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Caldwell HA, Yusuf J, Carrea C, Conrad P, Embrett M, Fierlbeck K, Hajizadeh M, Kirk SF, Rothfus M, Sampalli T, Sim SM, Tomblin Murphy G, Williams L. Strategies and indicators to integrate health equity in health service and delivery systems in high-income countries: a scoping review. JBI Evid Synth 2024; 22:949-1070. [PMID: 38632975 PMCID: PMC11163892 DOI: 10.11124/jbies-23-00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE The objective of this review was to describe how health service and delivery systems in high-income countries define and operationalize health equity. A secondary objective was to identify implementation strategies and indicators being used to integrate and measure health equity. INTRODUCTION To improve the health of populations, a population health and health equity approach is needed. To date, most work on health equity integration has focused on reducing health inequities within public health, health care delivery, or providers within a health system, but less is known about integration across the health service and delivery system. INCLUSION CRITERIA This review included academic and gray literature sources that described the definitions, frameworks, level of integration, strategies, and indicators that health service and delivery systems in high-income countries have used to describe, integrate, and/or measure health equity. Sources were excluded if they were not available in English (or a translation was not available), were published before 1986, focused on strategies that were not implemented, did not provide health equity indicators, or featured strategies that were implemented outside the health service or delivery systems (eg, community-based strategies). METHODS This review was conducted in accordance with the JBI methodology for scoping reviews. Titles and abstracts were screened for eligibility followed by a full-text review to determine inclusion. The information extracted from the included studies consisted of study design and key findings, such as health equity definitions, strategies, frameworks, level of integration, and indicators. Most data were quantitatively tabulated and presented according to 5 secondary review questions. Some findings (eg, definitions and indicators) were summarized using qualitative methods. Most findings were visually presented in charts and diagrams or presented in tabular format. RESULTS Following review of 16,297 titles and abstracts and 824 full-text sources, we included 122 sources (108 scholarly and 14 gray literature) in this scoping review. We found that health equity was inconsistently defined and operationalized. Only 17 sources included definitions of health equity, and we found that both indicators and strategies lacked adequate descriptions. The use of health equity frameworks was limited and, where present, there was little consistency or agreement in their use. We found that strategies were often specific to programs, services, or clinics, rather than broadly applied across health service and delivery systems. CONCLUSIONS Our findings suggest that strategies to advance health equity work are siloed within health service and delivery systems, and are not currently being implemented system-wide (ie, across all health settings). Healthy equity definitions and frameworks are varied in the included sources, and indicators for health equity are variable and inconsistently measured. Health equity integration needs to be prioritized within and across health service and delivery systems. There is also a need for system-wide strategies to promote health equity, alongside robust accountability mechanisms for measuring health equity. This is necessary to ensure that an integrated, whole-system approach can be consistently applied in health service and delivery systems internationally. REVIEW REGISTRATION DalSpace dalspace.library.dal.ca/handle/10222/80835.
