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Okuyan CB, Bilgili N. Assessment of health perceptions, use of health services and traditional health practices of Afghan immigrants in Türkiye. Glob Health Promot 2024:17579759241243365. [PMID: 38822634 DOI: 10.1177/17579759241243365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
Immigration, as a social determinant of health, encompasses several social and economic transformations. Neglecting to adequately address this issue could potentially worsen pre-existing challenges within health systems and in the management of migration. In the present study, we aim to evaluate the health perceptions, traditional health practices and use of health services of Afghan immigrants. We enrolled 1597 Afghan immigrants over 18 years old in the descriptive cross-sectional research. The mean age of the immigrants was 49.19 ± 1.6 years. The smallest number of points that can be achieved on the health perception scale is 15, while the greatest number is 75. We found that the health perception scale average score is 37.61 ± 7.32. Some factors, such as age 65 and over, female gender, postgraduate education level, good social insurance and economic status, being a public officer, not having any infectious diseases, and having a good Turkish level, have positively affected the health perception levels (p < 0.05). Moreover, we observed that cultural differences, expensive health care, a lack of social insurance, fear and anxiety, lack of language skills, waiting times and traditional health practices were the most common barriers to accessing healthcare services. Considering these issues in the health system, identifying the factors that negatively affect the perception of health and related to the use of health services can help immigrants increase their use of health services and improve their health.
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Affiliation(s)
- Canan Birimoglu Okuyan
- Department of Public Health Nursing, Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Türkiye
| | - Naile Bilgili
- 2Department of Public Health Nursing, Faculty of Nursing, Gazi University, Ankara, Türkiye
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Moulis L, Le SM, Hai VV, Huong DT, Minh KP, Oanh KTH, Rapoud D, Quillet C, Thi TTN, Vallo R, Hoang GT, Moles JP, Laureillard D, Feelemyer J, Des Jarlais DC, Michel L, Nagot N. Gender, homelessness, hospitalization and methamphetamine use fuel depression among people who inject drugs: implications for innovative prevention and care strategies. Front Psychiatry 2023; 14:1233844. [PMID: 38025448 PMCID: PMC10661402 DOI: 10.3389/fpsyt.2023.1233844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background The co-occurrence of substance use disorder and mental disorder, known as dual diagnosis, has a distressingly high prevalence among individuals grappling with either of these conditions. Mood disorders, especially depression, constitute a substantial burden for People Who Inject Drugs (PWID) and a significant public health concern in Vietnam. Identifying risk factors for depression in PWID is imperative for the development of targeted interventions. Methods We enrolled PWID into a cohort using the respondent-driven sampling method. Over a 36-month period, we systematically tracked the emergence of depression and employed multiple imputation in conjunction with a mixed nonlinear model to pinpoint risk factors for depression in this demographic. At inclusion, depression was screened using the PHQ-2 questionnaire, and subsequent episodes of depression were assessed semi-annually using the CES-D8. Results Three hundred and ninety-one PWID (26.6%) were depressed. Major risk factors for depression included being female, not having a permanent residency, having been hospitalized and using methamphetamine more than weekly. Other risk factors included age, being single, not having a health insurance card and not being on methadone. Limitations The exclusion of missing visits and social desirability could have led to selection and information biases. In this observational study, confusion biases are possible despite our best efforts. Conclusion Depression is alarmingly frequent in PWID. In this study taking in account the chronological relationship between sociodemographic and clinical factors and depression, risk factors were identified in this specific setting of low-to-middle income country. The findings highlight the need to develop innovative targeted psychiatric interventions with the help of supporting peers.
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Affiliation(s)
- Lionel Moulis
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Sao Mai Le
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Vinh Vu Hai
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Haiphong, Vietnam
| | - Duong Thi Huong
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Khuê Pham Minh
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | | | - Delphine Rapoud
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Catherine Quillet
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | | | - Roselyne Vallo
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Giang Thi Hoang
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Jean-Pierre Moles
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Didier Laureillard
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | | | | | - Laurent Michel
- CESP Inserm UMRS, Pierre Nicole Center, Paris Saclay University, Fench Red Cross, Paris, France
| | - Nicolas Nagot
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
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Herrera K, Maldonado-Ruiz R, Camacho-Morales A, de la Garza AL, Castro H. Maternal methyl donor supplementation regulates the effects of cafeteria diet on behavioral changes and nutritional status in male offspring. Food Nutr Res 2023; 67:9828. [PMID: 37920679 PMCID: PMC10619398 DOI: 10.29219/fnr.v67.9828] [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: 07/11/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 11/04/2023] Open
Abstract
Background Nutritional status and maternal feeding during the perinatal and postnatal periods can program the offspring to develop long-term health alterations. Epidemiologic studies have demonstrated an association between maternal obesity and intellectual disability/cognitive deficits like autism spectrum disorders (ASDs) in offspring. Experimental findings have consistently been indicating that maternal supplementation with methyl donors, attenuated the social alterations and repetitive behavior in offspring. Objective This study aims to analyze the effect of maternal cafeteria diet and methyl donor-supplemented diets on social, anxiety-like, and repetitive behavior in male offspring, besides evaluating weight gain and food intake in both dams and male offspring. Design C57BL/6 female mice were randomized into four dietary formulas: control Chow (CT), cafeteria (CAF), control + methyl donor (CT+M), and cafeteria + methyl donor (CAF+M) during the pre-gestational, gestational, and lactation period. Behavioral phenotyping in the offspring was performed by 2-month-old using Three-Chamber Test, Open Field Test, and Marble Burying Test. Results We found that offspring prenatally exposed to CAF diet displayed less social interaction index when compared with subjects exposed to Chow diet (CT group). Notably, offspring exposed to CAF+M diet recovered social interaction when compared to the CAF group. Discussion These findings suggest that maternal CAF diet is efficient in promoting reduced social interaction in murine models. In our study, we hypothesized that a maternal methyl donor supplementation could improve the behavioral alterations expected in maternal CAF diet offspring. Conclusions The CAF diet also contributed to a social deficit and anxiety-like behavior in the offspring. On the other hand, a maternal methyl donor-supplemented CAF diet normalized the social interaction in the offspring although it led to an increase in anxiety-like behaviors. These findings suggest that a methyl donor supplementation could protect against aberrant social behavior probably targeting key genes related to neurotransmitter pathways.
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Affiliation(s)
- Katya Herrera
- Universidad Autonoma de Nuevo León, Facultad de Salud Pública y Nutrición, Centro de Investigación en Nutrición y Salud Pública. Monterrey, Nuevo León, México
| | - Roger Maldonado-Ruiz
- Universidad Autonoma de Nuevo Leon, Unidad de Neurometabolismo, Centro de Investigación y Desarrollo en Ciencias de la Salud. Monterrey, Nuevo León, México
| | - Alberto Camacho-Morales
- Universidad Autonoma de Nuevo Leon, Unidad de Neurometabolismo, Centro de Investigación y Desarrollo en Ciencias de la Salud. Monterrey, Nuevo León, México
- Universidad Autonoma de Nuevo Leon, Facultad de Medicina, Departamento de Bioquímica. Monterrey, Nuevo León, México
| | - Ana Laura de la Garza
- Universidad Autonoma de Nuevo Leon, Unidad de Nutrición, Centro de Investigación y Desarrollo en Ciencias de la Salud. Monterrey, Nuevo León, México
| | - Heriberto Castro
- Universidad Autonoma de Nuevo León, Facultad de Salud Pública y Nutrición, Centro de Investigación en Nutrición y Salud Pública. Monterrey, Nuevo León, México
- Universidad Autonoma de Nuevo Leon, Unidad de Nutrición, Centro de Investigación y Desarrollo en Ciencias de la Salud. Monterrey, Nuevo León, México
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Frank J, Mustard C, Smith P, Siddiqi A, Cheng Y, Burdorf A, Rugulies R. Work as a social determinant of health in high-income countries: past, present, and future. Lancet 2023; 402:1357-1367. [PMID: 37838441 DOI: 10.1016/s0140-6736(23)00871-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 01/17/2023] [Accepted: 04/27/2023] [Indexed: 10/16/2023]
Abstract
This paper, the first in a three-part Series on work and health, provides a narrative review of research into work as a social determinant of health over the past 25 years, the key emerging challenges in this field, and the implications of these challenges for future research. By use of a conceptual framework for work as a social determinant of health, we identified six emerging challenges: (1) the influence of technology on the nature of work in high-income countries, culminating in the sudden shift to telework during the COVID-19 pandemic; (2) the intersectionality of work with gender, sexual orientation, age, race, ethnicity, migrant status, and socioeconomic status as codeterminants of health disparities; (3) the arrival in many Organisation for Economic Co-operation and Development countries of large migrant labour workforces, who are often subject to adverse working conditions and social exclusion; (4) the development of precarious employment as a feature of many national labour markets; (5) the phenomenon of working long and irregular hours with potential health consequences; and (6) the looming threat of climate change's effects on work. We conclude that profound changes in the nature and availability of work over the past few decades have led to widespread new psychosocial and physical exposures that are associated with adverse health outcomes and contribute to increasing disparities in health. These new exposures at work will require novel and creative methods of data collection for monitoring of their potential health impacts to protect the workforce, and for new research into better means of occupational health promotion and protection. There is also an urgent need for a better integration of occupational health within public health, medicine, the life sciences, and the social sciences, with the work environment explicitly conceptualised as a major social determinant of health.
