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Schultz S, Beissmann F, Zorbas C, Yoong S, Peeters A, Backholer K. A realist impact evaluation of a tool to strengthen equity in local government policy-making. Int J Equity Health 2024; 23:179. [PMID: 39252013 PMCID: PMC11385146 DOI: 10.1186/s12939-024-02266-5] [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: 07/21/2024] [Accepted: 08/29/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Local governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts. METHODS We conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs. RESULTS Almost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA's related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support. CONCLUSION Our study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health.
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Affiliation(s)
- Sally Schultz
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia.
| | - Felicity Beissmann
- City of Greater Bendigo, Galkangu Bendigo, VIC, 189-229 Lyttleton Terrace, Australia
| | - Christina Zorbas
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Serene Yoong
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Anna Peeters
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, Australia
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Yusuf J, D'Souza NJ, A T Caldwell H, Meaghan Sim S, Embrett M, F L Kirk S. Exploring health equity integration among health service and delivery systems in Nova Scotia: perspectives of health system partners. Int J Equity Health 2024; 23:171. [PMID: 39187882 PMCID: PMC11345956 DOI: 10.1186/s12939-024-02256-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 08/15/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Achieving health equity is important to improve population health; however, health equity is not typically well defined, integrated, or measured within health service and delivery systems. To improve population health, it is necessary to understand barriers and facilitators to health equity integration within health service and delivery systems. This study aimed to explore health equity integration among health systems workers and identify key barriers and facilitators to implementing health equity strategies within the health service and delivery system in Nova Scotia, ahead of the release of a Health Equity Framework, focused on addressing inequities within publicly funded institutions. METHODS Purposive sampling was used to recruit individuals working on health equity initiatives including those in high-level leadership positions within the Nova Scotia health system. Individual interviews and a joint interview session were conducted. Topics of discussion included current integration of health equity through existing strategies and perceptions within participant roles. The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis, with interviews transcribed and deductively analyzed in NVivo. Qualitative description was employed to describe study findings as barriers and facilitators to health equity integration. RESULTS Eleven individual interviews and one joint interview (n = 5 participants) were conducted, a total of 16 participants. Half (n = 8) of the participants were High-level Leaders (i.e., manager or higher) within the health system. We found that existing strategies within the health system were inadequate to address inequities, and variation in the use of indicators of health equity was indicative of a lack of health equity integration. Applying the CFIR allowed us to identify barriers to and facilitators of health equity integration, with the power of legislation to implement a Health Equity Framework, alongside the value of partnerships and engagement both being seen as key facilitators to support health equity integration. Barriers to health equity integration included inadequate resources devoted to health equity work, a lack of diversity among senior system leaders and concerns that existing efforts to integrate health equity were siloed. CONCLUSION Our findings suggest that health equity integration needs to be prioritized within the health service and delivery system within Nova Scotia and identifies possible strategies for implementation. Appropriate measures, resources and partnerships need to be put in place to support health equity integration following the introduction of the Health Equity Framework, which was viewed as a key driver for action. Greater diversity within health system leadership was also identified as an important strategy to support integration. Our findings have implications for other jurisdictions seeking to advance health equity across health service and delivery systems.
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Affiliation(s)
- Joshua Yusuf
- School of Health and Human Performance, Dalhousie University, 6230 South St, Halifax, NS, B3H 4R2, Canada
- Healthy Populations Institute, Dalhousie University, 1318 Robie St, Halifax, Halifax, NS, B3H 3E2, Canada
| | - Ninoshka J D'Souza
- Healthy Populations Institute, Dalhousie University, 1318 Robie St, Halifax, Halifax, NS, B3H 3E2, Canada
| | - Hilary A T Caldwell
- Healthy Populations Institute, Dalhousie University, 1318 Robie St, Halifax, Halifax, NS, B3H 3E2, Canada
| | | | | | - Sara F L Kirk
- School of Health and Human Performance, Dalhousie University, 6230 South St, Halifax, NS, B3H 4R2, Canada.
- Healthy Populations Institute, Dalhousie University, 1318 Robie St, Halifax, Halifax, NS, B3H 3E2, Canada.
