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Hensher M, McCartney G, Ochodo E. Health Economics in a World of Uneconomic Growth. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:427-433. [PMID: 38637451 PMCID: PMC11178562 DOI: 10.1007/s40258-024-00883-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
Multiple, accelerating and interacting ecological crises are increasingly understood as constituting a major threat to human health and well-being. Unconstrained economic growth is strongly implicated in these growing crises, and it has been argued that this growth has now become "uneconomic growth", which is a situation where the size of the economy is still expanding, but this expansion is causing more harm than benefit. This article summarises the multiple pathways by which uneconomic growth can be expected to harm human health. It describes how health care systems-especially through overuse, low value and poor quality care-can themselves drive uneconomic growth. Health economists need to understand not only the consequences of environmental impacts on health care, but also the significance of uneconomic growth, and pay closer attention to the growing body of work by heterodox economists, especially in the fields of ecological and feminist economics. This will involve paying closer heed to the existence and consequences of diminishing marginal returns to health care consumption at high levels; the central importance of inequalities and injustice in health; and the need to remedy health economists' currently limited ability to deal effectively with low value care, overdiagnosis and overtreatment.
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Affiliation(s)
- Martin Hensher
- Henry Baldwin Professorial Research Fellow in Health System Sustainability, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Eleanor Ochodo
- Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Kenya Medical Research Institute, Nairobi, Kenya
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Broadbent P, Walsh D, Katikireddi SV, Gallagher C, Dundas R, McCartney G. Is Austerity Responsible for the Stalled Mortality Trends Across Many High-Income Countries? A Systematic Review. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024:27551938241255041. [PMID: 38767141 DOI: 10.1177/27551938241255041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
This article systematically reviews evidence evaluating whether macroeconomic austerity policies impact mortality, reviewing high-income country data compiled through systematic searches of nine databases and gray literature using pre-specified methods (PROSPERO registration: CRD42020226609). Eligible studies were quantitatively assessed to determine austerity's impact on mortality. Two reviewers independently assessed eligibility and risk of bias using ROBINS-I. Synthesis without meta-analysis was conducted due to heterogeneity. Certainty of evidence was assessed using the GRADE framework. Of 5,720 studies screened, seven were included, with harmful effects of austerity policies demonstrated in six, and no effect in one. Consistent harmful impacts of austerity were demonstrated for all-cause mortality, life expectancy, and cause-specific mortality across studies and different austerity measures. Excess mortality was higher in countries with greater exposure to austerity. Certainty of evidence was low. Risk of bias was moderate to critical. A typical austerity dose was associated with 74,090 [-40,632, 188,792] and 115,385 [26,324, 204,446] additional deaths per year. Austerity policies are consistently associated with adverse mortality outcomes, but the magnitude of this effect remains uncertain and may depend on how austerity is implemented (e.g., balance between public spending reductions or tax rises, and distributional consequences). Policymakers should be aware of potential harmful health effects of austerity policies.
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Affiliation(s)
- Philip Broadbent
- University of Glasgow MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
| | - David Walsh
- University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | | | | | - Ruth Dundas
- University of Glasgow MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
| | - Gerry McCartney
- University of Glasgow College of Social Sciences, Glasgow, UK
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Levinsky M. Can countries shape the association between cumulative adversity and old-age health? Front Public Health 2024; 12:1364868. [PMID: 38813420 PMCID: PMC11133626 DOI: 10.3389/fpubh.2024.1364868] [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: 01/03/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction The present study examined the relationships of Lifetime Cumulative Adversity (LCA) and country inequalities, as well as the interactions between them, with the self-rated health (SRH) in old age. Methods Using data from the Survey of Health, Aging and Retirement in Europe (SHARE), the study regressed self-rated health on Lifetime Cumulative Adversity and country-level inequality indices across European countries in two points in time. The analysis also considered adversity-inequality interactions, controlling for confounders. The sample was comprised of 28,789 adults, aged 50 to 80, from 25 European countries and Israel. Results The findings pointed out that LCA is negatively associated with SRH, but democracy and welfare regimes modify the ill effects of LCA on health. These effects are reduced as the LCA level increases. The effects remained significant over two measurement time-points over three years, showing that life-course trajectories may be shaped by individual accumulated risk exposure to stress, along with inequalities at the society level. Discussion The study provides constructive and important guidance for decreasing the harmful effect of lifetime adversity in old age, by the modification of the country's welfare policies.
