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Social determinants of health (SDoHs) are receiving growing attention and are particularly relevant to persons with schizophrenia-spectrum psychotic disorders (SSPDs), considering their heightened risk of comorbidities, cognitive and functional decline, and early mortality. Yet, we did not find any comprehensive review of multiple SDoHs in SSPD. STUDY DESIGN We conducted a scoping review of meta-analyses and systematic reviews of nine major SDoHs in SSPD. STUDY RESULTS Childhood abuse, parental psychopathology, parental communication problems, bullying, and urban settings with lower socioeconomic status were major risk factors for the greater incidence of SSPD and/or worse health. Social network size was inversely associated with overall psychopathology and negative symptoms. Experiences of racial/ethnic discrimination correlated with the prevalence of psychotic symptoms and experiences. Compared to native populations, the risk of psychosis was higher in immigrants, refugees, and asylees. Social fragmentation was associated with an increased prevalence of schizophrenia. Homeless populations had a 30-fold higher prevalence of schizophrenia than the general population. Seriously mentally ill people were 2.7 times more likely to report food insecurity than controls. The prevalence of non-affective psychosis in prisoners was 2.0%-6.5%, compared to 0.3% in the general population. Certain potentially positive factors like family and community resilience remain poorly studied. CONCLUSIONS SDoHs are associated with higher rates of and worse outcomes in SSPD. Well-designed longitudinal studies are needed to understand SDoHs' contribution to health in persons with SSPD, to develop interventions, and to implement changes in clinical care and public health policies that would reduce adverse health impacts of SDoHs. Positive SDoHs deserve greater attention.
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Affiliation(s)
- Dylan J Jester
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Emily T Sturm
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Philip D Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine, and Research Service, Bruce W. Carter Miami VA Medical Center, Miami, FL, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Beth Israel Deaconess medical Center and Harvard Medical School, Boston, MA, USA
| | - Beshaun J Davis
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Shekhar Saxena
- Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rajesh Tampi
- Department of Psychiatry, Creighton University School of Medicine, Omaha, NE, USA
| | - Heather Leutwyler
- Department of Physiological Nursing, University of California, San Francisco, CA, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, CA, USA
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Green H, MacPhail C, Fernandez R. "I just wanted money for food": a qualitative study of the experiences of Australians during the COVID-19 pandemic. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-12. [PMID: 37361318 PMCID: PMC10241130 DOI: 10.1007/s10389-023-01952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
Aim The social and economic impacts that have occurred during the COVID-19 pandemic can disproportionally affect those already experiencing poverty or at risk of poverty. Therefore, this study sought to explore the relationship between well-being and social determinants of health among Australian adults during the pandemic. Subject and Methods Semi-structured interviews were undertaken with 20 participants, aged 21-65 years, from various socioeconomic areas. Results Three main themes emerged from the analysis of the data: food security; housing outcomes; and psychological and emotional impact. Participants in low socioeconomic areas struggled with food security, having to access food banks, which was precipitated by employment loss during the pandemic. Some female participants experienced worsening inequalities and lack of financial and housing stability, affecting their overall well-being. Conclusion This study identified that there was a clear social divide between adults living in low socioeconomic areas compared with those living in high socioeconomic areas, with participants in low socioeconomic areas faring worse in terms of exacerbated social determinants of health and consequent impacts on well-being.