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Affiliation(s)
- Hilary A.T. Caldwell
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Joshua Yusuf
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Cecilia Carrea
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Patricia Conrad
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Katherine Fierlbeck
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- MacEachen Institute for Public Policy and Governance, Dalhousie University, Halifax, NS, Canada
- Dalhousie Libraries, Dalhousie University, Halifax, NS, Canada
| | - Mohammad Hajizadeh
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Sara F.L. Kirk
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Melissa Rothfus
- Department of Political Science, Dalhousie University, Halifax, NS, Canada
| | | | - Sarah Meaghan Sim
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health, Halifax, NS, Canada
| | | | - Lane Williams
- Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
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Moon D, Pabayo R, Hwang J. An evolution of socioeconomic inequalities in self-rated health in Korea: Evidence from Korea National Health and Nutrition Examination Survey (KNHANES) 1998-2018. SSM Popul Health 2024; 26:101689. [PMID: 38952742 PMCID: PMC11215416 DOI: 10.1016/j.ssmph.2024.101689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024] Open
Abstract
Reducing socioeconomic inequalities in health has become an important health policy agenda. This study aimed to measure socioeconomic inequalities in health in Korea over the past two decades and identify the contributing factors to the observed inequalities. Data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 1998 to 2016/2018 were utilized. The concentration index (CI) was calculated to measure health inequalities, and decomposition analysis was applied to identify and quantify the contributing factors to the observed inequalities in health. The results indicated that health inequalities exist, suggesting that poor health was consistently more concentrated among Korean adults with lower income (1998: -0.154; 2016/2018: -0.152). Gender-stratified analyses also showed that poor health was more concentrated in lower income women and men, with the degree of inequalities slightly more pronounced among women. The decomposition approach revealed that income and educational attainment were the largest contributors to the observed health inequalities as higher income and education associated with better self-rated health. These findings suggest the importance of considering socioeconomic determinants, such as income and education, in efforts to tackling health inequalities, particularly considering that self-rated health is a predictor of future mortality and morbidity. Furthermore, it is essential to implement more egalitarian social, labour market, and health policies in order to eliminate the existing socioeconomic inequalities in health in Korea.
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Affiliation(s)
- Daseul Moon
- Centre for Labour Health, People's Health Institute, Seoul, South Korea
| | - Roman Pabayo
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jongnam Hwang
- Division of Social Welfare & Health Administration, Wonkwang University, Iksan, South Korea
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Subedi RK, VanderZanden A, Adhikari K, Bastola S, Hirschhorn LR, Binagwaho A, Maskey M. Integrated Management of Childhood Illness implementation in Nepal: understanding strategies, context, and outcomes. BMC Pediatr 2024; 23:645. [PMID: 38413892 PMCID: PMC10900553 DOI: 10.1186/s12887-023-03889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 02/03/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Health system-delivered evidence-based interventions (EBIs) are important to reducing amenable under-5 mortality (U5M). Implementation research (IR) can reduce knowledge gaps and decrease lags between new knowledge and its implementation in real world settings. IR can also help understand contextual factors and strategies useful to adapting EBIs and their implementation to local settings. Nepal has been a leader in dropping U5M including through adopting EBIs such as integrated management of childhood illness (IMCI). We use IR to identify strategies used in Nepal's adaptation and implementation of IMCI. METHODS We conducted a mixed methods case study using an implementation research framework developed to understand how Nepal outperformed its peers between 2000-2015 in implementing health system-delivered EBIs known to reduce amenable U5M. We combined review of existing literature and data supplemented by 21 key informant interviews with policymakers and implementers, to understand implementation strategies and contextual factors that affected implementation outcomes. We extracted relevant results from the case study and used explanatory mixed methods to understand how and why Nepal had successes and challenges in adapting and implementing one EBI, IMCI. RESULTS Strategies chosen and adapted to meet Nepal's specific context included leveraging local research to inform national decision-makers, pilot testing, partner engagement, and building on and integrating with the existing community health system. These cross-cutting strategies benefited from facilitating factors included community health system and structure, culture of data use, and local research capacity. Geography was a critical barrier and while substantial drops in U5M were seen in both the highest and lowest wealth quintiles, with the wealth equity gap decreasing from 73 to 39 per 1,000 live births from 2001 to 2016, substantial geographic inequities remained. CONCLUSIONS Nepal's story shows that implementation strategies that are available across contexts were key to adopting and adapting IMCI and achieving outcomes including acceptability, effectiveness, and reach. The value of choosing strategies that leverage facilitating factors such as investments in community-based and facility-based approaches as well as addressing barriers such as geography are useful lessons for countries working to accelerate adaptation and implementation of strategies to implement EBIs to continue achieving child health targets.