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Affiliation(s)
- Michal Levinsky
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
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Karuveettil V, Janakiram C, John D, Mathur M, Varma B, Green H. Political economy analysis of health: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00309. [PMID: 38745473 DOI: 10.11124/jbies-23-00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The objective of this scoping review is to identify and map the literature on concepts, definitions, frameworks, outcomes, and applications of political economic analysis of health. INTRODUCTION The political economy of health approach seeks to understand how political and economic domains interact and shape individual and population health outcomes. A political economic analysis can provide insights into health problems and inequalities; however, there needs to be more clarity on how the political economy framework is defined and the methods adopted for conducting political economy analysis concerning health. INCLUSION CRITERIA Studies focusing on the political economy analysis addressing specific health problems will be included. The study population is not limited to any sociodemographic characteristics, and there will be no restrictions on language or the source of evidence (primary studies or secondary data studies). Both qualitative and quantitative methodologies will included, but narrative and systematic reviews will be excluded, as will conference abstracts and editorials. Studies involving sector- or country-level analysis will be included. METHODS The review will follow the JBI methodology for scoping reviews. Databases to be searched include MEDLINE, Scopus, Web of Science, Cochrane CENTRAL, CINAHL, Embase, ProQuest, DynaMed, and gray literature via Google Scholar and OAIster. Two reviewers will perform study screening and data extraction using a customized data extraction form. The concepts, definitions, frameworks, outcomes, and applications of the political economy of health will be summarized and discussed. The health problems addressed using political economy analysis will be enumerated. Stakeholder engagement will guide all steps of the study. Results will be presented in tabular and graphical formats accompanied by a narrative summary. REVIEW REGISTRATION Open Science Framework https://osf.io/4qaxr/.
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Affiliation(s)
- Vineetha Karuveettil
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
- Amrita Centre for Evidence Based Oral Health: A JBI Centre of Excellence, Ernakulam, Kerala, India
| | - Chandrashekar Janakiram
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
- Amrita Centre for Evidence Based Oral Health: A JBI Centre of Excellence, Ernakulam, Kerala, India
| | - Denny John
- Evidence Synthesis and Implementation for Indigenous Health: A JBI Affiliated Group, MANT (Manbhum Ananda Ashram Nityananda Trust), Kolkata, India
- Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Manu Mathur
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Balagopal Varma
- Department of Paediatric and Preventive Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Heidi Green
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, NSW, Australia
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Houpert R, Bendiane MK, Huiart L, Bouhnik AD, Alleaume C, Touzani R, Veronique-Baudin J, Mancini J, Joachim C, Chirpaz E. Socioeconomic and cultural factors associated with pap smear screening among French women living in Réunion Island. BMC Public Health 2024; 24:1125. [PMID: 38654197 DOI: 10.1186/s12889-024-18633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Réunion Island is a French overseas territory located in the southern Indian Ocean, with a challenging socioeconomic and multicultural context. Compared to mainland France, Réunion has an overincidence and overmortality of cervical cancer. In order to investigate these two issues, it is important to evaluate the barriers and potential levers to Pap smear screening among female inhabitants of the island. We aimed to identify the specific socio-demographic factors, cultural factors, and living conditions associated with Pap smear screening in Réunion, with a view to increasing uptake. METHODS We conducted a Knowledge Attitude Behavior and Practices (KABP) survey on cervical cancer screening practices among women aged between 25 and 65 years old living in Réunion Island, selected using random digit dialing sampling. Data were collected using Computer Assistant Telephone Interviews. Weighted chi-squared tests and Student's t-tests were used to compare women who had up-to-date Pap smear screening with women who did not. Weighted logistic models were used to identify the factors associated with not having up-to-date screening. RESULTS A total of 1000 women were included in the study. Of these, 88.1% had a Pap smear test during the previous three years. Factors independently associated with not being up to date were as follows: aged over 55 (AOR 2.3 [1.2-4.3]), no children (AOR 2.5 [1.4-4.3]), having free universal health coverage (AOR 1.7 [1.1-2.7]), an income per unit consumption lower than 1500€ per month (AOR 2.0 [1.1-3.7]), low health literacy (AOR 2.7 [1.7-4.1]), not consulting a general practitioner in the prior 12 months (AOR 3.6 [2.0-6.5]), and a BMI > 30 (AOR 2.6 [1.5-4.4]). CONCLUSIONS This is the first large-scale survey focusing on recommended Pap smear screening uptake in Réunion Island. Although self-reported screening incidence was higher than in mainland France, national screening policies must take into account the island's diverse social and cultural characteristics (e.g., an ageing population, low health literacy), while implementing actions to fight against poverty and increase general access to healthcare.