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Affiliation(s)
- Heidi Green
- School of Health and Society, University of Wollongong, Wollongong, NSW Australia
- Centre for Evidence Based Initiatives in Health Care: A JBI Centre of Excellence, St George Hospital, Kogarah, NSW Australia
| | - Catherine MacPhail
- School of Health and Society, University of Wollongong, Wollongong, NSW Australia
| | - Ritin Fernandez
- School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW Australia
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Aran N, Card KG, Lee K, Hogg RS. Patterns of Suicide and Suicidal Ideation in Relation to Social Isolation and Loneliness in Newcomer Populations: A Review. J Immigr Minor Health 2023; 25:415-426. [PMID: 36348251 PMCID: PMC9643969 DOI: 10.1007/s10903-022-01422-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
The purpose of this systematic review was to locate and synthesise existing peer-reviewed quantitative and qualitative evidence regarding the relationship between social connection and suicide among newcomers, immigrants, and asylum seekers. Systematic searches were conducted according to PRISMA guidelines using Web of Science and Pubmed. Search terms included those related to (1) social isolation and loneliness, (2) suicide and suicidal ideation, and (3) newcomer, immigrant, and asylum-seeking populations. Inclusion was limited to studies that were published in English and conducted between January 2001 and July 2021 in core anglosphere countries (Canada, United States, Australia, United Kingdom, Scotland, Wales, and Ireland). All potentially eligible articles were screened at two stages: First, we reviewed title and abstracts to omit obviously irrelevant studies and second, we reviewed the full text of each candidate article. Our initial search yielded 136 results. A total of 108 unique results were included for screening; 12 of which were eligible for inclusion in this review. Studies were categorized into 2 themes based on the methodologies of the articles found: qualitative perspectives of immigrants and newcomers; quantitative assessment of the risk of suicide burden and impact of social support and engagement on health and wellbeing of newcomers. Both types of studies highlight a social (dis)connection as an important determinant of mental health and suicide risk among immigrant populations in core anglo-sphere countries, highlighting the continued importance of community programs and funding to support inclusion and community-development among newcomer, immigrant, and asylum-seeking populations.
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Affiliation(s)
- Niloufar Aran
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 8888 University Dr, Burnaby, BC, V5A 1S6, Canada
| | - Kiffer G Card
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 8888 University Dr, Burnaby, BC, V5A 1S6, Canada.
| | - Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 8888 University Dr, Burnaby, BC, V5A 1S6, Canada
| | - Robert S Hogg
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 8888 University Dr, Burnaby, BC, V5A 1S6, Canada
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9
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Molarius A. Socioeconomic inequalities in health - debates on the persistence. Perspect Public Health 2023; 143:20-21. [PMID: 36694968 DOI: 10.1177/17579139221138447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A Molarius
- Region Värmland, Centre for Clinical Research, 651 85 Karlstad, Sweden.,Department of Public Health Sciences, Karlstad University, Karlstad, Sweden
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Heimburg DV, Prilleltensky I, Ness O, Ytterhus B. From public health to public good: Toward universal wellbeing. Scand J Public Health 2022; 50:1062-1070. [PMID: 36245410 PMCID: PMC9578101 DOI: 10.1177/14034948221124670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 08/14/2022] [Indexed: 11/15/2022]
Abstract
We aim to consolidate recent trends in public health into a reconceptualization of the field as public good. We build on several strands of theory, research and action to formulate a more impactful future for the field. Our argument comprises three main parts. In the first part, we describe the central components of the proposed public good: conditions of justice, experiences of mattering, and outcomes of subjective and objective wellbeing. In the second section, we identify continua of practices that paint a trajectory from traditional public health to ecological and participatory public health, to universal wellbeing framed as a public good. The continua are defined in terms of assumptions, practices and roles. Among others, these continua pertain to capabilities, scope of the field, ecological focus, timing of intervention, role of citizen, role of professional, role of settings and role of government. Finally, the third section introduces a series of strategies and recommendations to make the narrative of universal wellbeing as public good a reality.