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Maina NM, Miled N, Crump M. Self-identification and workplace experience surveys for equity and inclusion in healthcare. Healthc Manage Forum 2024:8404704241266139. [PMID: 39047287 DOI: 10.1177/08404704241266139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Data and evaluation have become integral to efforts aimed at transforming organizational cultures. This is true in Diversity, Equity, and Inclusion (DEI), where organizations are assessing their employee make-up and the impact of their programs and services on systematically marginalized communities. This article presents a case study of a self-identification and workplace experience survey that was the first of its kind at the Provincial Health Services Authority in British Columbia. With a 30.7% response rate, we share an overview of the survey, lessons learned, and recommendations for other healthcare institutions embarking on their DEI journey. Key takeaways include engaging leaders early and allowing adequate time and resources for planning and executing the survey. Confidentiality is a crucial element to ensure that everyone feels confident to take the survey. Ultimately, adequate implementation of actions from survey results will build trust among staff and advance DEI priorities in organizations.
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Affiliation(s)
- Naomi Mumbi Maina
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Neila Miled
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
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Barcellona C, Mariñas YB, Tan SY, Lee G, Ko KC, Chham S, Chhorvann C, Leerapan B, Pham Tien N, Lim J. Measuring health equity in the ASEAN region: conceptual framework and assessment of data availability. Int J Equity Health 2023; 22:251. [PMID: 38053205 PMCID: PMC10696689 DOI: 10.1186/s12939-023-02059-2] [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: 06/20/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Existing research on health equity falls short of identifying a comprehensive set of indicators for measurement across health systems. Health systems in the ASEAN region, in particular, lack a standardised framework to assess health equity. This paper proposes a comprehensive framework to measure health equity in the ASEAN region and highlights current gaps in data availability according to its indicator components. METHODS A comprehensive literature review was undertaken to map out a core set of indicators to evaluate health equity at the health system level. Secondary data collection was subsequently conducted to assess current data availability for ASEAN states in key global health databases, national health accounts, and policy documents. RESULTS A robust framework to measure health equity was developed comprising 195 indicators across Health System Inputs and Processes, Outputs, Outcomes, and Contextual Factors. Total indicator data availability equated to 72.9% (1423/1950). Across the ASEAN region, the Inputs and Processes sub-component of Health Financing had complete data availability for all indicators (160/160, 100%), while Access to Essential Medicine had the least data available (6/30, 20%). Under Outputs and Outcomes, Coverage of Selected Interventions (161/270, 59.63%) and Population Health (350/350, 100%) respectively had the most data available, while other indicator sub-components had little to none (≤ 38%). 72.145% (384/530) of data is available for all Contextual Factors. Out of the 10 ASEAN countries, the Philippines had the highest data availability overall at 77.44% (151/195), while Brunei Darussalam and Vietnam had the lowest data availability at 67.18% (131/195). CONCLUSIONS The data availability gaps highlighted in this study underscore the need for a standardised framework to guide data collection and benchmarking of health equity in ASEAN. There is a need to prioritise regular data collection for overlooked indicator areas and in countries with low levels of data availability. The application of this indicator framework and resulting data availability analysis could be conducted beyond ASEAN to enable cross-regional benchmarking of health equity.