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Affiliation(s)
- Rémi Houpert
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Research & Development in Oncology (UF3596), Oncology Hematology Urology department, University Hospital of Martinique, Fort-de-France Martinique, Martinique
| | - Marc-Karim Bendiane
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Internal Medicine, Geriatrics and Therapeutic Unit, AP-HM, Marseille, France
| | - Laetitia Huiart
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Santé Publique France, Paris, France
| | - Anne-Deborah Bouhnik
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France.
| | - Caroline Alleaume
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Santé Publique France, Paris, France
| | - Rajae Touzani
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Jacqueline Veronique-Baudin
- Research & Development in Oncology (UF3596), Oncology Hematology Urology department, University Hospital of Martinique, Fort-de-France Martinique, Martinique
| | - Julien Mancini
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- APHM, Hop Timone, BioSTIC, Biostatistique et Technologies de l'Information et de la Communication, Marseille, France
| | - Clarisse Joachim
- General Cancer Registry (UF 1441), Oncology Hematology Urology department, University Hospital of Martinique, Fort-de-France Martinique, Martinique
| | - Emmanuel Chirpaz
- Reunion cancer Registry - Clinical Investigation Center (INSERM CIC-1410), University Hospital FR, Saint Pierre Cedex, France
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Iftikhar R, Ahmad U, Haider G, Mahmood H, Khan M, Masood M, Anwar N, Javed Q, Sajid N, Tariq R, Mehmod S, Haider J, Abro NA, Shahbaz S, Khokhar A, Khan ZA, Pervez H, Moosajee M, Aziz Z. Real-World Challenges of Managing Diffuse Large B-Cell Lymphoma in a Developing Country. JCO Glob Oncol 2024; 10:e2300386. [PMID: 38603657 DOI: 10.1200/go.23.00386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/26/2023] [Accepted: 02/20/2024] [Indexed: 04/13/2024] Open
Abstract
PURPOSE To highlight challenges and cancer care disparities in patients of diffuse large B-cell lymphoma management in resource-constrained settings. MATERIALS AND METHODS This multicenter retrospective study included 738 patients from 12 public and private sector hematology-oncology centers across Pakistan. Patients were divided into limited-resource and enhanced-resource settings as per national diffuse large B-cell lymphoma (DLBCL) guidelines. RESULTS The median age at diagnosis was 47 years (range, 14-89). Male:female ratio was 2.5:1. Majority of the patients (69.3%) were treated in limited-resource settings. Computed tomography was used as a staging modality in 442 (60%) patients. Limited-stage DLBCL was present in 13.5% of patients, while 86.3% had advanced-stage disease at diagnosis. First-line regimens included rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone in 56% and cyclophosphamide, doxorubicin, vincristine, prednisone in 34% of patients, while 10% of patients received palliative regimens upfront. Of evaluable data, complete remission was documented in 299 (74.4%) patients, 39 (9.8%) had partial response and 63 (13.5%) had progressive disease. Disease-free survival (DFS) and overall survival (OS) status were not available for 345 (46.8%) patients at the time of data collection. Overall study cohort had a median follow-up of 2.2 years with a median OS of 3.6 years (95% CI, 3.1 to 4.1), median DFS of 3.1 years (95% CI, 2.6 to 3.6), and a 5-year OS of 40% and DFS of 36%. CONCLUSION Patients from low- and middle-income countries present at an earlier age and have more advanced disease. Patients were frequently lost to follow-up, and record keeping was inadequate more so in patients treated in limited-resource settings. There is a need to establish a national lymphoma registry, improve record keeping, and standardize treatments to ensure improvement in treatment outcomes.