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Affiliation(s)
| | | | | | | | - Lisa R Hirschhorn
- University of Global Health Equity, Kigali, Rwanda
- Northwestern University Feinberg School of Medicine, Chicago, USA
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Gharacheh L, Amini-Rarani M, Torabipour A, Karimi S. A Scoping Review of Possible Solutions for Decreasing Socioeconomic Inequalities in Type 2 Diabetes Mellitus. Int J Prev Med 2024; 15:5. [PMID: 38487697 PMCID: PMC10935579 DOI: 10.4103/ijpvm.ijpvm_374_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/17/2023] [Indexed: 03/17/2024] Open
Abstract
Background As socioeconomic inequalities are key factors in access and utilization of type 2 diabetes (T2D) services, the purpose of this scoping review was to identify solutions for decreasing socioeconomic inequalities in T2D. Methods A scoping review of scientific articles from 2000 and later was conducted using PubMed, Web of Science (WOS), Scopus, Embase, and ProQuest databases. Using the Arksey and O'Malley framework for scoping review, articles were extracted, meticulously read, and thematically analyzed. Results A total of 7204 articles were identified from the reviewed databases. After removing duplicate and nonrelevant articles, 117 articles were finally included and analyzed. A number of solutions and passways were extracted from the final articles. Solutions for decreasing socioeconomic inequalities in T2D were categorized into 12 main solutions and 63 passways. Conclusions Applying identified solutions in diabetes policies and interventions would be recommended for decreasing socioeconomic inequalities in T2D. Also, the passways could be addressed as entry points to help better implementation of diabetic policies.
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Affiliation(s)
- Laleh Gharacheh
- Student Research Committee, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Amini-Rarani
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amin Torabipour
- Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Karimi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Cancelliere C, Yu H, Southerst D, Connell G, Verville L, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G, Nordin M, Shearer HM, Wong JJ, Hayden JA, Ogilvie R, Wang D, Côté P, Hincapié CA. Improving Rehabilitation Research to Optimize Care and Outcomes for People with Chronic Primary Low Back Pain: Methodological and Reporting Recommendations from a WHO Systematic Review Series. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:673-686. [PMID: 37991649 PMCID: PMC10684421 DOI: 10.1007/s10926-023-10140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 11/23/2023]
Abstract
Chronic primary low back pain (CPLBP) is a prevalent and disabling condition that often requires rehabilitation interventions to improve function and alleviate pain. This paper aims to advance future research, including systematic reviews and randomized controlled trials (RCTs), on CPLBP management. We provide methodological and reporting recommendations derived from our conducted systematic reviews, offering practical guidance for conducting robust research on the effectiveness of rehabilitation interventions for CPLBP. Our systematic reviews contributed to the development of a WHO clinical guideline for CPLBP. Based on our experience, we have identified methodological issues and recommendations, which are compiled in a comprehensive table and discussed systematically within established frameworks for reporting and critically appraising RCTs. In conclusion, embracing the complexity of CPLBP involves recognizing its multifactorial nature and diverse contexts and planning for varying treatment responses. By embracing this complexity and emphasizing methodological rigor, research in the field can be improved, potentially leading to better care and outcomes for individuals with CPLBP.