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Affiliation(s)
- John Frank
- Usher Institute, University of Edinburgh, Edinburgh, UK; Institute for Work & Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Cameron Mustard
- Institute for Work & Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Peter Smith
- Institute for Work & Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Yawen Cheng
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Alex Burdorf
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Reiner Rugulies
- National Research Centre for the Working Environment, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
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Samson DR, Clerget A, Abbas N, Senese J, Sarma MS, Lew-Levy S, Mabulla IA, Mabulla AZP, Miegakanda V, Borghese F, Henckaerts P, Schwartz S, Sterpenich V, Gettler LT, Boyette A, Crittenden AN, Perogamvros L. Evidence for an emotional adaptive function of dreams: a cross-cultural study. Sci Rep 2023; 13:16530. [PMID: 37783728 PMCID: PMC10545663 DOI: 10.1038/s41598-023-43319-z] [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: 06/26/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023] Open
Abstract
The function of dreams is a longstanding scientific research question. Simulation theories of dream function, which are based on the premise that dreams represent evolutionary past selective pressures and fitness improvement through modified states of consciousness, have yet to be tested in cross-cultural populations that include small-scale forager societies. Here, we analyze dream content with cross-cultural comparisons between the BaYaka (Rep. of Congo) and Hadza (Tanzania) foraging groups and Global North populations, to test the hypothesis that dreams in forager groups serve a more effective emotion regulation function due to their strong social norms and high interpersonal support. Using a linear mixed effects model we analyzed 896 dreams from 234 individuals across these populations, recorded using dream diaries. Dream texts were processed into four psychosocial constructs using the Linguistic Inquiry and Word Count (LIWC-22) dictionary. The BaYaka displayed greater community-oriented dream content. Both the BaYaka and Hadza exhibited heightened threat dream content, while, at the same time, the Hadza demonstrated low negative emotions in their dreams. The Global North Nightmare Disorder group had increased negative emotion content, and the Canadian student sample during the COVID-19 pandemic displayed the highest anxiety dream content. In conclusion, this study supports the notion that dreams in non-clinical populations can effectively regulate emotions by linking potential threats with non-fearful contexts, reducing anxiety and negative emotions through emotional release or catharsis. Overall, this work contributes to our understanding of the evolutionary significance of this altered state of consciousness.
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Affiliation(s)
- David R Samson
- Sleep and Human Evolution Lab, University of Toronto, Mississauga, Canada.
- Department of Anthropology, University of Toronto, 3359 Mississauga Road, Mississauga, ON, L5L 1C6, Canada.
| | - Alice Clerget
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Noor Abbas
- Sleep and Human Evolution Lab, University of Toronto, Mississauga, Canada
| | - Jeffrey Senese
- Sleep and Human Evolution Lab, University of Toronto, Mississauga, Canada
| | - Mallika S Sarma
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Sheina Lew-Levy
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Ibrahim A Mabulla
- Department of Archaeology and Heritage, Institute of Resource Assessment, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Audax Z P Mabulla
- Department of Archaeology and Heritage, Institute of Resource Assessment, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Valchy Miegakanda
- Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Francesca Borghese
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Pauline Henckaerts
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Sophie Schwartz
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Virginie Sterpenich
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Lee T Gettler
- Department of Anthropology, University of Notre Dame, Notre Dame, IN, USA
| | - Adam Boyette
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | | | - Lampros Perogamvros
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland.
- Department of Psychiatry, Center for Sleep Medicine, University Hospitals of Geneva, Geneva, Switzerland.
- Department of Psychiatry, Center for Sleep Medicine, 2 Chemin du Petit-Bel-Air, 1226 Thônex, Switzerland.
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Öcek ZA, Geise M, Volkmann AM, Basili A, Klünder V, Coenen M. Strengthening the social resilience of people living at the intersection of precariousness and migration during pandemics: action recommendations developed in Munich, Germany. Front Public Health 2023; 11:1201215. [PMID: 37601211 PMCID: PMC10433162 DOI: 10.3389/fpubh.2023.1201215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction An EU-funded project in five countries examined vulnerability mechanisms during the COVID-19 pandemic. The research team in Germany concentrated on people living at the intersection of migration and precariousness. The study aimed first to provide an understanding of how migrants living in precarious conditions in Munich had been affected by the pandemic, both from their own and from experts' perspectives. The second aim was to develop action recommendations to reduce structural vulnerabilities and increase resilience with a view towards improved pandemic preparedness. Methods The study followed a two-phase process. The first was a qualitative study based on interviews with 25 migrants and 13 experts. In the second, researchers developed action recommendations based on the vulnerability/ resilience factors that had been generated in the first phase. Three consecutive meetings with stakeholders (expert panel, focus group discussion with two migrant organization, meeting with the Munich Migration Council) were then held to further strengthen the draft recommendations. Results Content analysis revealed twelve vulnerability and eight resilience factors in three domains (COVID-19 prevention; human rights, living and housing environment; social support). Migrants had limited access to COVID-19 prevention measures; living conditions made outbreaks inevitable; uncertainty about legal status, employment, and housing, as well as stigma and discrimination, exacerbated their precariousness; social support had decreased; and resilience mechanisms had failed. The initial draft of recommendations contained 24 proposed actions. The meetings added recommendations such as enhancing psychosocial support, preventing ghettoization, improving social housing, preventing the interruption of language education in times of crisis, severe penalties for media stigmatisation and proactive truth-telling. The final list included 30 actions. Conclusion In Munich, the COVID-19 pandemic exacerbated vulnerability mechanisms commonly associated with being a migrant. The recommendations developed here speak to those vulnerabilities but need to be refined further to be more actionable and comprehensive. Nonetheless, the recommendations and the processes that led to them highlight the importance of migrant-inclusive approaches and empowerment in increasing migrants' resilience to future crises.
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Affiliation(s)
- Zeliha Asli Öcek
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Medical Faculty, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Rachel Carson Centre for Environment and Society, LMU Munich, Munich, Germany
| | - Mandy Geise
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | | | - Acelya Basili
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Medical Faculty, LMU Munich, Munich, Germany
| | - Vera Klünder
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Medical Faculty, LMU Munich, Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Medical Faculty, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Broadbent P, Thomson R, Kopasker D, McCartney G, Meier P, Richiardi M, McKee M, Katikireddi SV. The public health implications of the cost-of-living crisis: outlining mechanisms and modelling consequences. THE LANCET REGIONAL HEALTH. EUROPE 2023; 27:100585. [PMID: 37035237 PMCID: PMC10068020 DOI: 10.1016/j.lanepe.2023.100585] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 02/16/2023]
Abstract
The UK, and other high-income countries, are experiencing substantial increases in living costs. Several overlapping and intersecting economic crises threaten physical and mental health in the immediate and longer term. Policy responses may buffer against the worst effects (e.g. welfare support) or further undermine health (e.g. austerity). We explore fundamental causes underpinning the cost-of-living crisis, examine potential pathways by which the crisis could impact population health and use a case study to model potential impacts of one aspect of the crisis on a specific health outcome. Our modelling illustrates how policy approaches can substantially protect health and avoid exacerbating health inequalities. Targeting support at vulnerable households is likely to protect health most effectively. The current crisis is likely to be the first of many in era of political and climate uncertainty. More refined integrated economic and health modelling has the potential to inform policy integration, or 'health in all policies'.