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Affiliation(s)
- Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan
| | - Usman Ahmad
- Shoukat Khanam Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Ghulam Haider
- Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| | - Humera Mahmood
- Nuclear Medicine, Oncology and Radiotherapy Institute, Rawalpindi, Pakistan
| | - Maryam Khan
- Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan
| | - Misbah Masood
- Institute of Nuclear Medicine and Oncology, Lahore, Pakistan
| | - Nida Anwar
- National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, Pakistan
| | | | - Nadia Sajid
- Institute of Nuclear Medicine and Oncology, Lahore, Pakistan
| | - Rija Tariq
- Institute of Nuclear Medicine and Oncology, Lahore, Pakistan
| | - Sana Mehmod
- Nuclear Medicine, Oncology and Radiotherapy Institute, Rawalpindi, Pakistan
| | - Javeria Haider
- Nuclear Medicine, Oncology and Radiotherapy Institute, Rawalpindi, Pakistan
| | | | - Shanzah Shahbaz
- Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, Pakistan
| | | | | | | | | | - Zeba Aziz
- Hameed Latif Hospital, Lahore, Pakistan
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Orwelius L, Kristenson M, Fredrikson M, Sjöberg F, Walther S. Effects of education, income and employment on ICU and post-ICU survival - A nationwide Swedish cohort study of individual-level data with 1-year follow up. J Crit Care 2024; 80:154497. [PMID: 38086226 DOI: 10.1016/j.jcrc.2023.154497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE The aim of this study was to examine relationships between education, income, and employment (socioeconomic status, SES) and intensive care unit (ICU) survival and survival 1 year after discharge from ICU (Post-ICU survival). METHODS Individual data from ICU patients were linked to register data of education level, disposable income, employment status, civil status, foreign background, comorbidities, and vital status. Associations between SES, ICU survival and 1-year post-ICU survival was analysed using Cox's regression. RESULTS We included 58,279 adults (59% men, median length of stay in ICU 4.0 days, median SAPS3 score 61). Survival rates at discharge from ICU and one year after discharge were 88% and 63%, respectively. Risk of ICU death (Hazard ratios, HR) was significantly higher in unemployed and retired compared to patients who worked prior to admission (1.20; 95% CI: 1.10-1.30 and 1.15; (1.07-1.24), respectively. There was no consistent association between education, income and ICU death. Risk of post-ICU death decreased with greater income and was roughly 16% lower in the highest compared to lowest income quintile (HR 0.84; 0.79-0.88). Higher education levels appeared to be associated with reduced risk of death during the first year after ICU discharge. CONCLUSIONS Significant relationships between low SES in the critically ill and increased risk of death indicate that it is important to identify and support patients with low SES to improve survival after intensive care. Studies of survival after critical illness need to account for participants SES.
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Affiliation(s)
- Lotti Orwelius
- Department of Anaesthesia and Intensive Care, Linköping University Hospital, 581 85 Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden.
| | - Margareta Kristenson
- Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 581 83 Linköping, Sweden.
| | - Mats Fredrikson
- Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden.
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Linköping University Hospital, 581 85 Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, 581 85 Linköping, Sweden; Burns, Hand, and Plastic Surgery, Linköping University Hospital, 581 85 Linköping, Sweden.
| | - Sten Walther
- Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 581 83 Linköping, Sweden; Department of Cardiothoracic Anaesthesia and Intensive Care, Linköping University Hospital, 581 85 Linköping, Sweden.