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Affiliation(s)
- Dina Von Heimburg
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Isaac Prilleltensky
- Department of Educational and Psychological Studies, University of Miami, USA
| | - Ottar Ness
- Department of Education and Lifelong Learning, Norwegian University of Science and Technology, Trondheim, Norway
| | - Borgunn Ytterhus
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Can Sex Differences in Old Age Disabilities be Attributed to Socioeconomic Conditions? Evidence from a Mapping Review of the Literature. JOURNAL OF POPULATION AGEING 2022. [DOI: 10.1007/s12062-022-09395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractOld age disabilities are more common among women than men, and adverse socioeconomic conditions are associated with a higher prevalence of disabilities among older adults. The goal of this study was to complete a mapping review of the available evidence assessing the extent to which the observed sex differences in older adults’ disabilities can be attributed to sex differences in socioeconomic status. We searched three databases for articles published between 2009 and 2019, and after screening and looking at eligibility criteria, 6 articles were included in the review. For those studies that did not directly analyse the contribution of socioeconomic conditions, we used the ‘difference method’ to estimate the proportion of the sex gap in disabilities among older adults that could be attributed to socioeconomic conditions. Our review demonstrated that women generally have a higher prevalence of disabilities than men. In several studies, these differences could be partly attributed to sex differences in the distribution of socioeconomic conditions. We also find great elasticity in the magnitude of both the sex gap in disabilities and in the proportion that could be attributed to differences in socioeconomic conditions.
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12
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Davey F, McGowan V, Birch J, Kuhn I, Lahiri A, Gkiouleka A, Arora A, Sowden S, Bambra C, Ford J. Levelling up health: A practical, evidence-based framework for reducing health inequalities. PUBLIC HEALTH IN PRACTICE 2022; 4:100322. [PMID: 36164497 PMCID: PMC9494865 DOI: 10.1016/j.puhip.2022.100322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022] Open
Abstract
There are substantial inequalities in health across society which have been exacerbated by the COVID-19 pandemic. The UK government have committed to a programme of levelling-up to address geographical inequalities. Here we undertake rapid review of the evidence base on interventions to reduce such health inequalities and developed a practical, evidence-based framework to 'level up' health across the country. This paper overviews a rapid review undertaken to develop a framework of guiding principles to guide policy. To that end and based on an initial theory, we searched one electrotonic database (MEDLINE) from 2007 to July 2021 to identify published umbrella reviews and undertook an internet search to identify relevant systematic reviews, primary studies, and grey literature. Titles and abstracts were screened according to the eligibility criteria. Key themes were extracted from the included studies and synthesised into an overarching framework of guiding principles in consultation with an expert panel. Included studies were cross checked with the initial theoretical domains and further searching undertaken to fill any gaps. We identified 16 published umbrella reviews (covering 667 individual studies), 19 grey literature publications, and 15 key systematic reviews or primary studies. Based on these studies, we develop a framework applicable at national, regional and local level which consisted of five principles - 1) healthy-by-default and easy to use initiatives; 2) long-term, multi-sector action; 3) locally designed focus; 4) targeting disadvantaged communities; and 5) matching of resources to need. Decision-makers working on policies to level up health should be guided by these five principles.
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Affiliation(s)
- Fiona Davey
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Vic McGowan
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - Jack Birch
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Isla Kuhn
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Anwesha Lahiri
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Anna Gkiouleka
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Ananya Arora
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Sarah Sowden
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - Clare Bambra
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - John Ford
- Cambridge Public Health, University of Cambridge, United Kingdom
- NIHR School for Public Health Research, United Kingdom
- NIHR Applied Research Collaboration East of England, United Kingdom
- Corresponding author. Cambridge Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom.
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Högberg P, Henriksson G, Borrell C, Ciutan M, Costa G, Georgiou I, Halik R, Hoebel J, Kilpeläinen K, Kyprianou T, Lesnik T, Petrauskaite I, Ruijsbroek A, Scintee SG, Vasic M, Olsson G. Monitoring Health Inequalities in 12 European Countries: Lessons Learned from the Joint Action Health Equity Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7663. [PMID: 35805322 PMCID: PMC9265987 DOI: 10.3390/ijerph19137663] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/10/2022] [Accepted: 06/15/2022] [Indexed: 12/04/2022]
Abstract
To raise awareness about health inequalities, a well-functioning health inequality monitoring system (HIMS) is crucial. Drawing on work conducted under the Joint Action Health Equity Europe, the aim of this paper is to illustrate the strengths and weaknesses in current health inequality monitoring based on lessons learned from 12 European countries and to discuss what can be done to strengthen their capacities. Fifty-five statements were used to collect information about the status of the capacities at different steps of the monitoring process. The results indicate that the preconditions for monitoring vary greatly between countries. The availability and quality of data are generally regarded as strong, as is the ability to disaggregate data by age and gender. Regarded as poorer is the ability to disaggregate data by socioeconomic factors, such as education and income, or by other measures of social position, such as ethnicity. Few countries have a proper health inequality monitoring strategy in place and, where in place, it is often regarded as poorly up to date with policymakers' needs. These findings suggest that non-data-related issues might be overlooked aspects of health inequality monitoring. Structures for stakeholder involvement and communication that attracts attention from policymakers are examples of aspects that deserve more effort.