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Affiliation(s)
- Capucine Barcellona
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | | | - Si Ying Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Gabriel Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Savina Chham
- National Institute of Public Health Cambodia, Phnom Penh, Cambodia
| | - Chhea Chhorvann
- National Institute of Public Health Cambodia, Phnom Penh, Cambodia
| | - Borwornsom Leerapan
- Faculty of Medicine Ramathibodi Hospital, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Jeremy Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Uehling M, Hall-Clifford R, Kinnard C, Wimberly Y. Advancing Equity in U.S. Hospital Systems: Employee Understandings of Health Equity and Steps for Improvement. J Healthc Manag 2023; 68:342-355. [PMID: 37678826 DOI: 10.1097/jhm-d-22-00187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
GOALS Equity in the U.S. healthcare system remains a vital goal for healthcare leaders. Although many hospitals and healthcare systems have adopted a social determinants of health approach to more equitable care, many challenges have limited the effectiveness of their efforts. In this study, we wanted to explore whether healthcare leaders and providers understand the concept of equity and can link the concepts to practical applications within healthcare systems. METHODS We explored how hospital leadership and providers at a major public hospital in Atlanta, Georgia, understand equity topics both conceptually and at a practical implementation level. We conducted 28 focus groups for >4 months involving 233 staff members, during which participants were asked about their understanding of various equity-related terms and equity implementation within the hospital. PRINCIPAL FINDINGS Our findings reveal that there is little consensus among staff regarding the conceptual meanings of various health equity-related terms, and only a small minority of staff can articulate a conceptual definition that reflects current research-based understandings of equity. Furthermore, there is little consensus regarding how staff believes that health equity is practically enacted through various hospital programs, even among interviewees who could correctly articulate equity topics. These findings have no association with a role in the organization or length of time employed at the hospital. PRACTICAL APPLICATIONS These findings indicate a need for a more nuanced understanding of health equity and further clarification and education on how to implement health equity. Although understanding at the conceptual level is an important first step, conceptual knowledge alone is not enough to support health equity at either the individual staff level or the system level. Our recommendations cover strategic development; education specific to the hospital system and its unique needs; consideration of the specific roles of individuals in the organization; and the designation of diversity, equity, and inclusion staff and offices in a hospital organization.
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Affiliation(s)
| | - Rachel Hall-Clifford
- Department of Sociology and Center for the Study of Human Health, Emory University
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Carroll Á, Collins C, McKenzie J, Stokes D, Darley A. Application of complexity theory in health and social care research: a scoping review. BMJ Open 2023; 13:e069180. [PMID: 36921939 PMCID: PMC10030763 DOI: 10.1136/bmjopen-2022-069180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Complexity theory has been chosen by many authors as a suitable lens through which to examine health and social care. Despite its potential value, many empirical investigations apply the theory in a tokenistic manner without engaging with its underlying concepts and underpinnings. OBJECTIVES The aim of this scoping review is to synthesise the literature on empirical studies that have centred on the application of complexity theory to understand health and social care provision. METHODS This scoping review considered primary research using complexity theory-informed approaches, published in English between 2012 and 2021. Cochrane Database of Systematic Reviews, MEDLINE, CINAHL, EMBASE, Web of Science, PSYCHINFO, the NHS Economic Evaluation Database, and the Health Economic Evaluations Database were searched. In addition, a manual search of the reference lists of relevant articles was conducted. Data extraction was conducted using Covidence software and a data extraction form was created to produce a descriptive summary of the results, addressing the objectives and research question. The review used the revised Arksey and O'Malley framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR). RESULTS 2021 studies were initially identified with a total of 61 articles included for extraction. Complexity theory in health and social care research is poorly defined and described and was most commonly applied as a theoretical and analytical framework. The full breadth of the health and social care continuum was not represented in the identified articles, with the majority being healthcare focused. DISCUSSION Complexity theory is being increasingly embraced in health and care research. The heterogeneity of the literature regarding the application of complexity theory made synthesis challenging. However, this scoping review has synthesised the most recent evidence and contributes to translational systems research by providing guidance for future studies. CONCLUSION The study of complex health and care systems necessitates methods of interpreting dynamic prcesses which requires qualitative and longitudinal studies with abductive reasoning. The authors provide guidance on conducting complexity-informed primary research that seeks to promote rigor and transparency in the area. REGISTRATION The scoping review protocol was registered at Open Science Framework, and the review protocol was published at BMJ Open (https://bit.ly/3Ex1Inu).
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Affiliation(s)
- Áine Carroll
- School of Medicine, University College Dublin, Dublin, Ireland
- Academic Department, National Rehabilitation University Hospital, Dublin, Ireland
| | - Claire Collins
- Henley Business School, University of Reading, Reading, UK
| | - Jane McKenzie
- Henley Business School, University of Reading, Reading, UK
| | - Diarmuid Stokes
- College of Health Sciences, University College Dublin, Dublin, Ireland
| | - Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland
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7
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Astbury CC, Lee KM, McGill E, Clarke J, Egan M, Halloran A, Malykh R, Rippin H, Wickramasinghe K, Penney TL. Systems Thinking and Complexity Science Methods and the Policy Process in Non-communicable Disease Prevention: A Systematic Scoping Review. Int J Health Policy Manag 2023; 12:6772. [PMID: 37579437 PMCID: PMC10125079 DOI: 10.34172/ijhpm.2023.6772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/14/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy. METHODS Systematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS. RESULTS 4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use. CONCLUSION This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.