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Shaw J, Glover W. The Political Economy of Digital Health Equity: Structural Analysis. J Med Internet Res 2024; 26:e46971. [PMID: 38530341 PMCID: PMC11005444 DOI: 10.2196/46971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/30/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wiljeana Glover
- Technology, Operations, and Information Management Division, Babson College, Wellesley, MA, United States
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Dally D, Amith M, Mauldin RL, Thomas L, Dang Y, Tao C. A Semantic Approach to Describe Social and Economic Characteristics That Impact Health Outcomes (Social Determinants of Health): Ontology Development Study. Online J Public Health Inform 2024; 16:e52845. [PMID: 38477963 PMCID: PMC10973958 DOI: 10.2196/52845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Social determinants of health (SDoH) have been described by the World Health Organization as the conditions in which individuals are born, live, work, and age. These conditions can be grouped into 3 interrelated levels known as macrolevel (societal), mesolevel (community), and microlevel (individual) determinants. The scope of SDoH expands beyond the biomedical level, and there remains a need to connect other areas such as economics, public policy, and social factors. OBJECTIVE Providing a computable artifact that can link health data to concepts involving the different levels of determinants may improve our understanding of the impact SDoH have on human populations. Modeling SDoH may help to reduce existing gaps in the literature through explicit links between the determinants and biological factors. This in turn can allow researchers and clinicians to make better sense of data and discover new knowledge through the use of semantic links. METHODS An experimental ontology was developed to represent knowledge of the social and economic characteristics of SDoH. Information from 27 literature sources was analyzed to gather concepts and encoded using Web Ontology Language, version 2 (OWL2) and Protégé. Four evaluators independently reviewed the ontology axioms using natural language translation. The analyses from the evaluations and selected terminologies from the Basic Formal Ontology were used to create a revised ontology with a broad spectrum of knowledge concepts ranging from the macrolevel to the microlevel determinants. RESULTS The literature search identified several topics of discussion for each determinant level. Publications for the macrolevel determinants centered around health policy, income inequality, welfare, and the environment. Articles relating to the mesolevel determinants discussed work, work conditions, psychosocial factors, socioeconomic position, outcomes, food, poverty, housing, and crime. Finally, sources found for the microlevel determinants examined gender, ethnicity, race, and behavior. Concepts were gathered from the literature and used to produce an ontology consisting of 383 classes, 109 object properties, and 748 logical axioms. A reasoning test revealed no inconsistent axioms. CONCLUSIONS This ontology models heterogeneous social and economic concepts to represent aspects of SDoH. The scope of SDoH is expansive, and although the ontology is broad, it is still in its early stages. To our current understanding, this ontology represents the first attempt to concentrate on knowledge concepts that are currently not covered by existing ontologies. Future direction will include further expanding the ontology to link with other biomedical ontologies, including alignment for granular semantics.
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Affiliation(s)
- Daniela Dally
- The University of Texas Health Science Center at Houston School of Public Health, The Brownsville Region, Brownsville, TX, United States
| | - Muhammad Amith
- Department of Biostatistics and Data Science, University of Texas Medical Branch, Galveston, TX, United States
- Department of Internal Medicine, University of Texas Medical Branch, Galveton, TX, United States
| | - Rebecca L Mauldin
- School of Social Work, The University of Texas at Arlington, Arlington, TX, United States
| | - Latisha Thomas
- School of Social Work, The University of Texas at Arlington, Arlington, TX, United States
| | - Yifang Dang
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Cui Tao
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL, United States
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Bocean CG, Vărzaru AA. Assessing social protection influence on health status in the European Union. Front Public Health 2024; 12:1287608. [PMID: 38528863 PMCID: PMC10962762 DOI: 10.3389/fpubh.2024.1287608] [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: 09/02/2023] [Accepted: 02/26/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Health status and access to healthcare services are crucial factors that directly impact the well-being of individuals and societies. In the European Union (EU), social protection measures are significant in supporting citizens' health and providing access to healthcare resources. Methods This study investigates the relationship between social protection and health status in EU countries. We collected data from Eurostat on the EU member states' health status, healthcare expenditure, and social protection expenditure. The paper used structural equation modeling (SEM) and cluster analysis to analyze the complex interplay among these variables. Results Findings revealed a strong positive correlation between EU countries' social protection expenditure and healthcare status. Higher social protection spending was associated with improved access to healthcare services and facilities. Moreover, the analysis showed that countries with higher social protection expenditure tended to exhibit better overall health status indicators among their populations. Discussion The results suggest that adequate social protection expenditure positively influences health status in the European Union. By investing in robust social protection programs, governments can enhance citizens' access to healthcare services and resources, ultimately leading to improved health outcomes. These findings underscore the importance of prioritizing social protection policies to address health disparities and promote public health in the EU.