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Affiliation(s)
- Philip Broadbent
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Rachel Thomson
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Daniel Kopasker
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Gerry McCartney
- School of Social & Political Sciences, University of Glasgow, United Kingdom
| | - Petra Meier
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
| | - Matteo Richiardi
- Institute for Social and Economic Research, University of Essex, United Kingdom
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
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van Pinxteren M, Mbokazi N, Murphy K, Mair FS, May C, Levitt N. The impact of persistent precarity on patients' capacity to manage their treatment burden: A comparative qualitative study between urban and rural patients with multimorbidity in South Africa. Front Med (Lausanne) 2023; 10:1061190. [PMID: 37064034 PMCID: PMC10098191 DOI: 10.3389/fmed.2023.1061190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/07/2023] [Indexed: 04/18/2023] Open
Abstract
Background People living with multimorbidity in low-and middle-income countries (LMICs) experience a high workload trying to meet the demands of self-management. In an unequal society like South Africa, many people face continuous economic uncertainty, which can impact on their capacity to manage their illnesses and lead to poor health outcomes. Using precariousness - the real and perceived impact of uncertainty - as a lens, this paper aims to identify, characterise, and understand the workload and capacity associated with self-management amongst people with multimorbidity living in precarious circumstances in urban and rural South Africa. Methods We conducted qualitative semi-structured interviews with 30 patients with HIV and co-morbidities between February and April 2021. Patients were attending public clinics in Cape Town (Western Cape) and Bulungula (Eastern Cape). Interviews were transcribed and data analysed using qualitative framework analysis. Burden of Treatment Theory (BoTT) and the Cumulative Complexity Model (CuCoM) were used as theoretical lenses through which to conceptualise the data. Results People with multimorbidity in rural and urban South Africa experienced multi-faceted precariousness, including financial and housing insecurity, dangerous living circumstances and exposure to violence. Women felt unsafe in their communities and sometimes their homes, whilst men struggled with substance use and a lack of social support. Older patients relied on small income grants often shared with others, whilst younger patients struggled to find stable employment and combine self-management with family responsibilities. Precariousness impacted access to health services and information and peoples' ability to buy healthy foods and out-of-pocket medication, thus increasing their treatment burden and reducing their capacity. Conclusion This study highlights that precariousness reduces the capacity and increases treatment burden for patients with multimorbidity in low-income settings in South Africa. Precariousness is both accumulative and cyclic, as financial insecurity impacts every aspect of peoples' daily lives. Findings emphasise that current models examining treatment burden need to be adapted to accommodate patients' experiences in low-income settings and address cumulative precariousness. Understanding treatment burden and capacity for patients in LMICs is a crucial first step to redesign health systems which aim to improve self-management and offer comprehensive person-centred care.
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Affiliation(s)
- Myrna van Pinxteren
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Nonzuzo Mbokazi
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Katherine Murphy
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Frances S. Mair
- School of Health and Well-Being, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Carl May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- NIHR North Thames Applied Research Collaboration, London, United Kingdom
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Preventing Respiratory Syncytial Virus in Children in France: A Narrative Review of the Importance of a Reinforced Partnership Between Parents, Healthcare Professionals, and Public Health Authorities. Infect Dis Ther 2022; 12:317-332. [PMID: 36520324 PMCID: PMC9753881 DOI: 10.1007/s40121-022-00737-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
The highly contagious respiratory syncytial virus (RSV) is responsible for up to approximately 50,000 hospitalisations during each RSV season in children aged under 5 years in France, with the burden greatest in infants younger than 1 year who were born at term. There is a need for a strategy to universally protect young children from RSV infection, and thereby reduce the pressure that RSV places every year on RSV-infected children, their parents, and French healthcare systems. Potential strategies currently undergoing clinical investigation include passive immunisation via maternal vaccination or administration of long-acting monoclonal antibodies at or soon after birth, followed by vaccination later in infancy or childhood. An ongoing partnership and collaboration between parents, public health authorities, and frontline primary healthcare will need to be reinforced once these new RSV prevention strategies are available, to facilitate their use and ensure that all children receive adequate protection from the start of their first RSV season.
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Earle S, Blackburn M, Chambers L, Downing J, Flemming K, Hale J, Marston HR, O’Dell L, Sinason V, Watts L, Whitney S. 'Whose life are They Going to Save? It's Probably Not Going to be Mine!' Living With a Life-Shortening Condition During the Coronavirus (COVID-19) Pandemic: A Grounded Theory Study of Embodied Precarity. QUALITATIVE HEALTH RESEARCH 2022; 32:2055-2065. [PMID: 36250473 PMCID: PMC9574525 DOI: 10.1177/10497323221131692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This article explores the experiences of young adults with a life-shortening condition in the first wave of the Coronavirus (COVID-19) pandemic in the UK. It presents the findings from an inclusive qualitative research study using constructivist grounded theory which aimed to examine the unintended consequences of pandemic control measures (lockdown and 'shielding') on this population. Purposive and theoretical sampling methods were used to recruit young adults with a life-shortening condition, employing a range of recruitment methods such as social media, advertising in newsletters and snowballing. Twenty-six young adults (aged 22-40 years), with a wide range of life-shortening conditions participated in the study. Seventeen participants were female and nine male. The majority identified as White British/Other and the remainder as Black British (2), Mixed Race (2) or Latin American (1). Data were generated iteratively using in-depth guided interviews and analysed collectively by an inclusive research team using the constant comparative method. The article explores a theory of embodied precariousness of living with a life-shortening condition during the first wave of the Coronavirus pandemic in relation to three categories: the rationing of life-saving treatment, the deterioration of health and retraction of healthcare provision, and the disruption of typical care arrangements. The findings show that the pandemic control measures introduced to keep people safe have intensified the precarity of this group promoting inequalities in healthcare and health outcomes. The article identifies some implications for practice to support the future management of unexpected and unwanted change.
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Affiliation(s)
| | | | | | - Julia Downing
- International Children’s Palliative Care
Network, UK/South Africa
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11
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Pulford A, Thapa A, Thomson RM, Guilding A, Green MJ, Leyland A, Popham F, Katikireddi SV. Does persistent precarious employment affect health outcomes among working age adults? A systematic review and meta-analysis. J Epidemiol Community Health 2022; 76:jech-2022-219292. [PMID: 36137738 PMCID: PMC9554022 DOI: 10.1136/jech-2022-219292] [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: 05/20/2022] [Accepted: 08/31/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To evaluate the impact of persistent precarious employment (lasting 12+ months) on the health of working age adults, compared with more stable employment. Persistent precarity reflects a shift towards less secure forms of employment and may be particularly important for health. METHODS Nine databases were systematically searched to identify quantitative studies that assessed the relationship between persistent precarious employment and health outcomes. Risk of bias (RoB) was assessed using an adaptation of the Effective Public Health Practice Project tool. Narrative synthesis and random effects meta-analysis were conducted. Certainty of evidence was assessed using the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS Of 12 940 records screened, 50 studies met the inclusion criteria and 29 were included in meta-analyses. RoB was generally high (n=18). The most reported outcome domain was mental health; with evidence also reported relating to general health, physical health,and health behaviours. Of GRADE assessed outcomes, persistent precarious employment was associated with increased risk of poor self-rated health (OR 1.53, 95% CI 1.09 to 2.14, I2=80%) and mental health symptoms (OR 1.44, 95% CI 1.23 to 1.70, I2=65%). The association with all-cause mortality was imprecisely estimated (OR 1.10, 5% CI 0.91 to 1.33, I2=73%). There was very low GRADE certainty across all outcomes. CONCLUSIONS Persistent precarious employment is associated with poorer health, particularly for outcomes with short time lags, though associations are small and causality is highly uncertain. Further research using more robust methods is needed but given potential health harms of persistent precarious employment, exploration of precautionary labour regulations and employment policies is warranted.
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Affiliation(s)
- Andrew Pulford
- Evidence for Action Team, Public Health Scotland Glasgow Office, Glasgow, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alekh Thapa
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Rachel M Thomson
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Annette Guilding
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Michael James Green
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alastair Leyland
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Frank Popham
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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12
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Huang J, Kwan MP. Examining the Influence of Housing Conditions and Daily Greenspace Exposure on People's Perceived COVID-19 Risk and Distress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8876. [PMID: 35886727 PMCID: PMC9321234 DOI: 10.3390/ijerph19148876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022]
Abstract
Many people have worried about COVID-19 infection, job loss, income reduction, and family conflict during the COVID-19 pandemic. Some social groups may be particularly vulnerable due to their residential neighborhoods and daily activities. On the other hand, people's daily exposure to greenspace offers promising pathways for reducing these worries associated with COVID-19. Using data collected with a questionnaire and a two-day activity diary from two typical neighborhoods in Hong Kong, this study examines how people's housing conditions and daily greenspace exposure affect their perceived COVID-19 risk and distress (i.e., worries about job loss, income reduction, and family conflict) during the pandemic. First, the study compares people's perceived COVID-19 risk and distress based on their residential neighborhoods. Further, it examines the associations between people's perceived COVID-19 risk and distress with their housing conditions and daily greenspace exposure using ordinal logistic regression models. The results indicate that living in a high-risk neighborhood, being married, renting a residential unit, and living in a large household are significantly associated with a higher neighborhood-based perceived COVID-19 risk and distress during the pandemic. In addition, people also reported lower mobility-based perceived COVID-19 risk when compared to their neighborhood-based perceived COVID-19 risk, while they still have a high perceived COVID-19 risk in their occupational venues if they have to work in a high-risk district (e.g., Kowloon). Lastly, daily greenspace exposure (i.e., woodland) could reduce people's perceived COVID-19 risk and distress. These results have important implications for the public health authority when formulating the measures during the COVID-19 pandemic.