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Affiliation(s)
- Chloe Clifford Astbury
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Kirsten M. Lee
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Elizabeth McGill
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Janielle Clarke
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Afton Halloran
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
- Department of Nutrition, ExercDepartment of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.ise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Regina Malykh
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Holly Rippin
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Kremlin Wickramasinghe
- World Health Organization European Office for the Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Tarra L. Penney
- Global Food System & Policy Research, School of Global Health, York University, Toronto, ON, Canada
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Birenbaum-Carmeli D. Too much equity - is there such a thing? The public discourse surrounding elective egg freezing subsidy in Israel. Int J Equity Health 2023; 22:34. [PMID: 36803514 PMCID: PMC9938687 DOI: 10.1186/s12939-023-01831-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/12/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND The preservation of human ova for future fertilization has been made available to healthy women in 2011-2012. This treatment, dubbed elective egg freezing (EEF), is undertaken primarily by highly educated unpartnered women without children, concerned of age-related fertility decline. In Israel, treatment is available to women aged 30-41. However, unlike many other fertility treatments, EEF is not state subsidized. The public discourse of EEF funding in Israel is the focus of the present study. METHOD The article analyzes three sources of data: press presentations of EEF; a Parliamentary Committee discussion dedicated to EEF funding; interviews with 36 Israeli women who have undertaken EEF. RESULTS Numerous speakers raised the issue of equity, claiming that reproduction was a state interest and therefore, a state responsibility, including securing equitable treatment to Israeli women of all economic strata. Highlighting the generous funding of other fertility treatments, they claimed that EEF was inequitable, discriminating against poorer single women, who could not afford it. Few actors, however, rejected state funding as intervention in women's reproductive lives and called for reconsideration of the local reproductive imperative. CONCLUSION The invocation of equity by Israeli users of EEF, clinicians and some policy makers as grounds for a call to fund a treatment that serves a well-established subpopulation seeking to relieve a social rather than a medical problem, illustrates the profound context-embeddedness of notions of health equity. More generally, it may suggest that using an inclusive language in a discourse of equity may potentially be invoked so as to promote the interests of a particular subpopulation.
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Affiliation(s)
- Daphna Birenbaum-Carmeli
- Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
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Conley C, Rock R, Lenhart M, Singh S. Characteristics of US nonprofit hospitals using equity as a guiding framework for developing their community health needs assessments and implementation strategies. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01771-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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van Eijk MS, Kett PM, Prueher L, Frogner BK, Guenther GA. Lack of Consistent Investment in Federal Insurance Navigator Program Undermines Navigators' Equity Work in Vulnerable Communities. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:399-405. [PMID: 35121713 DOI: 10.1097/phh.0000000000001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT Navigators in the federal Insurance Navigator Program ("Navigator Program"), who are employed by organizations in states with Federally Facilitated Marketplaces, provide enrollment assistance, outreach, and education to individuals who are eligible for health insurance coverage. Such work is central to public health efforts to address inequities but continues to be poorly understood and undervalued. More information is needed to understand the components of navigators' equity work and how decreases in program funding have affected their service provision. OBJECTIVE To examine navigators' labor at a granular level to better understand and highlight the equity work they do, the training and skills required for this work, and the Navigator Program-based challenges they face. DESIGN This was a descriptive qualitative study using data collected from interviews conducted in February-May 2021. We used a thematic analysis approach to develop major themes and subthemes. SETTING This was a national study. PARTICIPANTS We conducted 18 semistructured interviews with 24 directors, navigators, and other professionals at organizations funded as federally certified Navigator Programs. MAIN OUTCOME MEASURES Components of navigators' work; required training and skills; and challenges faced in accomplishing the work. RESULTS We identified 3 major themes: (1) navigators' health equity work goes beyond required responsibilities; (2) equity skills are built on the job; and (3) financial instabilities challenge navigators' health equity work. CONCLUSION Navigators bring specialized and essential skills and services to underserved communities. They are trusted sources of information, advocates, resource connectors, and, most significantly, health equity workers. However, the Navigator Program fails to support navigators' work and the communities they serve in the long term. To facilitate organizations' capacities to train, keep, and support navigators in this health equity work and to guarantee long-term enrollment assistance for underserved communities, efforts to stabilize funding are needed.