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Affiliation(s)
- Claudiu George Bocean
- Department of Management, Marketing and Business Administration, Faculty of Economics and Business Administration, University of Craiova, Craiova, Romania
| | - Anca Antoaneta Vărzaru
- Department of Economics, Accounting and International Business, Faculty of Economics and Business Administration, University of Craiova, Craiova, Romania
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Max BL, Mashauri HL. Economic priorities over population health: A political dilemma in addressing noncommunicable diseases in developing countries. Health Sci Rep 2024; 7:e1974. [PMID: 38505686 PMCID: PMC10948585 DOI: 10.1002/hsr2.1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/21/2024] Open
Abstract
The world is observing a rapid shift in the burden of diseases with predominance of noncommunicable diseases (NCDs). NCDs contribute to 41 million deaths which is equivalent to 74% of all death globally per year. There is ongoing debate on the approaches to reduce public exposure to NCDs' modifiable risk factors which are of economic potential. As the World Health Organization and the World Bank recommend the implementation of taxation to these factors, still questions arise on the effectiveness, sustainability, and practicality of this strategy. With the ongoing transition globally from consumption of natural to processed foods, it is important to counter-check the best interventions on how to protect people from unhealthy eating behaviors. While taxation on unhealthy food and other products like tobacco has been recommended as one among interventional approaches, its effectiveness on sugar sweetened beverages is not reliable compared to approaches that increase self-control. Despite the perceived economic benefits of tobacco and sugar sweetened products, there is detrimental implication in terms of public health. The introduction of taxation which favors public health faces challenges due to conflict of interest from government authorities and other stakeholders. The intertwined relationship between public health and economic development becomes more obvious during implementation of preventive and control measures against modifiable risk factors for NCDs. It is evident that reaching a balanced rational decision on choosing between economic growth and public health is difficult. Countries should enhance both local and international intersectoral and multisectoral approaches in creating integrative policies which include health component in all non-health policies including economic policies so as to harmonize public health and economic growth during this era of extensive globalization.
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Affiliation(s)
- Baraka L. Max
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Health, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Internal MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Harold L. Mashauri
- Department of Epidemiology and Biostatistics, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Community Health, Institute of Public HealthKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Internal MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of Internal MedicineKamanga Medics HospitalMwanzaTanzania
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SHIMONOVICH MICHAL, CAMPBELL MHAIRI, THOMSON RACHELM, BROADBENT PHILIP, WELLS VALERIE, KOPASKER DANIEL, McCARTNEY GERRY, THOMSON HILARY, PEARCE ANNA, KATIKIREDDI SVITTAL. Causal Assessment of Income Inequality on Self-Rated Health and All-Cause Mortality: A Systematic Review and Meta-Analysis. Milbank Q 2024; 102:141-182. [PMID: 38294094 PMCID: PMC10938942 DOI: 10.1111/1468-0009.12689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 02/01/2024] Open
Abstract
Policy Points Income is thought to impact a broad range of health outcomes. However, whether income inequality (how unequal the distribution of income is in a population) has an additional impact on health is extensively debated. Studies that use multilevel data, which have recently increased in popularity, are necessary to separate the contextual effects of income inequality on health from the effects of individual income on health. Our systematic review found only small associations between income inequality and poor self-rated health and all-cause mortality. The available evidence does not suggest causality, although it remains methodologically flawed and limited, with very few studies using natural experimental approaches or examining income inequality at the national level. CONTEXT Whether income inequality has a direct effect on health or is only associated because of the effect of individual income has long been debated. We aimed to understand the association between income inequality and self-rated health (SRH) and all-cause mortality (mortality) and assess if these relationships are likely to be causal. METHODS We searched Medline, ISI Web of Science, Embase, and EconLit (PROSPERO: CRD42021252791) for studies