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Affiliation(s)
- Pi Högberg
- Unit for Public Health Reporting and Evaluation, Public Health Agency of Sweden, 17182 Solna, Sweden;
| | | | - Carme Borrell
- Public Health Agency of Barcelona, Place Lesseps 1, 08023 Barcelona, Spain;
- CIBER of Epidemiology and Public Health, Av. Monforte de Lemos 3-5, 28029 Madrid, Spain
| | - Marius Ciutan
- Centre for Health Services Research and Evaluation, National School of Public Health Management and Professional Development, Vaselor Str. 31, 021253 Bucharest, Romania; (M.C.); (S.G.S.)
| | - Giuseppe Costa
- Epidemiology Unit ASL TO3, Region Piedmont, Via Sabaudia 164, 10095 Grugliasco, Italy;
| | - Irene Georgiou
- Administration Unit, Ministry of Health, 2 Prodromou & Chilonos Str. 17, Nicosia 1448, Cyprus;
| | - Rafal Halik
- Department of Population Health Monitoring and Analysis, National Institute of Public Health NIH—National Research Institute, Chocimska 24, 00-791 Warsaw, Poland;
| | - Jens Hoebel
- Division of Social Determinants of Health, Robert Koch Institute, General-Pape-Str. 62-66, 12101 Berlin, Germany;
| | - Katri Kilpeläinen
- Health and Welfare Promotion Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland;
| | - Theopisti Kyprianou
- Health Monitoring Unit, Ministry of Health, 2 Prodromou & Chilonos Str. 17, Nicosia 1448, Cyprus;
| | - Tina Lesnik
- Analysis and Development of Health, National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia;
| | | | - Annemarie Ruijsbroek
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands;
| | - Silvia Gabriela Scintee
- Centre for Health Services Research and Evaluation, National School of Public Health Management and Professional Development, Vaselor Str. 31, 021253 Bucharest, Romania; (M.C.); (S.G.S.)
| | - Milena Vasic
- Institute of Public Health of Serbia, Dr Subotica 5, 11000 Belgrade, Serbia;
- Faculty of Dentistry Pancevo, Zarka Zrenjanina 179, 13000 Pancevo, Serbia
| | - Gabriella Olsson
- Unit for Public Health Reporting and Evaluation, Public Health Agency of Sweden, 17182 Solna, Sweden;
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14
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Rehnberg J, Östergren O, Fors S, Fritzell J. Trends in the shape of the income-mortality association in Sweden between 1995 and 2017: a repeated cross-sectional population register study. BMJ Open 2022; 12:e054507. [PMID: 35354639 PMCID: PMC8968639 DOI: 10.1136/bmjopen-2021-054507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We investigate recent trends in income inequalities in mortality and the shape of the association in Sweden. We consider all-cause, preventable and non-preventable mortality for three age groups (30-64, 65-79 and 80+ years). DESIGN AND SETTING Repeated cross-sectional design using Swedish total population register data. PARTICIPANTS All persons aged 30 years and older living in Sweden 1995-1996, 2005-2006 and 2016-2017 (n=8 084 620). METHODS Rate differences and rate ratios for all-cause, preventable and non-preventable mortality were calculated per income decile and age group. RESULTS From 1995 to 2017, relative inequalities in mortality by income increased in Sweden in the age groups 30-64 years and 65-79 years. Absolute inequalities increased in the age group 65-79 years. Among persons aged 80+ years, inequalities were small. The shape of the income-mortality association was curvilinear in the age group 30-64 years; the gradient was stronger below the fourth percentile. In the age group 65-79 years, the shape shifted from linear in 1995-1996 to a more curvilinear shape in 2016-2017. In the oldest age group (80+ years), varied shapes were observed. Inequalities were more pronounced in preventable mortality compared with non-preventable mortality. Income inequalities in preventable and non-preventable mortality increased at similar rates between 1995 and 2017. CONCLUSIONS The continued increase of relative (ages 30-79 years) and absolute (ages 65-79 years) mortality inequalities in Sweden should be a primary concern for public health policy. The uniform increase of inequalities in preventable and non-preventable mortality suggests that a more complex explanatory model than only social causation is responsible for increased health inequalities.