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Affiliation(s)
- Marieke S van Eijk
- Departments of Anthropology (Drs Van Eijk and Prueher) and Family Medicine (Drs Kett and Frogner and Ms Guenther), Center for Health Workforce Studies, University of Washington, Seattle, Washington
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Marcellus L, Pauly B, Martin W, Revai T, Easton K, MacDonald M. Navigating conflicting value systems: a grounded theory of the process of public health equity work in the context of mental health promotion and prevention of harms of substance use. BMC Public Health 2022; 22:210. [PMID: 35100999 PMCID: PMC8805448 DOI: 10.1186/s12889-022-12627-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/19/2022] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Promoting health equity and reducing heath inequities is a foundational aim and ethical imperative in public health. There has been limited attention to and research on the ethical issues inherent in promoting health equity and reducing health inequities that public health practitioners experience in their work. The aim of the study was to explore how public health providers identified and navigated ethical issues and their management related to promoting health equity within services focused on mental health promotion and preventing harms of substance use. METHODS Semi-structured individual interviews and focus groups were conducted with 32 public health practitioners who provided public-health oriented services related to mental health promotion and prevention of substance use harms (e.g. harm reduction) in one Canadian province. RESULTS Participants engaged in the basic social process of navigating conflicting value systems. In this process, they came to recognize a range of ethically challenging situations related to health equity within a system that held values in conflict with health equity. The extent to which practitioners recognized, made sense of, and acted on these fundamental challenges was dependent on the degree to which they had developed a critical public health consciousness. Ethically challenging situations had impacts for practitioners, most importantly, the experiences of responding emotionally to ethical issues and the experience of living in dissonance when working to navigate ethical issues related to promoting health equity in their practice within a health system based in biomedical values. CONCLUSIONS There is an immediate need for practice-oriented tools for recognizing ethical dilemmas and supporting ethical decision making related to health equity in public health practice in the context of mental health promotion and prevention of harms of substance use. An increased focus on understanding public health ethical issues and working collaboratively and reflexively to address the complexity of equity work has the potential to strengthen equity strategies and improve population health.
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Affiliation(s)
- Lenora Marcellus
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Bernie Pauly
- School of Nursing and Scientist, Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Wanda Martin
- College of Nursing, University of Saskatchewan, Health Science Building - 1A10, Box 6, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
| | - Tina Revai
- First Nations Health Authority, 501-100 Park Royal South Coast Salish Territory, West Vancouver, BC V7T-1A2, Canada
| | - Kathy Easton
- Island Health, 345 Wale Rd, Victoria, BC, V9B 6X2, Canada
| | - Marjorie MacDonald
- School of Nursing, and Scientist, Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, Canada
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Wallace B, Rea K. Enhancing equity-oriented care in psychedelic medicine: Utilizing the EQUIP framework. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 98:103429. [PMID: 34461409 DOI: 10.1016/j.drugpo.2021.103429] [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] [Received: 05/27/2021] [Revised: 08/03/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
Psychedelic-assisted therapies are experiencing a re-emergence in mainstream medicine and mental health contexts. A wide variety of psychedelic-assisted therapy modalities are being utilized to address mental health issues such as substance use disorders, end of life anxiety, treatment-resistant depression, suicidality, PTSD and other conditions. The novel and inchoate acceptance of psychedelic-assisted therapies into mainstream medical and therapeutic realms raises questions of equity. Concerns have been raised that individuals and communities facing structural inequities are perhaps least able to access these treatments including Black, Indigenous and people of colour (BIPOC) as well as people who use drugs. Psychedelic-assisted therapies may exemplify the inverse law of care whereby services are most inaccessible to communities with the most need, especially if these therapies are regulated into the private sector. As legalization and wider implementation of these therapies appears to be imminent, now is a critical time to consider how health equity may be promoted within psychedelic medicine. This paper examines how the EQUIP Health Care approach (https://equiphealthcare.ca) may inform the development and provision of equity-oriented psychedelic-assisted therapies. The EQUIP approach seeks to reduce the effects of structural inequities on people's health, the impacts of discrimination and stigma, and the mismatches between usual approaches to care and the needs of people most affected by health and social inequities. Key dimensions of the EQUIP intervention include cultural safety, harm reduction, trauma and violence-informed care, and contextual tailoring.