considering income inequality and SRH or mortality using multilevel data and adjusting for individual-level socioeconomic position. We calculated pooled odds ratios (ORs) for poor SRH and relative risk ratios (RRs) for mortality from random-effects meta-analyses. We critically appraised included studies using the Risk of Bias in Nonrandomized Studies - of Interventions tool. We assessed certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework and causality using Bradford Hill (BH) viewpoints. FINDINGS The primary meta-analyses included 2,916,576 participants in 38 cross-sectional studies assessing SRH and 10,727,470 participants in 14 cohort studies of mortality. Per 0.05-unit increase in the Gini coefficient, a measure of income inequality, the ORs and RRs (95% confidence intervals) for SRH and mortality were 1.06 (1.03-1.08) and 1.02 (1.00-1.04), respectively. A total of 63.2% of SRH and 50.0% of mortality studies were at serious risk of bias (RoB), resulting in very low and low certainty ratings, respectively. For SRH and mortality, we did not identify relevant evidence to assess the specificity or, for SRH only, the experiment BH viewpoints; evidence for strength of association and dose-response gradient was inconclusive because of the high RoB; we found evidence in support of temporality and plausibility. CONCLUSIONS Increased income inequality is only marginally associated with SRH and mortality, but the current evidence base is too methodologically limited to support a causal relationship. To address the gaps we identified, future research should focus on income inequality measured at the national level and addressing confounding with natural experiment approaches.
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Affiliation(s)
- MICHAL SHIMONOVICH
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - MHAIRI CAMPBELL
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - RACHEL M. THOMSON
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - PHILIP BROADBENT
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - VALERIE WELLS
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - DANIEL KOPASKER
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - GERRY McCARTNEY
- School of Social and Political SciencesUniversity of Glasgow
| | - HILARY THOMSON
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - ANNA PEARCE
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
| | - S. VITTAL KATIKIREDDI
- MRC/CSO Social and Public Health Sciences Unit, School of Health and WellbeingUniversity of Glasgow
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Macintyre AK, Shipton D, Sarica S, Scobie G, Craig N, McCartney G. Assessing the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes for health equity in high-income countries: a systematic review of reviews. Syst Rev 2024; 13:58. [PMID: 38331910 PMCID: PMC10851517 DOI: 10.1186/s13643-023-02429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND A fairer economy is increasingly recognised as crucial for tackling widening social, economic and health inequalities within society. However, which actions have been evaluated for their impact on inclusive economy outcomes is yet unknown. OBJECTIVE Identify the effects of political, economic and social exposures, interventions and policies on inclusive economy (IE) outcomes in high-income countries, by systematically reviewing the review-level evidence. METHODS We conducted a review of reviews; searching databases (May 2020) EconLit, Web of Science, Sociological Abstracts, ASSIA, International Bibliography of the Social Sciences, Public Health Database, Embase and MEDLINE; and registries PROSPERO, Campbell Collaboration and EPPI Centre (February 2021) and grey literature (August/September 2020). We aimed to identify reviews which examined social, political and/or economic exposures, interventions and policies in relation to two IE outcome domains: (i) equitable distribution of the benefits of the economy and (ii) equitable access to the resources needed to participate in the economy. Reviews had to include primary studies which compared IE outcomes within or between groups. Quality was assessed using a modified version of AMSTAR-2 and data synthesised informed by SWiM principles. RESULTS We identified 19 reviews for inclusion, most of which were low quality, as was the underlying primary evidence. Most reviews (n = 14) had outcomes relating to the benefits of the economy (rather than access to resources) and examined a limited set of interventions, primarily active labour market programmes and social security. There was limited high-quality review evidence to draw upon to identify effects on IE outcomes. Most reviews focused on disadvantaged groups and did not consider equity impacts. CONCLUSIONS Review-level evidence is sparse and focuses on 'corrective' approaches. Future reviews should examine a diverse set of 'upstream' actions intended to be inclusive 'by design' and consider a wider range of outcomes, with particular attention to socioeconomic inequalities.