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Affiliation(s)
- Carol Cancelliere
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
| | - Hainan Yu
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Danielle Southerst
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Gaelan Connell
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Leslie Verville
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - André Bussières
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières (Québec), Canada
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Québec, Canada
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Paulo Pereira
- Department of Neurosurgery, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Ginny Brunton
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- EPPI-Centre, UCL Institute of Education, University College London, London, England, UK
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Margareta Nordin
- Departments of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, USA
| | - Heather M Shearer
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Rachel Ogilvie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Dan Wang
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Pierre Côté
- Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
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Yao Q, Zhang X, Wu Y, Liu C. Decomposing income-related inequality in health-related quality of life in mainland China: a national cross-sectional study. BMJ Glob Health 2023; 8:e013350. [PMID: 38035731 PMCID: PMC10689391 DOI: 10.1136/bmjgh-2023-013350] [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: 07/07/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION Health equity is an important indicator measuring social development and solidarity. However, there is a paucity in nationwide studies into the inequity in health-related quality of life (HRQoL) in mainland China, in particular using the most recent data measuring HRQoL using the EuroQol 5-Dimension-5 Level (EQ-5D-5L). This study aimed to address the gap in the literature by estimating and decomposing income-related inequality of the utility index (UI) of EQ-5D-5L in mainland China. METHODS Data were extracted from the Psychology and Behaviour Investigation of Chinese Residents (2022), including 19 738 respondents over the age of 18 years. HRQoL was assessed by the UI of the EQ-5D-5L. Concentration index (CI) was calculated to measure the degree of income-related inequality in the UI. The contributions of individual, behavioural and context characteristics to the CI were estimated using the Wagstaff decomposition method. RESULTS The CI of the EQ-5D-5L UI reached 0.0103, indicating pro-rich inequality in HRQoL. Individual characteristics made the greatest contribution to the CI (57.68%), followed by context characteristics (0.60%) and health behaviours (-3.28%). The contribution of individual characteristics was mainly attributable to disparities in the enabling (26.86%) and need factors (23.86%), with the chronic conditions (15.76%), health literacy (15.56%) and average household income (15.24%) as the top three contributors. Educational level (-5.24%) was the top negative contributor, followed by commercial (-1.43%) and basic medical insurance (-0.56%). Higher inequality was found in the least developed rural (CI=0.0140) and western regions (CI=0.0134). CONCLUSION Pro-rich inequality in HRQoL is evident in mainland China. Targeted interventions need to prioritise measures that aim at reducing disparities in chronic conditions, health literacy and income.
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Affiliation(s)
- Qiang Yao
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, China
- Centre for Social Security Studies, Wuhan University, Wuhan, Hubei, China
| | - Xiaodan Zhang
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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Kunonga TP, Hanratty B, Bower P, Craig D. A systematic review finds a lack of consensus in methodological approaches in health inequality/inequity focused reviews. J Clin Epidemiol 2023; 156:76-84. [PMID: 36813002 DOI: 10.1016/j.jclinepi.2023.02.013] [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: 10/13/2022] [Revised: 01/09/2023] [Accepted: 02/13/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES To critically review and analyze evidence synthesis articles using health inequality/inequity guidance to support their review. STUDY DESIGN AND SETTING A comprehensive, systematic search of six social science databases (1990 to May 2022) and grey literature sources was undertaken. A narrative approach to synthesis was adopted, describing and categorizing the characteristics of included articles. A comparison of the existing methodological guides was also conducted, discussing the similarities and differences between them. RESULTS From 205 identified reviews published between 2008 and 2022, 62 (30%) focusing on health inequality/inequity, met the criteria. The reviews were diverse in terms of methodology, populations, intervention level, and clinical areas. Only 19 (31%) reviews discussed the definition of inequality/inequity. Two methodological guides were identified: (i) the PROGRESS/Plus framework and (ii) the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity checklist. CONCLUSION A critique on the methodological guides reaffirms a lack of clarity or guidance on how health inequality/inequity should be considered. The PROGRESS/Plus framework narrowly focuses on dimensions of health inequality/inequity but rarely considers the pathways and interactions of these dimensions and their effect on outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity checklist on the other hand provides guidance on report. A conceptual framework is needed to show the pathways and interactions of dimensions of health inequality/inequity.
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Affiliation(s)
- Tafadzwa Patience Kunonga
- Population Health Sciences Institute, Newcastle University, National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Newcastle Biomedical Research Building, Newcastle upon Tyne, NE4 5PL, UK.