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Affiliation(s)
- Johan Rehnberg
- Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
| | - Olof Östergren
- Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Johan Fritzell
- Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
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15
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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; 19:3679. [PMID: 35329365 PMCID: PMC8950291 DOI: 10.3390/ijerph19063679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [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.
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Affiliation(s)
| | - 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.)
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16
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McMahon NE. What shapes local health system actors' thinking and action on social inequalities in health? A meta-ethnography. SOCIAL THEORY & HEALTH 2022; 21:119-139. [PMID: 35125968 PMCID: PMC8801929 DOI: 10.1057/s41285-022-00176-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 12/14/2022]
Abstract
Local health systems are increasingly tasked to play a more central role in driving action to reduce social inequalities in health. Past experience, however, has demonstrated the challenge of reorienting health system actions towards prevention and the wider determinants of health. In this review, I use meta-ethnographic methods to synthesise findings from eleven qualitative research studies that have examined how ambitions to tackle social inequalities in health take shape within local health systems. The resulting line-of-argument illustrates how such inequalities continue to be problematised in narrow and reductionist ways to fit both with pre-existing conceptions of health, and the institutional practices which shape thinking and action. Instances of health system actors adopting a more social view of inequalities, and taking a more active role in influencing the social and structural determinants of health, were attributed to the beliefs and values of system leaders, and their ability to push-back against dominant discourses and institutional norms. This synthesised account provides an additional layer of understanding about the specific challenges experienced by health workforces when tasked to address this complex and enduring problem, and provides essential insights for understanding the success and shortcomings of future cross-sectoral efforts to tackle social inequalities in health. Supplementary Information The online version contains supplementary material available at 10.1057/s41285-022-00176-6.
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Affiliation(s)
- Naoimh E. McMahon
- Division of Health Research, National Institute for Health Research School for Public Health Research (NIHR SPHR), Lancaster University, Lancaster, LA1 4YW UK
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17
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Verity F, Richards J, Read S, Wallace S. Towards a contemporary social care 'prevention narrative' of principled complexity: An integrative literature review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e51-e66. [PMID: 33991131 DOI: 10.1111/hsc.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/23/2021] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
Prevention has become increasingly central in social care policy and commissioning strategies within the United Kingdom (UK). Commonly there is reliance on understandings borrowed from the sphere of public health, leaning on a prevention discourse characterised by the 'upstream and downstream' metaphor. Whilst framing both structural factors and responses to individual circumstances, the public health approach nonetheless suggests linearity in a cause and effect relationship. Social care and illness follow many trajectories and this conceptualisation of prevention may limit its effectiveness and scope in social care. Undertaken as part of a commissioned evaluation of the Social Services and Wellbeing Act (2014) Wales, a systematic integrative review was conducted to establish the key current debates within prevention work, and how prevention is conceptually framed, implemented and evaluated within the social care context. The databases Scopus, ASSIA, CINAHL and Social Care Online were initially searched in September 2019 resulting in 52 documents being incorporated for analysis. A further re-run of searches was run in March 2021, identifying a further 14 documents, thereby creating a total of 66. Predominantly, these were journal articles or research reports (n = 53), with the remainder guidance or strategy documents, briefings or process evaluations (n = 13). These were categorised by their primary theme and focus, as well as document format and research method before undergoing thematic analysis. This highlighted the continued prominence of three-tiered, linear public health narratives in the framing of prevention for social care, with prevention work often categorised and enacted with inconsistency. Common drivers for prevention activity continue to be cost reduction and reduced dependence on the care system in the future. Through exploring prevention for older people and caregivers, we argue for an approach to prevention aligning with the complexities of the social world surrounding it. Building on developments in complexity theory in social science and healthcare, we offer an alternative view of social care prevention guided by principles rooted in the everyday realities of communities, service users and caregivers.