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Affiliation(s)
- Jianwei Huang
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Shatin, Hong Kong, China;
| | - Mei-Po Kwan
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Shatin, Hong Kong, China;
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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13
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Rajan S, McKee M, Hernández-Quevedo C, Karanikolos M, Richardson E, Webb E, Cylus J. What have European countries done to prevent the spread of COVID-19? Lessons from the COVID-19 Health System Response Monitor. Health Policy 2022; 126:355-361. [PMID: 35339282 PMCID: PMC8912990 DOI: 10.1016/j.healthpol.2022.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 01/24/2022] [Accepted: 03/09/2022] [Indexed: 11/07/2022]
Abstract
Although some European countries imposed measures that successfully slowed the transmission of Covid-19 during the first year of the pandemic, others struggled, either because they acted slowly or implemented measures ineffectively. In this paper we consider the European experience with public health measures designed to prevent transmission of COVID-19. Based on literature and country responses described in the COVID-19 Health System Response Monitor from March 2020 to December 2020, we consider some critical aspects of public health policy responses. These include the importance of public health capacity that can scale up surveillance and outbreak control, including effective testing and contract tracing, of clear messaging based on an understanding of human behaviour, policies that address the undesirable consequences of necessary measures, such as support for those isolating or unable to earn, and the ability to implement at pace and scale a major vaccine rollout. We conclude that for countries to be successful at preventing COVID-19 transmission, there is a need for a clear strategy with explicit goals and a whole systems approach to implementation.
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14
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Gunn V, Kreshpaj B, Matilla-Santander N, Vignola EF, Wegman DH, Hogstedt C, Ahonen EQ, Bodin T, Orellana C, Baron S, Muntaner C, O’Campo P, Albin M, Håkansta C. Initiatives Addressing Precarious Employment and Its Effects on Workers' Health and Well-Being: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2232. [PMID: 35206419 PMCID: PMC8872425 DOI: 10.3390/ijerph19042232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/04/2022] [Accepted: 02/12/2022] [Indexed: 11/22/2022]
Abstract
The prevalence of precarious employment has increased in recent decades and aspects such as employment insecurity and income inadequacy have intensified during the COVID-19 pandemic. The purpose of this systematic review was to identify, appraise, and synthesise existing evidence pertaining to implemented initiatives addressing precarious employment that have evaluated and reported health and well-being outcomes. We used the PRISMA framework to guide this review and identified 11 relevant initiatives through searches in PubMed, Scopus, Web of Science, and three sources of grey literature. We found very few evaluated interventions addressing precarious employment and its impact on the health and well-being of workers globally. Ten out of 11 initiatives were not purposefully designed to address precarious employment in general, nor specific dimensions of it. Seven out of 11 initiatives evaluated outcomes related to the occupational health and safety of precariously employed workers and six out of 11 evaluated worker health and well-being outcomes. Most initiatives showed the potential to improve the health of workers, although the evaluation component was often described with less detail than the initiative itself. Given the heterogeneity of the 11 initiatives regarding study design, sample size, implementation, evaluation, economic and political contexts, and target population, we found insufficient evidence to compare outcomes across types of initiatives, generalize findings, or make specific recommendations for the adoption of initiatives.
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Affiliation(s)
- Virginia Gunn
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 11365 Stockholm, Sweden; (B.K.); (N.M.-S.); (C.H.); (T.B.); (C.O.); (M.A.); (C.H.)
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada;
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, St. George Campus, Toronto, ON M5T 1P8, Canada;
| | - Bertina Kreshpaj
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 11365 Stockholm, Sweden; (B.K.); (N.M.-S.); (C.H.); (T.B.); (C.O.); (M.A.); (C.H.)
| | - Nuria Matilla-Santander
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 11365 Stockholm, Sweden; (B.K.); (N.M.-S.); (C.H.); (T.B.); (C.O.); (M.A.); (C.H.)
| | - Emilia F. Vignola
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10025, USA;
| | - David H. Wegman
- University of Massachusetts Lowell, Lowell, MA 01854, USA;
- La Isla Network, Washington, DC 20005, USA
| | - Christer Hogstedt
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 11365 Stockholm, Sweden; (B.K.); (N.M.-S.); (C.H.); (T.B.); (C.O.); (M.A.); (C.H.)
| | - Emily Q. Ahonen
- Division of Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA;
| | - Theo Bodin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 11365 Stockholm, Sweden; (B.K.); (N.M.-S.); (C.H.); (T.B.); (C.O.); (M.A.); (C.H.)
- Center for Occupational and Environmental Medicine, Stockholm Region, 11365 Stockholm, Sweden
| | - Cecilia Orellana
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 11365 Stockholm, Sweden; (B.K.); (N.M.-S.); (C.H.); (T.B.); (C.O.); (M.A.); (C.H.)
| | - Sherry Baron
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, New York, NY 11367, USA;
| | - Carles Muntaner
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, St. George Campus, Toronto, ON M5T 1P8, Canada;
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P8, Canada
- Department of Mental Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MA 21205, USA
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1W8, Canada;
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Maria Albin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 11365 Stockholm, Sweden; (B.K.); (N.M.-S.); (C.H.); (T.B.); (C.O.); (M.A.); (C.H.)
- Center for Occupational and Environmental Medicine, Stockholm Region, 11365 Stockholm, Sweden
| | - Carin Håkansta
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, 11365 Stockholm, Sweden; (B.K.); (N.M.-S.); (C.H.); (T.B.); (C.O.); (M.A.); (C.H.)
- Working Life Science, Karlstad Business School, Karlstad University, 65188 Karlstad, Sweden
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15
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Forman R, Azzopardi-Muscat N, Kirkby V, Lessof S, Nathan NL, Pastorino G, Permanand G, van Schalkwyk MC, Torbica A, Busse R, Figueras J, McKee M, Mossialos E. Drawing light from the pandemic: Rethinking strategies for health policy and beyond. Health Policy 2021; 126:1-6. [PMID: 34961678 PMCID: PMC8645287 DOI: 10.1016/j.healthpol.2021.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/11/2021] [Accepted: 12/01/2021] [Indexed: 01/11/2023]
Abstract
The COVID-19 pandemic is a catastrophe. It was also preventable. The potential impacts of a novel pathogen were foreseen and for decades scientists and commentators around the world warned of the threat. Most governments and global institutions failed to heed the warnings or to pay enough attention to risks emerging at the interface of human, animal, and environmental health. We were not ready for COVID-19, and people, economies, and governments around the world have suffered as a result. We must learn from these experiences now and implement transformational changes so that we can prevent future crises, and if and when emergencies do emerge, we can respond in more timely, robust and equitable ways, and minimize immediate and longer-term impacts. In 2020–21 the Pan-European Commission on Health and Sustainable Development assessed the challenges posed by COVID-19 in the WHO European region and the lessons from the response. The Commissioners have addressed health in its entirety, analyzing the interactions between health and sustainable development and considering how other policy priorities can contribute to achieving both. The Commission's final report makes a series of policy recommendations that are evidence-informed and above all actionable. Adopting them would achieve seven key objectives and help build truly sustainable health systems and fairer societies.
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Affiliation(s)
- Rebecca Forman
- London School of Economics and Political Science, United Kingdom
| | | | - Victoria Kirkby
- London School of Hygiene and Tropical Medicine, United Kingdom
| | - Suszy Lessof
- European Observatory on Health Systems and Policies, Belgium
| | | | | | - Govin Permanand
- World Health Organization Regional Office for Europe, Denmark
| | | | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Italy
| | - Reinhard Busse
- European Observatory on Health Systems and Policies, Belgium; Technische Universität Berlin, Germany
| | - Josep Figueras
- European Observatory on Health Systems and Policies, Belgium
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, United Kingdom; European Observatory on Health Systems and Policies, Belgium
| | - Elias Mossialos
- London School of Economics and Political Science, United Kingdom; European Observatory on Health Systems and Policies, Belgium; Imperial College London, United Kingdom.
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16
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McNamara CL, McKee M, Stuckler D. Precarious employment and health in the context of COVID-19: a rapid scoping umbrella review. Eur J Public Health 2021; 31:iv40-iv49. [PMID: 34751369 PMCID: PMC8576296 DOI: 10.1093/eurpub/ckab159] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background There are widespread concerns that workers in precarious employment have suffered the most in the COVID-19 pandemic and merit special attention. The aim of this rapid scoping umbrella review was to examine what evidence exists about how COVID-19 has affected the health of this highly vulnerable group, and what gaps remain to be investigated. Methods Five databases were searched for systematic or scoping reviews from January 2020 to May 2021. The quality of the included reviews was determined using A MeaSurement Tool to Assess systematic Reviews. Results We identified 6 reviews that reported 30 unique relevant primary studies. The included studies indicate that essential (non-health) workers are at greater risk of COVID-19 infection and case fatality than others in their surrounding community. The occupational risk of exposure to COVID-19 also seems to be greater among more precarious categories of workers, including younger workers and workers in low-income and low-skilled occupations. Further, hazardous working conditions faced by many essential workers appear to have amplified the pandemic, as several occupational sites became ‘super-spreaders’, due to an inability to socially distance at work and high contact rates among workers. Finally, employment and financial insecurity generated by the pandemic appears to be associated with negative mental health outcomes. The quality of the included reviews however, and their primary studies, were generally weak and many gaps remain in the evidence base. Conclusions Our study highlights that COVID-19 is creating new health risks for precarious workers as well as exacerbating the pre-existing health risks of precarious employment.