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Newcastle Biomedical Research Building, Newcastle upon Tyne, NE4 5PL, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, 5th Floor, Williamson Building, Manchester, M13 9PL, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, National Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Newcastle Biomedical Research Building, Newcastle upon Tyne, NE4 5PL, UK
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van Dijk ML, te Loo LM, Vrijsen J, van den Akker-Scheek I, Westerveld S, Annema M, van Beek A, van den Berg J, Boerboom AL, Bouma A, de Bruijne M, Crasborn J, van Dongen JM, Driessen A, Eijkelenkamp K, Goelema N, Holla J, de Jong J, de Joode A, Kievit A, Klooster JV, Kruizenga H, van der Leeden M, Linders L, Marks-Vieveen J, Mulder DJ, Muller F, van Nassau F, Nauta J, Oostvogels S, Oude Sogtoen J, van der Ploeg HP, Rijnbeek P, Schouten L, Schuling R, Serné EH, Smuling S, Soeters MR, Verhagen EALM, Zwerver J, Dekker R, van Mechelen W, Jelsma JGM. LOFIT (Lifestyle front Office For Integrating lifestyle medicine in the Treatment of patients): a novel care model towards community-based options for lifestyle change-study protocol. Trials 2023; 24:114. [PMID: 36803271 PMCID: PMC9936650 DOI: 10.1186/s13063-022-06960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/25/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO. METHODS Two parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m2) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up. DISCUSSION This study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle. TRIAL REGISTRATION ISRCTN ISRCTN13046877 . Registered 21 April 2022.
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Affiliation(s)
- Marlinde L. van Dijk
- grid.16872.3a0000 0004 0435 165XAmsterdam UMC, VU University Medical Center, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, 1081BT Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XQuality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Leonie M. te Loo
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.448984.d0000 0003 9872 5642Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Joyce Vrijsen
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne Westerveld
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Annema
- Department of Orthopedics, Ommelander Hospital Groningen, Scheemda, Groningen, The Netherlands
| | - André van Beek
- grid.4494.d0000 0000 9558 4598Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jip van den Berg
- grid.4494.d0000 0000 9558 4598Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander L. Boerboom
- grid.4494.d0000 0000 9558 4598Department of Orthopedics, Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrie Bouma
- grid.4494.d0000 0000 9558 4598Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martine de Bruijne
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XQuality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jeroen Crasborn
- grid.491477.80000 0004 4907 7789Health Insurance Expertise (formerly Zilveren Kruis), Utrecht, The Netherlands
| | - Johanna M. van Dongen
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anouk Driessen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karin Eijkelenkamp
- grid.4494.d0000 0000 9558 4598Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nies Goelema
- Department of Orthopedics, Ommelander Hospital Groningen, Scheemda, Groningen, The Netherlands
| | - Jasmijn Holla
- grid.448984.d0000 0003 9872 5642Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands ,grid.418029.60000 0004 0624 3484Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Johan de Jong
- grid.411989.c0000 0000 8505 0496Institute of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Anoek de Joode
- grid.4494.d0000 0000 9558 4598Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arthur Kievit
- grid.7177.60000000084992262Department of Orthopedics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Josine van’t Klooster
- grid.4494.d0000 0000 9558 4598Department of Strategy, Development and External Relations, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hinke Kruizenga
- grid.509540.d0000 0004 6880 3010Department of Nutrition & Dietetics, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Marike van der Leeden
- grid.16872.3a0000 0004 0435 165XDepartment of Rehabilitation Medicine, Amsterdam Movement Sciences Research Institute, Amsterdam Public Health Research Institute, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands
| | - Lilian Linders
- grid.448984.d0000 0003 9872 5642Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, The Netherlands
| | - Jenny Marks-Vieveen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010Department of Anesthesiology, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Douwe Johannes Mulder
- grid.4494.d0000 0000 9558 4598Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Femmy Muller
- grid.491477.80000 0004 4907 7789Zilveren Kruis, Leiden, The Netherlands
| | - Femke van Nassau
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joske Nauta
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | | | - Hidde P. van der Ploeg
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Linda Schouten
- Team Sportservice Noord-Holland, Haarlem, The Netherlands
| | - Rhoda Schuling
- grid.411989.c0000 0000 8505 0496Institute of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Erik H. Serné
- grid.509540.d0000 0004 6880 3010Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit, De Boelelaan, 1117 Amsterdam, The Netherlands
| | - Simone Smuling
- Huis voor de Sport in Groningen, Groningen, The Netherlands
| | - Maarten R. Soeters
- grid.7177.60000000084992262Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Evert A. L. M. Verhagen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Johannes Zwerver
- grid.4494.d0000 0000 9558 4598Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,grid.415351.70000 0004 0398 026XSports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Rienk Dekker