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Affiliation(s)
- Fiona Verity
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Jonathan Richards
- Welsh Institute for Health and Social Care, University of South Wales, Pontypridd, UK
| | - Simon Read
- College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Sarah Wallace
- Welsh Institute for Health and Social Care, University of South Wales, Pontypridd, UK
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18
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Snodgrass JG, Dengah HJF, Upadhyay C, Else RJ, Polzer E. Indian Gaming Zones as Oppositional Subculture. CURRENT ANTHROPOLOGY 2021. [DOI: 10.1086/717769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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19
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Merz S, Jaehn P, Mena E, Pöge K, Strasser S, Saß AC, Rommel A, Bolte G, Holmberg C. Intersectionality and eco-social theory: a review of potentials for public health knowledge and social justice. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2021.1951668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sibille Merz
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
| | - Philipp Jaehn
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Potsdam and Cottbus, Germany
| | - Emily Mena
- , Department of Social Epidemiology, University of Bremen, Institute of Public Health and Nursing Research, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Kathleen Pöge
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Unit 34 - HIV/AIDS, STI and Blood-borne Infections, Berlin, Germany
| | - Sarah Strasser
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
| | - Anke-Christine Saß
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
| | - Alexander Rommel
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Unit 24 - Health Reporting, Berlin, Germany
| | - Gabriele Bolte
- , Department of Social Epidemiology, University of Bremen, Institute of Public Health and Nursing Research, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Potsdam and Cottbus, Germany
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20
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Von Heimburg D, Ness O. Relational welfare: a socially just response to co-creating health and wellbeing for all. Scand J Public Health 2021; 49:639-652. [PMID: 33323094 PMCID: PMC8512264 DOI: 10.1177/1403494820970815] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
AIMS Contemporary approaches to pursuing public value and the vision of health and wellbeing for all have evolved notably in the past few decades, with distinct approaches termed 'co-creation' and 'health promotion' gaining traction. This article explores a critique of ongoing paradigmatic shifts in public health and the public sector, focusing on cross-fertilisation between co-creation and the promotion of health and wellbeing. Drawing on Nancy Fraser's claims for social justice through redistribution, recognition and representation to achieve participatory parity, we discuss a need for transformative change to achieve societal goals of creating health and wellbeing for all, leaving no one behind. CONCLUSIONS Health promotion and co-creation converge in a quest for active citizenship through participation, as well as embracing a whole-of-government and whole-of-society approach. However, inequity in such processes, as well as health and wellbeing outcomes, are still persistent and contradictory to health promotion aims. This article argues that radically attending to human relationships and our dependency on other humans as a 'collective' need to be placed at the core of future-forming social construction of public and democratic institutions to allow the ongoing cross-fertilisation between health promotion and co-creation to work. Responding to this calls for transformation, the article presents a framework for developing a relational approach to welfare. The framework advocates for 'relational welfare', which captures the intersection of the welfare state, democracy and human relationships attending to social justice, capabilities and health and wellbeing for all as key public values in societal development.