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Affiliation(s)
- Courtney L McNamara
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Stuckler
- Dondena Centre for Research on Social Dynamics, Department of Social & Political Sciences, Bocconi University, Milano, Italy
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17
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Koltai J, Toffolutti V, McKee M, Stuckler D. Prevalence and changes in food-related hardships by socioeconomic and demographic groups during the COVID-19 pandemic in the UK: A longitudinal panel study. LANCET REGIONAL HEALTH-EUROPE 2021; 6:100125. [PMID: 34308408 PMCID: PMC8291709 DOI: 10.1016/j.lanepe.2021.100125] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Food insecurity concerns have featured prominently in the UK response to the COVID-19 pandemic. We assess changes in the prevalence of food-related hardships in the UK population from April to July 2020. Method We analysed longitudinal data on food-related hardships for 11,104 respondents from the April-July 2020 waves of the Understanding Society COVID-19 web survey with linked data from the 2017-9 wave of the annual Understanding Society survey. Outcome variables were reports of being hungry but not eating and of being unable to eat healthy and nutritious food in the last week, which were adapted from the Food Insecurity Experience Scale. We used unadjusted estimates to examine changes in population prevalence and logistic regression to assess the association between employment transitions and both outcomes at the individual level. Findings The prevalence of reporting an inability to eat healthy or nutritious food rose from 3•2% in April to 16•3% in July 2020. The largest increases in being unable to eat healthy or nutritious food were among Asian respondents, the self-employed, and 35-44-year-olds. The prevalence of being hungry but not eating rose from 3•3% in April to 5•1% in July, with the largest increases observed among unemployed individuals below age 65. Those moving from employment to unemployment had higher odds of being hungry but not eating in the last week relative to furloughed individuals (OR = 2•2; p < 0•05; 95% CI: 1•1 to 4•2) and to the persistently employed (OR = 3•5; p < 0•001; 95% CI: 1•8 to 6•9), adjusting for age, highest qualification in 2017-19, net household income in 2017-19 (equivalized), gender, race/ethnicity, number children at home (aged 0-4, 5-15, and 16-18), cohabitation status, and government office region. Respondents moving from employment to unemployment also had higher odds of reporting an inability to eat healthy and nutritious food relative to furloughed individuals (OR = 1•9; p < 0•05; 95% CI: 1•4 to 3•2) and to the persistently employed (OR = 2•0; p < 0•01; 95% CI: 1•2 to 3•4). No statistically significant differences were found between furloughed individuals and the persistently employed in their probability of reporting either outcome. Interpretation Food-related hardships increased substantially in the UK between April and July 2020, largely driven by reports of an inability to eat healthy and nutritious food. The Coronavirus Job Retention Scheme and Self-Employment Income Support Scheme appeared to have conferred some protection, but more could have been done to mitigate the problems we describe in obtaining affordable food. Funding DS is funded by the Wellcome Trust investigator award. JK and DS are funded by the European Research Council n. 313590 – HRES. VT is funded by the European Research Council n. 694145- IFAMID.
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Affiliation(s)
- Jonathan Koltai
- Sociology Department, University of New Hampshire, Durham, USA
- Corresponding author.
| | - Veronica Toffolutti
- Centre for Health Economics & Policy Innovation and Department of Economics & Public Policy, Imperial College London, London, UK
| | - Martin McKee
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | - David Stuckler
- Dondena Centre for Research on Social Dynamics and Public Policy and Department of Social and Political Sciences, Bocconi University, Milan, Italy
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18
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McKee M, Dunnell K, Anderson M, Brayne C, Charlesworth A, Johnston-Webber C, Knapp M, McGuire A, Newton JN, Taylor D, Watt RG. The changing health needs of the UK population. Lancet 2021; 397:1979-1991. [PMID: 33965065 PMCID: PMC9751760 DOI: 10.1016/s0140-6736(21)00229-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/22/2020] [Accepted: 01/07/2021] [Indexed: 12/23/2022]
Abstract
The demographics of the UK population are changing and so is the need for health care. In this Health Policy, we explore the current health of the population, the changing health needs, and future threats to health. Relative to other high-income countries, the UK is lagging on many health outcomes, such as life expectancy and infant mortality, and there is a growing burden of mental illness. Successes exist, such as the striking improvements in oral health, but inequalities in health persist as well. The growth of the ageing population relative to the working-age population, the rise of multimorbidity, and persistent health inequalities, particularly for preventable illness, are all issues that the National Health Service (NHS) will face in the years to come. Meeting the challenges of the future will require an increased focus on health promotion and disease prevention, involving a more concerted effort to understand and tackle the multiple social, environmental, and economic factors that lie at the heart of health inequalities. The immediate priority of the NHS will be to mitigate the wider and long-term health consequences of the COVID-19 pandemic, but it must also strengthen its resilience to reduce the impact of other threats to health, such as the UK leaving the EU, climate change, and antimicrobial resistance.
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Affiliation(s)
- Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Michael Anderson
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Anita Charlesworth
- The Health Foundation, London, UK; College of Social Sciences, Health Services Management Centre, University of Birmingham, Birmingham, UK
| | | | - Martin Knapp
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Alistair McGuire
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - David Taylor
- UCL School of Pharmacy, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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19
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Affiliation(s)
- Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - May C I van Schalkwyk
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nason Maani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- School of Public Health, Boston University, Boston, MA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
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20
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Papadimos TJ, Soghoian SE, Nanayakkara P, Singh S, Miller AC, Saddikuti V, Jayatilleke AU, Dubhashi SP, Firstenberg MS, Dutta V, Chauhan V, Sharma P, Galwankar SC, Garg M, Taylor N, Stawicki SP. COVID-19 Blind Spots: A Consensus Statement on the Importance of Competent Political Leadership and the Need for Public Health Cognizance. J Glob Infect Dis 2020; 12:167-190. [PMID: 33888955 PMCID: PMC8045535 DOI: 10.4103/jgid.jgid_397_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/11/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023] Open
Abstract
As the COVID-19 pandemic continues, important discoveries and considerations emerge regarding the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pathogen; its biological and epidemiological characteristics; and the corresponding psychological, societal, and public health (PH) impacts. During the past year, the global community underwent a massive transformation, including the implementation of numerous nonpharmacological interventions; critical diversions or modifications across various spheres of our economic and public domains; and a transition from consumption-driven to conservation-based behaviors. Providing essential necessities such as food, water, health care, financial, and other services has become a formidable challenge, with significant threats to the existing supply chains and the shortage or reduction of workforce across many sectors of the global economy. Food and pharmaceutical supply chains constitute uniquely vulnerable and critically important areas that require high levels of safety and compliance. Many regional health-care systems faced at least one wave of overwhelming COVID-19 case surges, and still face the possibility of a new wave of infections on the horizon, potentially in combination with other endemic diseases such as influenza, dengue, tuberculosis, and malaria. In this context, the need for an effective and scientifically informed leadership to sustain and improve global capacity to ensure international health security is starkly apparent. Public health "blind spotting," promulgation of pseudoscience, and academic dishonesty emerged as significant threats to population health and stability during the pandemic. The goal of this consensus statement is to provide a focused summary of such "blind spots" identified during an expert group intense analysis of "missed opportunities" during the initial wave of the pandemic.
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Affiliation(s)
- Thomas J. Papadimos
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Samara E. Soghoian
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Prabath Nanayakkara
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Sarman Singh
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Andrew C. Miller
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | | | | | - Siddharth P. Dubhashi
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Michael S. Firstenberg
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Vibha Dutta
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Vivek Chauhan
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Pushpa Sharma
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Sagar C. Galwankar
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Manish Garg
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Nicholas Taylor
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
| | - Stanislaw P. Stawicki
- On Behalf of the Multidisciplinary ACAIM-WACEM COVID-19 Consensus Group, Bethlehem, PA, USA
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21
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What Is Rural Adversity, How Does It Affect Wellbeing and What Are the Implications for Action? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020. [PMID: 33019735 DOI: 10.3390/ijerph17197205.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A growing body of literature recognises the profound impact of adversity on mental health outcomes for people living in rural and remote areas. With the cumulative effects of persistent drought, record-breaking bushfires, limited access to quality health services, the COVID-19 pandemic and ongoing economic and social challenges, there is much to understand about the impact of adversity on mental health and wellbeing in rural populations. In this conceptual paper, we aim to review and adapt our existing understanding of rural adversity. We undertook a wide-ranging review of the literature, sought insights from multiple disciplines and critically developed our findings with an expert disciplinary group from across Australia. We propose that rural adversity be understood using a rural ecosystem lens to develop greater clarity around the dimensions and experiences of adversity, and to help identify the opportunities for interventions. We put forward a dynamic conceptual model of the impact of rural adversity on mental health and wellbeing, and close with a discussion of the implications for policy and practice. Whilst this paper has been written from an Australian perspective, it has implications for rural communities internationally.