- grid.4494.d0000 0000 9558 4598Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Willem van Mechelen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Judith G. M. Jelsma
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XHealth Behaviors & Chronic Diseases, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XQuality of Care, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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9
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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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10
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Tsai E, Allen P, Saliba LF, Brownson RC. The power of partnerships: state public health department multisector collaborations in major chronic disease programme areas in the United States. Health Res Policy Syst 2022; 20:80. [PMID: 35804420 PMCID: PMC9264297 DOI: 10.1186/s12961-021-00765-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multisector collaboration between state public health departments (SHDs) and diverse community partners is increasingly recognized as important for promoting positive public health outcomes, addressing social determinants of health, and reducing health inequalities. This study investigates collaborations between SHDs in the United States and different types of organizations addressing chronic disease in and outside of the health sector. METHODS SHD employees were randomly selected from the National Association of Chronic Disease Directors membership list for participation in an online survey. Participants were asked about their primary chronic disease work unit (cancer, obesity, tobacco, diabetes, cardiovascular disease, and others), as well as their work unit collaborations (exchange of information/cooperation in activities) with organizations in health and non-health sectors. As a measure of the different organizations SHDs collaborated with in health and non-health sectors, a collaboration heterogeneity score for each programme area was calculated. One-way analysis of variance (ANOVA) with Tukey's post hoc tests were used to assess differences in collaborator heterogeneity between programme areas. RESULTS A total of 574 participants were surveyed. Results indicated that the cancer programme area, along with diabetes and cardiovascular disease, had significantly less collaboration heterogeneity with organizations outside of the health sector compared to the obesity and tobacco programme areas. CONCLUSIONS While collaborations with health sector organizations are commonly reported, public health departments can increase collaboration with sectors outside of health to more fully address chronic disease prevention.
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Affiliation(s)
- Edward Tsai
- Division of Public Health Sciences, Department of Surgery, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA.
| | - Peg Allen
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
| | - Louise Farah Saliba
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
| | - Ross C Brownson
- Division of Public Health Sciences, Department of Surgery, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, Campus Box 8100, St. Louis, MO, 63110, USA
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, USA
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11
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Ricardo LIC, Wendt A, Costa CDS, Mielke GI, Brazo-Sayavera J, Khan A, Kolbe-Alexander TL, Crochemore-Silva I. Gender inequalities in physical activity among adolescents from 64 Global South countries. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:509-520. [PMID: 35074485 PMCID: PMC9338337 DOI: 10.1016/j.jshs.2022.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/17/2021] [Accepted: 12/17/2021] [Indexed: 05/10/2023]
Abstract
PURPOSE The aims of this study were to (a) describe gender inequalities in physical activity (PA) among adolescents from Global South countries, and (b) investigate the relationship between gender inequalities in PA and contextual factors, such as geographic region, human development index, gender inequality index, and unemployment rates. METHODS We analyzed cross-sectional data from the Global School-Based Student Health Survey conducted in Global South countries between 2010 and 2020 among 13- to 17-year-old adolescents. Country-context variables were retrieved from secondary data sources (World Health Organization, World Bank, and Human Development Reports). PA was assessed by a self-administered questionnaire querying the number of days in the past week in which participants were physically active for a total of at least 60 min. PA absolute gender inequalities were evaluated by the differences in the prevalence between boys and girls, 95% confidence intervals (95%CIs) were estimated using the bootstrap method. Relative inequalities were obtained through Poisson regression. Meta-analyses with random effects were used to calculate pooled estimates of absolute and relative inequalities. RESULTS Based on 64 Global South countries/surveys, the prevalence of PA was 6.7 percentage points (p.p.) higher in boys than in girls, ranging from 0.5 p.p. in Afghanistan to 15.6 p.p. in Laos (I2= 85.1%). The pooled ratio for all countries showed that boys presented a PA prevalence 1.58 times higher than girls (95%CI: 1.47-1.70) on average. The highest absolute and relative inequalities were observed in high income countries. Countries with higher Human Development Index rankings and lower Gender Inequality Index rankings also presented greater gender differences. CONCLUSION Given that girls are overall less active than boys across the globe, the findings of this study reinforce that macro- and micro-level changes should be actively sought if we aim to increase population levels of PA in adolescents and promote equity in PA.