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Affiliation(s)
| | - Ottar Ness
- Department of Education and Lifelong
Learning, Norwegian University of Science and Technology, Trondheim, Norway
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21
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Holman D, Salway S, Bell A, Beach B, Adebajo A, Ali N, Butt J. Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders. Health Res Policy Syst 2021; 19:97. [PMID: 34172066 PMCID: PMC8227357 DOI: 10.1186/s12961-021-00742-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/30/2021] [Indexed: 12/12/2022] Open
Abstract
Background The concept of “intersectionality” is increasingly employed within public health arenas, particularly in North America, and is often heralded as offering great potential to advance health inequalities research and action. Given persistently poor progress towards tackling health inequalities, and recent calls to reframe this agenda in the United Kingdom and Europe, the possible contribution of intersectionality deserves attention. Yet, no existing research has examined professional stakeholder understandings and perspectives on applying intersectionality to this field. Methods In this paper we seek to address that gap, drawing upon a consultation survey and face-to-face workshop (n = 23) undertaken in the United Kingdom. The survey included both researchers (n = 53) and policy and practice professionals (n = 20) with varied roles and levels of engagement in research and evaluation. Topics included familiarity with the term and concept “intersectionality”, relevance to health inequalities work, and issues shaping its uptake. Respondents were also asked to comment on two specific policy suggestions: intersectionally targeting and tailoring interventions, and evaluating the intersectional effects of policies. The workshop aims were to share examples of applying intersectionality within health inequalities research and practice; understand the views of research and practice colleagues on potential contributions and challenges; and identify potential ways to promote intersectional approaches. Results Findings indicated a generally positive response to the concept and a cautiously optimistic assessment that intersectional approaches could be valuable. However, opinions were mixed and various challenges were raised, especially around whether intersectionality research is necessarily critical and transformative and, accordingly, how it should be operationalized methodologically. Nonetheless, there was general agreement that intersectionality is concerned with diverse inequalities and the systems of power that shape them. Conclusions We position intersectionality within the wider context of health inequalities policy and practice, suggesting potential ways forward for the approach in the context of the United Kingdom. The views of policy and practice professionals suggest that intersectionality has far to travel to help counter individualistic narratives and to encourage an approach that is sensitive to subgroup inequalities and the processes that generate them. Examples of promising practice, albeit mostly in North America, suggest that it is possible for intersectionality to gain traction. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00742-w.
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Affiliation(s)
- Daniel Holman
- Department of Sociological Studies, University of Sheffield, Elmfield building, Northumberland Road, Sheffield, S10 2TU, United Kingdom.
| | - Sarah Salway
- Department of Sociological Studies, University of Sheffield, Elmfield building, Northumberland Road, Sheffield, S10 2TU, United Kingdom
| | - Andrew Bell
- Sheffield Methods Institute, Interdisciplinary Centre of the Social Sciences, University of Sheffield, 219 Portobello, Sheffield, S1 4DP, United Kingdom
| | - Brian Beach
- International Longevity Centre-UK. Vintage House, 36-37 Albert Embankment, Vauxhall, London, SE1 7TL, United Kingdom
| | - Adewale Adebajo
- Centre for Assistive Technology and Connected Healthcare, University of Sheffield, 217 Portobello, Sheffield, S1 4DP, United Kingdom
| | - Nuzhat Ali
- Public Health England. Seaton House, City Link, Nottingham, NG2 4LA, United Kingdom
| | - Jabeer Butt
- Race Equality Foundation, 27 Greenwood Pl, Kentish Town, London, NW5 1LB, United Kingdom
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22
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McMahon NE. Framing action to reduce health inequalities: what is argued for through use of the 'upstream-downstream' metaphor? J Public Health (Oxf) 2021; 44:671-678. [PMID: 34056659 PMCID: PMC9424054 DOI: 10.1093/pubmed/fdab157] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/25/2021] [Accepted: 05/01/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Public health insights struggle to compete with dominant ideas which frame health inequalities as a problem of individual behaviour. There is consequently a need to critically reflect upon and question the effectiveness of different strategies for framing and communicating key insights. Taking the example of the 'upstream-downstream' metaphor, this literature review contributes to a necessary first step by asking what exactly is being argued for through its use. METHODS An iterative search strategy was used to identify peer-reviewed articles which could contribute to the review question. A discourse analysis framework informed data extraction and synthesis of 24 articles. Articles were subsequently categorized into groups which reflected the different uses of the metaphor identified. RESULTS All authors used the metaphor to promote a particular causal understanding of health inequalities, leading some to recommend policies and programmes, and others to focus on implementation processes. This seemingly simple metaphor has evolved beyond differentiating 'upstream' from 'downstream' determinants, to communicate an ambitious politically engaged agenda for change. CONCLUSIONS The metaphor is not without its critics and in light of the complexity of the arguments encapsulated in its use, work is needed to establish if it can, and does, resonate as intended with wider audiences.