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Lawrence-Bourne J, Dalton H, Perkins D, Farmer J, Luscombe G, Oelke N, Bagheri N. What Is Rural Adversity, How Does It Affect Wellbeing and What Are the Implications for Action? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7205. [PMID: 33019735 PMCID: PMC7578975 DOI: 10.3390/ijerph17197205] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 01/28/2023]
Abstract
A growing body of literature recognises the profound impact of adversity on mental health outcomes for people living in rural and remote areas. With the cumulative effects of persistent drought, record-breaking bushfires, limited access to quality health services, the COVID-19 pandemic and ongoing economic and social challenges, there is much to understand about the impact of adversity on mental health and wellbeing in rural populations. In this conceptual paper, we aim to review and adapt our existing understanding of rural adversity. We undertook a wide-ranging review of the literature, sought insights from multiple disciplines and critically developed our findings with an expert disciplinary group from across Australia. We propose that rural adversity be understood using a rural ecosystem lens to develop greater clarity around the dimensions and experiences of adversity, and to help identify the opportunities for interventions. We put forward a dynamic conceptual model of the impact of rural adversity on mental health and wellbeing, and close with a discussion of the implications for policy and practice. Whilst this paper has been written from an Australian perspective, it has implications for rural communities internationally.
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Affiliation(s)
- Joanne Lawrence-Bourne
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW 2800, Australia; (J.L.-B.); (H.D.)
| | - Hazel Dalton
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW 2800, Australia; (J.L.-B.); (H.D.)
| | - David Perkins
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, NSW 2800, Australia; (J.L.-B.); (H.D.)
| | - Jane Farmer
- Social Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC 3122, Australia;
| | - Georgina Luscombe
- School of Rural Health, University of Sydney, Orange, NSW 2800, Australia;
| | - Nelly Oelke
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC V1V 1V7, Canada;
| | - Nasser Bagheri
- Centre for Mental Health Research, Australian National University, Acton, ACT 2601, Australia;
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Venkataramani AS, O’Brien R, Whitehorn GL, Tsai AC. Economic influences on population health in the United States: Toward policymaking driven by data and evidence. PLoS Med 2020; 17:e1003319. [PMID: 32877406 PMCID: PMC7467305 DOI: 10.1371/journal.pmed.1003319] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Atheendar S. Venkataramani and colleagues discuss economic factors and population health in the United States.
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Affiliation(s)
- Atheendar S. Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Rourke O’Brien
- Department of Sociology, Yale University, New Haven, Connecticut, United States of America
| | - Gregory L. Whitehorn
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
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Papadimos TJ. What's New in Critical Illness and Injury Science? Mental health and COVID-19: Self-inflicted and interpersonal violence amid a pandemic. Int J Crit Illn Inj Sci 2020; 10:45-48. [PMID: 32904505 PMCID: PMC7456292 DOI: 10.4103/ijciis.ijciis_66_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/11/2020] [Accepted: 08/15/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Thompson K, Wagemakers A, van Ophem J. Assessing health outcomes in the aftermath of the great recession: a comparison of Spain and the Netherlands. Int J Equity Health 2020; 19:84. [PMID: 32503561 PMCID: PMC7275523 DOI: 10.1186/s12939-020-01203-6] [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: 02/20/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
Background Across time and space, financial security has been shown to impact health outcomes, with the acute loss of financial security being particularly detrimental. We compare financial security’s association with health in Spain and the Netherlands. These countries respectively exemplify low and high levels of financial security, general trends that have been exacerbated by the Great Recession of the 2010s. Methods We exploit the Spanish (n = 1001) and Dutch (n = 1010) editions of the European Social Survey 7, conducted in 2014, and condense relevant financial security- and health-related survey questions into latent variables using factor analyses. Using the component loadings as quasi-weightings, we generate one financial security variable and three health variables (mental, physical and social). Then, we run ordinary least squares regressions interacting financial security and nationality, for each of the three health outcomes. Results In unadjusted models, we find that financial security (p < 0.01) is positively associated with the three health outcomes, while being Spanish relative to being Dutch (p < 0.01) is associated with worse health outcomes. However, the results of the interaction term show that being Spanish relative to being Dutch weakens the relationship between physical health and social health, although not mental health. Conclusions We find evidence that financial security’s influence on health outcomes may vary in different contexts. This may be an important aspect of determining the Great Recession’s influence on health outcomes. Our study is a first step in understanding how the relationships between financial security and health may differ in countries with different experiences of the Great Recession.
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Affiliation(s)
- Kristina Thompson
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annemarie Wagemakers
- Health and Society Group, Wageningen University & Research, Wageningen, the Netherlands.
| | - Johan van Ophem
- Urban Economics Group, Wageningen University & Research, Wageningen, the Netherlands
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If the world fails to protect the economy, COVID-19 will damage health not just now but also in the future. Nat Med 2020; 26:640-642. [PMID: 32273610 DOI: 10.1038/s41591-020-0863-y] [Citation(s) in RCA: 256] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Douglas M, Katikireddi SV, Taulbut M, McKee M, McCartney G. Mitigating the wider health effects of covid-19 pandemic response. BMJ 2020; 369:m1557. [PMID: 32341002 PMCID: PMC7184317 DOI: 10.1136/bmj.m1557] [Citation(s) in RCA: 493] [Impact Index Per Article: 123.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Margaret Douglas
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Public Health Scotland, Glasgow, UK
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Glasgow, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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Douglas M, Katikireddi SV, Taulbut M, McKee M, McCartney G. Mitigating the wider health effects of covid-19 pandemic response. BMJ 2020. [PMID: 32341002 DOI: 10.1136/bmj.m.1557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Affiliation(s)
- Margaret Douglas
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Public Health Scotland, Glasgow, UK
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Glasgow, UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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29
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Thompson K, Ophem JV, Wagemakers A. Studying the impact of the Eurozone's Great Recession on health: Methodological choices and challenges. ECONOMICS AND HUMAN BIOLOGY 2019; 35:162-184. [PMID: 31376735 DOI: 10.1016/j.ehb.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
Europe's Great Recession provides an opportunity to study the impact of increased financial insecurity on health. A number of studies explored the impact of the Recession on health, but they often reached different conclusions. To understand the root of this debate, we undertook a systematic literature review. Articles were analysed thematically based on: geography, data type, operationalisations of wealth and health, and study design. A critical appraisal was also undertaken. Forty-two studies, published from January 2010 to October 2018, were included in our review. Twenty-six of the forty-two studies found that the Great Recession worsened physical health indicators in the Eurozone. In terms of geography, a large concentration of studies focussed on Spain and Greece, indicating that there may be a gap in understanding the health consequences for EU countries with less severe experiences of the Recession. Regarding data type, nearly all studies used secondary datasets, possibly meaning that studies were constrained by the data available. In terms of operationalisations of wealth and health, a majority of studies used single/simple measures of both, so that these multi-faceted concepts were not fully reflected. Further, fewer than half included studies used panel data, with the remaining studies unable to undertake more causal analyses. The results of the critical appraisal showed that lower-quality studies tended to not find a negative impact of the Recession on health, whereas higher quality studies generally did. In future, we recommend conducting cross-country comparisons, using (inter)nationally-representative panel data conducted over a minimum of a ten-year time horizon, and employing multi-faceted operationalisations of wealth and health. This could provide more common ground across studies, and a clearer indication of whether the Recession impacted health.
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Affiliation(s)
- Kristina Thompson
- Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands.
| | - Johan van Ophem
- Chair Group Urban Economics, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
| | - Annemarie Wagemakers
- Chair Group Health and Society, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
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Risk of suicide in households threatened with eviction: the role of banks and social support. BMC Public Health 2019; 19:1250. [PMID: 31510963 PMCID: PMC6737669 DOI: 10.1186/s12889-019-7548-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background One of the greatest effects of the financial crisis in Spain has been the enormous increase in the number of evictions. Several studies have shown the association of evictions with different aspects of the physical and mental health. Furthermore, evictions have been associated with an increased risk of suicide. Our objective was to evaluate the risk of suicide among victims of eviction and investigate whether it is associated with specific characteristics of households and interviewees, the eviction process and social support, and health needs. Methods A total of 205 participants from households threatened with eviction in Granada, Spain, and 673 being the total number of members of these households, were interviewed in one-on-one sessions between April 2013 and May 2014. Through a questionnaire, information was obtained on physical and mental health, characteristics of their eviction process and support networks, and the use of health services. Results Almost half of the sample (46.7%) were at low (11.8%), moderate (16.9%), or high suicide risk (17.9%). Household and interviewee features had a limited association with suicide risk. On the contrary, the risk of suicide is greater with a longer exposure to the eviction process. In addition, threatening phone calls from banks increased significantly the risk of suicide, especially among men. Suicide risk was also associated with low social support, especially among women. Interviewees at risk of suicide received more help from nongovernmental organizations than those who were not at risk. In interviewees at risk, the main unmet needs were emotional and psychological help, especially in men. A high percentage of those at risk of suicide declare having large unmeet health needs. Finally, there was a tendency among the evicted at risk of suicide to visit emergency room and primary care more often than those not at risk, especially among women. Conclusions To our knowledge, this is the first study showing that when banks adopt a threatening attitude, suicide risk increases among the evicted. As hypothesized, when the evicted felt socially supported, suicide risk decreased. Emotional help was the main mediator of suicide risk and the main unmet need, especially among men.