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Affiliation(s)
| | - Andrea Wendt
- Federal University of Pelotas, Pelotas, RS 96010-040, Brazil
| | | | - Gregore Iven Mielke
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | | | - Asaduzzaman Khan
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
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12
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Lin JS, Hoffman L, Bean SI, O'Connor EA, Martin AM, Iacocca MO, Bacon OP, Davies MC. Addressing Racism in Preventive Services: Methods Report to Support the US Preventive Services Task Force. JAMA 2021; 326:2412-2420. [PMID: 34747987 DOI: 10.1001/jama.2021.17579] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE In January 2021, the US Preventive Services Task Force (USPSTF) issued a values statement that acknowledged systemic racism and included a commitment to address racism and health equity in recommendations for clinical preventive services. OBJECTIVES To articulate the definitional and conceptual issues around racism and health inequity and to describe how racism and health inequities are currently addressed in preventive health. METHODS An audit was conducted assessing (1) published literature on frameworks or policy and position statements addressing racism, (2) a subset of cancer and cardiovascular topics in USPSTF reports, (3) recent systematic reviews on interventions to reduce health inequities in preventive health or to prevent racism in health care, and (4) health care-relevant professional societies, guideline-making organizations, agencies, and funding bodies to gather information about how they are addressing racism and health equity. FINDINGS Race as a social category does not have biological underpinnings but has biological consequences through racism. Racism is complex and pervasive, operates at multiple interrelated levels, and exerts negative effects on other social determinants and health and well-being through multiple pathways. In its reports, the USPSTF has addressed racial and ethnic disparities, but not racism explicitly. The systematic reviews to support the USPSTF include interventions that may mitigate health disparities through cultural tailoring of behavioral interventions, but reviews have not explicitly addressed other commonly studied interventions to increase the uptake of preventive services or foster the implementation of preventive services. Many organizations have issued recent statements and commitments around racism in health care, but few have provided substantive guidance on operational steps to address the effects of racism. Where guidance is unavailable regarding the proposed actions, it is principally because work to achieve them is in very early stages. The most directly relevant and immediately useful guidance identified is that from the GRADE working group. CONCLUSIONS AND RELEVANCE This methods report provides a summary of issues around racism and health inequity, including the status of how these are being addressed in preventive health.
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Affiliation(s)
- Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | | - Sarah I Bean
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth A O'Connor
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Allea M Martin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan O Iacocca
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | | - Melinda C Davies
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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13
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de Abreu MHNG, Cruz AJS, Borges-Oliveira AC, Martins RDC, Mattos FDF. Perspectives on Social and Environmental Determinants of Oral Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413429. [PMID: 34949037 PMCID: PMC8708013 DOI: 10.3390/ijerph182413429] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022]
Abstract
Most oral conditions have a multifactorial etiology; that is, they are modulated by biological, social, economic, cultural, and environmental factors. A consistent body of evidence has demonstrated the great burden of dental caries and periodontal disease in individuals from low socioeconomic strata. Oral health habits and access to care are influenced by the social determinants of health. Hence, the delivery of health promotion strategies at the population level has shown a great impact on reducing the prevalence of oral diseases. More recently, a growing discussion about the relationship between the environment, climate change, and oral health has been set in place. Certainly, outlining plans to address oral health inequities is not an easy task. It will demand political will, comprehensive funding of health services, and initiatives to reduce inequalities. This paper sought to give a perspective about the role of social and physical environmental factors on oral health conditions while discussing how the manuscripts published in this Special Issue could increase our knowledge of the topic.