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Affiliation(s)
- Naoimh E McMahon
- National Institute for Health Research School for Public Health Research (NIHR SPHR), Division of Health Research, Lancaster University, Lancaster, LA1 4YW, UK
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23
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McMahon NE. Working ‘upstream’ to reduce social inequalities in health: a qualitative study of how partners in an applied health research collaboration interpret the metaphor. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2021.1931663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Naoimh E. McMahon
- National Institute for Health Research School for Public Health Research (NIHR SPHR), Division of Health Research, Lancaster University, Lancaster, UK
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24
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Rehnberg J, Östergren O, Esser I, Lundberg O. Interdependent pathways between socioeconomic position and health: A Swedish longitudinal register-based study. Soc Sci Med 2021; 280:114038. [PMID: 34051557 DOI: 10.1016/j.socscimed.2021.114038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
Health inequalities are generated by the conditions in which people are born, grow, live, work and age. From a life-course perspective, these conditions are formed by complex causal relationships with mutual and intertwined paths between socioeconomic position and health. This study attempts to disentangle some of these processes by examining pathways between socioeconomic position and health across the life-course. We used yearly Swedish national register data with information from over 31 years for two cohorts born 1941-1945 and 1961-1965. We analyzed associations between several indicators of childhood and adult socioeconomic position and health, measured by number of in-patient hospitalizations. We estimated within- and between-person associations using random intercept cross-lagged panel models. The results showed bi-directional associations between socioeconomic position and health that varied in strength across the life-course. Age variations in the associations were primarily observed when individuals aged into or out of age-stratified institutions. In ages where transitions from education to the labor market are common, the associations from health to income and education were strong. Around and after retirement age, the between-person association from health to income was weak, while the association from income to health strengthened. Within-person estimates showed no association between income and subsequent hospitalization among older persons, indicating no direct causal effect of income change on health in this age group. For persons of middle age, the associations were of similar strength in both directions and present at both the between- and within-person level. Our findings highlight the importance of theoretical frameworks and methods that can incorporate the interplay between social, economic, and biological processes over the life-course in order to understand how health inequalities are generated.
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Affiliation(s)
- Johan Rehnberg
- Department of Public Health Sciences, Stockholm University, SE-106 91, Stockholm, Sweden; Aging Research Center, Karolinska Institutet, Solna, SE-171 65, Solna, Sweden.
| | - Olof Östergren
- Department of Public Health Sciences, Stockholm University, SE-106 91, Stockholm, Sweden; Aging Research Center, Karolinska Institutet, Solna, SE-171 65, Solna, Sweden.
| | - Ingrid Esser
- Department of Public Health Sciences, Stockholm University, SE-106 91, Stockholm, Sweden; Swedish Institute for Social Research, SOFI, Stockholm University, SE-106 91, Stockholm, Sweden.
| | - Olle Lundberg
- Department of Public Health Sciences, Stockholm University, SE-106 91, Stockholm, Sweden.
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25
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Lundberg O. Is lack of causal evidence linking socioeconomic position with health an 'inconvenient truth'? Eur J Public Health 2020; 30:619. [PMID: 32558898 PMCID: PMC7445041 DOI: 10.1093/eurpub/ckaa004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Olle Lundberg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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