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Pollard CM, Booth S, Jancey J, Mackintosh B, Pulker CE, Wright JL, Begley A, Imtiaz S, Silic C, Mukhtar SA, Caraher M, Berg J, Kerr DA. Long-Term Food Insecurity, Hunger and Risky Food Acquisition Practices: A Cross-Sectional Study of Food Charity Recipients in an Australian Capital City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152749. [PMID: 31374922 PMCID: PMC6696626 DOI: 10.3390/ijerph16152749] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/18/2019] [Accepted: 07/30/2019] [Indexed: 11/17/2022]
Abstract
Inadequate social protection, stagnant wages, unemployment, and homelessness are associated with Australian household food insecurity. Little is known about the recipients of food charity and whether their needs are being met. This cross-sectional study of 101 food charity recipients in Perth, Western Australia, measured food security, weight status, sociodemographic characteristics and food acquisition practices. Seventy-nine percent were male, aged 21–79 years, 90% were unemployed, 87% received social assistance payments, and 38% were homeless. Ninety-one percent were food insecure, 80% with hunger, and 56% had gone a day or more without eating in the previous week. Fifty-seven percent had used food charity for ≥1 year, and, of those, 7.5 years was the mode. Charitable services were the main food source in the previous week, however 76% used multiple sources. Begging for money for food (36%), begging for food (32%), stealing food or beverages (34%), and taking food from bins (28%) was commonplace. The omnipresence and chronicity of food insecurity, reliance on social security payments, and risky food acquisition suggest that both the social protection and charitable food systems are failing. Urgent reforms are needed to address the determinants of food insecurity (e.g., increased social assistance payments, employment and housing support) and the adequacy, appropriateness and effectiveness of food charity.
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Affiliation(s)
- Christina M Pollard
- Faculty of Health Science, School of Public Health, Curtin University GPO Box U1987, Perth Western 6845, Australia.
| | - Sue Booth
- College of Medicine & Public Health, Flinders University, GPO Box 2100, Adelaide 5000, Australia
| | - Jonine Jancey
- Faculty of Health Science, School of Public Health, Curtin University GPO Box U1987, Perth Western 6845, Australia
| | - Bruce Mackintosh
- School of Agriculture and Environment, The University of Western Australia, 35 Stirling Highway, Crawley, Perth 6009, Australia
| | - Claire E Pulker
- Faculty of Health Science, School of Public Health, Curtin University GPO Box U1987, Perth Western 6845, Australia
| | - Janine L Wright
- Faculty of Health Science, School of Public Health, Curtin University GPO Box U1987, Perth Western 6845, Australia
| | - Andrea Begley
- Faculty of Health Science, School of Public Health, Curtin University GPO Box U1987, Perth Western 6845, Australia
| | - Sabrah Imtiaz
- Faculty of Health Science, School of Public Health, Curtin University GPO Box U1987, Perth Western 6845, Australia
| | - Claire Silic
- Faculty of Health Science, School of Public Health, Curtin University GPO Box U1987, Perth Western 6845, Australia
| | - S Aqif Mukhtar
- Faculty of Health Science, School of Public Health, Curtin University GPO Box U1987, Perth Western 6845, Australia
| | - Martin Caraher
- Centre for Food Policy, City University of London, Northampton Square, London EC1V 0HB, UK
| | - Joel Berg
- Hunger Free America, 50 Broad Street, Suite 1103, New York, NY10004, USA
| | - Deborah A Kerr
- Faculty of Health Science, School of Public Health, Curtin University GPO Box U1987, Perth Western 6845, Australia
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Affiliation(s)
- Selina Rajan
- London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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Antunes A, Frasquilho D, Zózimo JR, Silva M, Cardoso G, Ferrão J, Caldas-de-Almeida JM. Exploring socioeconomic and mental health trajectories during times of economic recession: a qualitative study with primary health care users and professionals. J Ment Health 2019; 29:597-604. [PMID: 30862202 DOI: 10.1080/09638237.2019.1581343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The 2008 economic recession has been shown to affect populations' mental health due to deterioration of socioeconomic and living conditions. Concurrently, mental health problems may have constituted a vulnerability to wider social inequalities during this period.Aims: To explore perceptions and experiences of primary health care users and professionals regarding the relationship between mental health and socioeconomic position during the economic recession in Portugal.Method: Data were collected in three primary health care centres in Lisbon Metropolitan Area. Focus groups and semi-structured interviews were conducted with users and professionals, respectively. Interviews were audio-recorded, transcribed verbatim and underwent thematic analysis.Results: Two themes were obtained. The first comprised the relationship between changes in socioeconomic conditions (unemployment, precarious work conditions and financial hardship) and poor mental health. The second involved the consequences of experiencing mental health problems during the recession, namely disability, need of sick leave and early retirement.Conclusions: This study provided a comprehensive overview of the bidirectional relationship between socioeconomic conditions and mental health, emphasizing the need to develop policies to address the drivers of poor mental health during times of economic downturn and tackle the barriers faced by people with mental disorders to promote their full social inclusion.
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Affiliation(s)
- Ana Antunes
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal
| | - Diana Frasquilho
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal
| | - Joana Rocha Zózimo
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal.,CSG - Research in Social Sciences and Management, University of Lisbon, Lisbon, Portugal
| | - Manuela Silva
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal
| | - Graça Cardoso
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal
| | - João Ferrão
- Institute of Social Sciences, University of Lisbon, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC), Nova Medical School
- Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal
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Prescott SL, Logan AC, Katz DL. Preventive Medicine for Person, Place, and Planet: Revisiting the Concept of High-Level Wellness in the Planetary Health Paradigm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020238. [PMID: 30654442 PMCID: PMC6352196 DOI: 10.3390/ijerph16020238] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/11/2019] [Accepted: 01/13/2019] [Indexed: 12/29/2022]
Abstract
Experts in preventive medicine and public health have long-since recognized that health is more than the absence of disease, and that each person in the ‘waiting room’ and beyond manifests the social/political/economic ecosystems that are part of their total lived experience. The term planetary health—denoting the interconnections between the health of person and place at all scales—emerged from the environmental and preventive health movements of the 1970–1980s. Roused by the 2015 Lancet Commission on Planetary Health report, the term has more recently penetrated mainstream academic and medical discourse. Here, we discuss the relevance of planetary health in the era of personalized medicine, gross environmental concerns, and a crisis of non-communicable diseases. We frame our discourse around high-level wellness—a concept of vitality defined by Halbert L. Dunn (1896–1975); high-level wellness was defined as an integrated method of functioning which is oriented toward maximizing the potential of individuals within the total lived environment. Dunn maintained that high-level wellness is also applicable to organizations, communities, nations, and humankind as a whole—stating further that global high-level wellness is a product of the vitality and sustainability of the Earth’s natural systems. He called for a universal philosophy of living. Researchers and healthcare providers who focus on lifestyle and environmental aspects of health—and understand barriers such as authoritarianism and social dominance orientation—are fundamental to maintaining trans-generational vitality at scales of person, place, and planet.
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Affiliation(s)
- Susan L Prescott
- Department of Paediatrics, School of Medicine, University of Western Australia, Perth, WA 6009, Australia.
- The ORIGINS Project, Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia.
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network (WUN), West New York, NJ 10704, USA.
| | - Alan C Logan
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network (WUN), West New York, NJ 10704, USA.
| | - David L Katz
- Prevention Research Center, Yale University School of Public Health, Griffin Hospital, Derby, CT 06418, USA.
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Williams O, Fullagar S. Lifestyle drift and the phenomenon of 'citizen shift' in contemporary UK health policy. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:20-35. [PMID: 30073681 DOI: 10.1111/1467-9566.12783] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite political change over the past 25 years in Britain there has been an unprecedented national policy focus on the social determinants of health and population-based approaches to prevent chronic disease. Yet, policy impacts have been modest, inequalities endure and behavioural approaches continue to shape strategies promoting healthy lifestyles. Critical public health scholarship has conceptualised this lack of progress as a problem of 'lifestyle drift' within policy whereby 'upstream' social contributors to health inequalities are reconfigured 'downstream' as a matter of individual behaviour change. While the lifestyle drift concept is now well established there has been little empirical investigation into the social processes through which it is realised as policies are (re)formulated and implementation is localised. Addressing this gap we present empirical findings from an ethnography conducted in a deprived English neighbourhood in order to explore: (i) the local context in the process of lifestyle drift and; (ii) the social relations that reproduce (in)equities in the design and delivery of lifestyle interventions. Analysis demonstrates how and why 'precarious partnerships' between local service providers were significant in the process of 'citizen shift' whereby government responsibility for addressing inequity was decollectivised.