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14
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Leventhal DGP, Crochemore-Silva I, Vidaletti LP, Armenta-Paulino N, Barros AJD, Victora CG. Delivery channels and socioeconomic inequalities in coverage of reproductive, maternal, newborn, and child health interventions: analysis of 36 cross-sectional surveys in low-income and middle-income countries. LANCET GLOBAL HEALTH 2021; 9:e1101-e1109. [PMID: 34051180 PMCID: PMC8295042 DOI: 10.1016/s2214-109x(21)00204-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 01/13/2023]
Abstract
Background Global reports have described inequalities in coverage of reproductive, maternal, newborn, and child health (RMNCH) interventions, but little is known about how socioeconomic inequality in intervention coverage varies across multiple low-income and middle-income countries (LMICs). We aimed to assess the association between wealth-related inequalities in coverage of RMNCH interventions. Methods In this cross-sectional study, we identified publicly available Demographic Health Surveys and Multiple Indicator Cluster Surveys from LMICs containing information on household characteristics, reproductive health, women's and children's health, nutrition, and mortality. We identified the most recent survey from the period 2010–19 for 36 countries that contained data for our preselected set of 18 RMNCH interventions. 21 countries also had information on two common malaria interventions. We classified interventions into four groups according to their predominant delivery channels: health facility based, community based, environmental, and culturally driven (including breastfeeding practices). Within each country, we derived wealth quintiles from information on household asset indices. We studied two summary measures of within-country wealth-related inequality: absolute inequalities (akin to coverage differences among children from wealthy and poor households) using the slope index of inequality (SII), and relative inequalities (akin to the ratio of coverage levels for wealthy and poor children) using the concentration index (CIX). Pro-poor inequalities are present when intervention coverage decreased with increasing household wealth, and pro-rich inequalities are present when intervention coverage increased as household wealth increased. Findings Across the 36 LMICs included in our analyses, coverage of most interventions had pro-rich patterns in most countries, except for two breastfeeding indicators that mostly had higher coverage among poor women, children and households than wealthy women, children, and households. Environmental interventions were the most unequal, particularly use of clean fuels, which had median levels of SII of 48·8 (8·6–85·7) and CIX of 67·0 (45·0–85·8). Interventions primarily delivered in health facilities—namely institutional childbirth (median SII 46·7 [23·1–63·3] and CIX 11·4 [4·5–23·4]) and antenatal care (median SII 26·7 [17·0–47·2] and CIX 10·0 [4·2–17·1])—also usually had pro-rich patterns. By comparison, primarily community-based interventions, including those against malaria, were more equitably distributed—eg, oral rehydration therapy (median SII 9·4 [2·9–19·0] and CIX 3·4 [1·3–25·0]) and polio immunisation (SII 12·1 [2·3–25·0] and CIX 3·1 [0·5–7·1]). Differences across the four types of delivery channels in terms of both inequality indices were significant (SII p=0·0052; CIX p=0·0048). Interpretation Interventions that are often delivered at community level are usually more equitably distributed than those primarily delivered in fixed facilities or those that require changes in the home environment. Policy makers need to learn from community delivery channels to promote more equitable access to all RMNCH interventions. Funding Bill & Melinda Gates Foundation and Wellcome Trust. Translations For the French, Portuguese and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Daniel G P Leventhal
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Inácio Crochemore-Silva
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Luis P Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Nancy Armenta-Paulino
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, RS, Brazil.
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