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Affiliation(s)
- Bruce Wallace
- UVIC School of Social Work, Scientist, Canadian Institute for Substance Use Research (CISUR), University of Victoria, School of Social Work, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada.
| | - Kerri Rea
- University of Victoria, School of Social Work, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2, Canada
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Pauly B, Revai T, Marcellus L, Martin W, Easton K, MacDonald M. "The health equity curse": ethical tensions in promoting health equity. BMC Public Health 2021; 21:1567. [PMID: 34407781 PMCID: PMC8375114 DOI: 10.1186/s12889-021-11594-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Public health (PH) practitioners have a strong moral commitment to health equity and social justice. However, PH values often do not align with health systems values, making it challenging for PH practitioners to promote health equity. In spite of a growing range of PH ethics frameworks and theories, little is known about ethical concerns related to promotion of health equity in PH practice. The purpose of this paper is to examine the ethical concerns of PH practitioners in promoting health equity in the context of mental health promotion and prevention of harms of substance use. METHODS As part of a broader program of public health systems and services research, we interviewed 32 PH practitioners. RESULTS Using constant comparative analysis, we identified four systemic ethical tensions: [1] biomedical versus social determinants of health agenda; [2] systems driven agendas versus situational care; [3] stigma and discrimination versus respect for persons; and [4] trust and autonomy versus surveillance and social control. CONCLUSIONS Naming these tensions provides insights into the daily ethical challenges of PH practitioners and an opportunity to reflect on the relevance of PH frameworks. These findings highlight the value of relational ethics as a promising approach for developing ethical frameworks for PH practice.
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Affiliation(s)
- Bernie Pauly
- School of Nursing and Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Tina Revai
- Equity Lens in Public Health Project, University of Victoria, Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Lenora Marcellus
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Wanda Martin
- College of Nursing, University of Saskatchewan, Health Science Building-1A10, Box 6, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
| | - Kathy Easton
- Island Health, 345 Wale Rd, Victoria, BC, V9B 6X2, Canada
| | - Marjorie MacDonald
- School of Nursing and Canadian Institute for Substance Use Research, University of Victoria, Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
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Sohrabi M, Zandieh M, Afshar-Nadjafi B. A simple empirical inventory model for managing the processed corneal tissue equitably in hospitals with demand differentiation. COMPUTATIONAL AND APPLIED MATHEMATICS 2021; 40:281. [PMCID: PMC8529247 DOI: 10.1007/s40314-021-01663-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 09/04/2021] [Accepted: 09/29/2021] [Indexed: 06/18/2023]
Abstract
This paper peruses one of the most challenging healthcare concerns related to human organ transplantation. In this regard, a medical system’s health-economic objectives are investigated to (1) achieve a desirable level of health equity in offering healthcare services to patients who are differentiated in terms of medical conditions, and (2) minimize total costs incurred across managing the inventory. This paper presents the first-ever operational research study to manage processed corneal tissue (PCT). Besides, hybrid demand-oriented policies have been proposed to equitably issue and assign specific inventories to demands with distinct medical urgent levels (ULs). In this regard, a practical multi-objective mixed-integer linear programming (MOMILP) model is proposed for a system with multiple products that can be substituted with each other according to medical priorities. A goal programming (GP) approach is utilized to find the optimum solution. The applicability of the model is validated through a real case study. Finally, several sensitivity analyses are conducted to examine the effect of critical parameters on the solutions to gain useful managerial insights. The results show that the proposed health-economic trade-off is well performed and can efficiently handle the real case.
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Affiliation(s)
- Mahnaz Sohrabi
- Faculty of Industrial and Mechanical Engineering, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - Mostafa Zandieh
- Department of Industrial Management and Information Technology, Management and Accounting Faculty, Shahid Beheshti University, GC, Tehran, Iran
| | - Behrouz Afshar-Nadjafi
- Faculty of Industrial and Mechanical Engineering, Qazvin Branch, Islamic Azad University, Qazvin, Iran
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