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Affiliation(s)
- Oli Williams
- Department of Health Sciences, University of Leicester, Leicester, UK
- NIHR CLAHRC East Midlands, Leicester General Hospital, Leicester, UK
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The Association between Stressful Events and Food Insecurity: Cross-Sectional Evidence from Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112333. [PMID: 30360491 PMCID: PMC6266169 DOI: 10.3390/ijerph15112333] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/05/2018] [Accepted: 10/17/2018] [Indexed: 11/17/2022]
Abstract
A considerable body of empirical evidence exists on the demographic and socio-economic correlates of food insecurity in Australia. An important omission from recent studies, however, is an understanding of the role of stressful life events, or stressors in explaining exposure to food insecurity. Using nationally representative data from the 2014 General Social Survey and multivariable logistic regression, this paper reports on the association between 18 discrete stressors and the likelihood of reporting food insecurity in Australia. The results, adjusted for known correlates of food insecurity and complex survey design, show that exposure to stressors significantly increased the likelihood of experiencing food insecurity. Importantly, stressors related to employment and health approximately doubled the odds of experiencing food insecurity. The results underscore the complex correlates of food insecurity and indicates that conceptually it interacts with many important social and economic problems in contemporary Australia. There is no simple fix to food insecurity and solutions require co-ordination across a range of social and economic policies.
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Booth S, Pollard C, Coveney J, Goodwin-Smith I. 'Sustainable' Rather Than 'Subsistence' Food Assistance Solutions to Food Insecurity: South Australian Recipients' Perspectives on Traditional and Social Enterprise Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102086. [PMID: 30248978 PMCID: PMC6210539 DOI: 10.3390/ijerph15102086] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022]
Abstract
South Australian (SA) food charity recipients’ perspectives were sought on existing services and ideas for improvement of food assistance models to address food insecurity. Seven focus groups were conducted between October and November 2017 with 54 adults. Thematically analysed data revealed five themes: (1) Emotional cost and consequences of seeking food relief; (2) Dissatisfaction with inaccessible services and inappropriate food; (3) Returning the favour—a desire for reciprocity; (4) Desiring help beyond food; and, (5) “It’s a social thing”, the desire for social interaction and connection. Findings revealed that some aspects of the SA food assistance services were disempowering for recipients. Recipients desired more empowering forms of food assistance that humanise their experience and shift the locus of control and place power back into their hands. Some traditional models, such as provision of supermarket vouchers, empower individuals by fostering autonomy and enabling food choice in socially acceptable ways. Improvement in the quality of existing food assistance models, should focus on recipient informed models which re-dress existing power relations. Services which are more strongly aligned with typical features of social enterprise models were generally favoured over traditional models. Services which are recipient-centred, strive to empower recipients and provide opportunities for active involvement, social connection and broader support were preferred.
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Affiliation(s)
- Sue Booth
- College of Medicine and Public Health, Flinders University, Adelaide 5000, Australia.
| | - Christina Pollard
- Faculty of Health Sciences, School of Public Health, Curtin University, Perth 6102, Australia.
| | - John Coveney
- College of Nursing & Health Sciences, Flinders University, Adelaide 5000, Australia.
| | - Ian Goodwin-Smith
- College of Business, Government and Law, Flinders University, Adelaide 5000, Australia.
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Cabrera de León A, Rodríguez IM, Gannar F, Pedrero García AJ, González DA, Rodríguez Pérez MDC, Brito Díaz B, Alemán Sánchez JJ, Aguirre-Jaime A. Austerity Policies and Mortality in Spain After the Financial Crisis of 2008. Am J Public Health 2018; 108:1091-1098. [PMID: 29995474 DOI: 10.2105/ajph.2018.304346] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To analyze mortality in Spain and the United States before and after these countries implemented divergent policies in response to the financial crisis of 2008. METHODS We examined mortality statistics in both countries in the years 2000 to 2015. Spain started austerity policies in 2010. We compared differences in mortality ratios, on the basis of trends and effect size analysis. RESULTS During 2000 to 2010, overall mortality rates (r = 0.98; P < .001; Cohen's d = -0.228) decreased in both countries. In 2011, this trend changed abruptly in Spain, where observed mortality surpassed expected mortality by 29% in 2011 and by 41% in 2015. By contrast, observed mortality surpassed expected mortality in the United States by only 8% in 2015. As the mortality statistics diverged, the effect size greatly increased (d = 7.531). During this 5-year period, there were 505 559 more deaths in Spain than the expected number, while in the United States the difference was 431 501 more deaths despite the 7-fold larger population in the United States compared with Spain. CONCLUSIONS The marked excess mortality in 2011 to 2015 in Spain is attributable to austerity policies.
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Affiliation(s)
- Antonio Cabrera de León
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Itahisa Marcelino Rodríguez
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Fadoua Gannar
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Arturo J Pedrero García
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Delia Almeida González
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - M Del Cristo Rodríguez Pérez
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Buenaventura Brito Díaz
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - José Juan Alemán Sánchez
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
| | - Armando Aguirre-Jaime
- All authors are with Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain. Antonio Cabrera de León is also with Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
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Benavides FG, Delclós J, Serra C. [Welfare State and public health: the role of occupational health]. GACETA SANITARIA 2018; 32:377-380. [PMID: 28941662 DOI: 10.1016/j.gaceta.2017.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 11/25/2022]
Abstract
In the context of the current crisis of the Welfare State, occupational health can contribute significantly to its sustainability by facilitating decent and healthy employment throughout the working life. To this end, occupational health must take on the challenge of promoting health, preventing and managing injuries, illnesses and disability, based on better coordination of prevention services, mutual insurance companies, and health services, as well as by empowering the leadership in prevention of companies and the active participation of those who work.
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Affiliation(s)
- Fernando G Benavides
- Centro de Investigación en Salud Laboral, Universitat Pompeu Fabra, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; IMIM-Parc Salut Mar, Barcelona, España.
| | - Jordi Delclós
- Centro de Investigación en Salud Laboral, Universitat Pompeu Fabra, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; IMIM-Parc Salut Mar, Barcelona, España; Escuela de Salud Pública, Universidad de Texas, Houston, Estados Unidos
| | - Consol Serra
- Centro de Investigación en Salud Laboral, Universitat Pompeu Fabra, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; IMIM-Parc Salut Mar, Barcelona, España
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Pollard CM, Mackintosh B, Campbell C, Kerr D, Begley A, Jancey J, Caraher M, Berg J, Booth S. Charitable Food Systems' Capacity to Address Food Insecurity: An Australian Capital City Audit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061249. [PMID: 29895801 PMCID: PMC6025598 DOI: 10.3390/ijerph15061249] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 11/16/2022]
Abstract
Australian efforts to address food insecurity are delivered by a charitable food system (CFS) which fails to meet demand. The scope and nature of the CFS is unknown. This study audits the organisational capacity of the CFS within the 10.9 square kilometres of inner-city Perth, Western Australia. A desktop analysis of services and 12 face-to-face interviews with representatives from CFS organisations was conducted. All CFS organisations were not-for–profit and guided by humanitarian or faith-based values. The CFS comprised three indirect services (IS) sourcing, banking and/or distributing food to 15 direct services (DS) providing food to recipients. DS offered 30 different food services at 34 locations feeding over 5670 people/week via 16 models including mobile and seated meals, food parcels, supermarket vouchers, and food pantries. Volunteer to paid staff ratios were 33:1 (DS) and 19:1 (IS). System-wide, food was mainly donated and most funding was philanthropic. Only three organisations received government funds. No organisation had a nutrition policy. The organisational capacity of the CFS was precarious due to unreliable, insufficient and inappropriate financial, human and food resources and structures. System-wide reforms are needed to ensure adequate and appropriate food relief for Australians experiencing food insecurity.
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Affiliation(s)
- Christina M Pollard
- Faculty of Health Science, School of Public Health, Curtin University, GPO Box U1987, Perth 6845, Australia.
| | - Bruce Mackintosh
- School of Agriculture and Environment, The University of Western Australia, 35 Stirling Highway, Crawley, Perth 6009, Australia.
| | - Cathy Campbell
- Faculty of Health Science, School of Public Health, Curtin University, GPO Box U1987, Perth 6845, Australia.
| | - Deborah Kerr
- Faculty of Health Science, School of Public Health, Curtin University, GPO Box U1987, Perth 6845, Australia.
| | - Andrea Begley
- Faculty of Health Science, School of Public Health, Curtin University, GPO Box U1987, Perth 6845, Australia.
| | - Jonine Jancey
- Faculty of Health Science, School of Public Health, Curtin University, GPO Box U1987, Perth 6845, Australia.
| | - Martin Caraher
- Centre for Food Policy, City University of London, Northampton Square, London EC1V 0HB, UK.
| | - Joel Berg
- Hunger Free America, 50 Broad Street, Suite 1103, New York 10004, NY, USA.
| | - Sue Booth
- College of Medicine & Public Health, Flinders University, GPO Box 2100, Adelaide 5000, Australia.
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