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Affiliation(s)
- Anna K Macintyre
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK.
| | - Deborah Shipton
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Shifa Sarica
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Graeme Scobie
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Neil Craig
- Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK
| | - Gerry McCartney
- School of Social & Political Sciences, University of Glasgow, Glasgow, UK
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14
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Corell M, Friberg P, Petzold M, Löfstedt P. Socioeconomic inequalities in adolescent mental health in the Nordic countries in the 2000s - A study using cross-sectional data from the Health Behaviour in School-aged Children study. Arch Public Health 2024; 82:20. [PMID: 38326845 PMCID: PMC10848422 DOI: 10.1186/s13690-024-01240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/13/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Adolescents in Sweden experience more mental health problems and lower mental well-being than adolescents in other Nordic countries. According to the literature, one possible explanation may be differences in income inequality. The at-risk-of-poverty rate varies significantly across the Nordic countries, and the highest rate is found in Sweden. The aims of the study were to examine socioeconomic inequalities in subjective health complaints and life satisfaction among adolescents in the Nordic countries during 2002 - 2018 and to explore whether subjective health complaints and life satisfaction were related to income inequality in terms of the at-risk-of-poverty rate at the country level. METHODS Data regarding 15-year-olds from the Health Behaviour in School-aged Children study from five survey rounds (2002 - 2018) were used (n = 41,148). The HBSC Symptoms Checklist and Cantril's ladder were used as measures of subjective health complaints and life satisfaction, respectively. The Family Affluence Scale, the Perceived Family Wealth item and the at-risk-of-poverty rate in each country were used as measures of individual-level socioeconomic conditions and country-level income inequality. Statistical methods involved ANOVA, multiple linear regressions and multilevel regression analyses. RESULTS Absolute and relative socioeconomic inequalities in both subjective health complaints and life satisfaction were found in all countries. Sweden showed average socioeconomic inequalities, Iceland the largest and Denmark the smallest. Country-level income inequality in terms of the at-risk-of-poverty rate was associated with a higher prevalence of subjective health complaints and lower levels of life satisfaction in all countries. CONCLUSION Socioeconomic inequalities in adolescent mental health and well-being persisted in Nordic countries in the 2000s. Increasing income inequality may have contributed to higher levels of SHC and lower LS in Sweden compared to the other Nordic countries. Policies improving families' socioeconomic conditions and reducing income inequality at the country level are needed to improve and reduce inequalities in mental health and well-being among adolescents.
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Affiliation(s)
- Maria Corell
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, 405 30, Göteborg, Box 428, Sweden.
- Public Health Agency of Sweden, 171 82, Solna, Sweden.
| | - Peter Friberg
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, 405 30, Göteborg, Box 428, Sweden
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, 405 30, Göteborg, Box 428, Sweden
| | - Petra Löfstedt
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, 405 30, Göteborg, Box 428, Sweden
- Public Health Agency of Sweden, 171 82, Solna, Sweden
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15
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Han K, Gannon J, Moreland-Russell S. Barriers and Facilitators to Program Sustainability Among State Tobacco Control Programs. Prev Chronic Dis 2024; 21:E07. [PMID: 38300817 PMCID: PMC10833827 DOI: 10.5888/pcd21.230211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Public health programs, particularly tobacco control programs (TCPs) in state health departments, face numerous barriers and facilitators to sustainability, which affect delivery and, consequently, health outcomes achieved. We used the Program Sustainability Framework to review and analyze qualitative interview data from states that received training and technical assistance during the Plans, Actions, and Capacity to Sustain Tobacco Control (PACT) study to better understand the barriers and facilitators to sustainability capacity that these public health programs face at the state level. The PACT study was a multiyear, randomized controlled trial to assess the effectiveness of an action planning workshop and technical assistance in improving capacity for sustainability among 11 intervention and 12 control TCPs. Technical assistance calls focused on the progress and barriers of implementing the sustainability action plan created during the in-person workshops. Calls were audio recorded and professionally transcribed. Thematic analysis focused on the codes describing barriers and facilitators faced by TCPs in increasing their capacity for sustainability. Barriers were reported in the Organization Capacity, Environmental Support, Partnerships, Communication, and Funding Stability domains of the Program Sustainability Framework. Facilitators to action planning and building capacity for program sustainability were primarily in the Strategic Planning, Program Evaluation, Program Adaptation, and Partnership domains. Our study is the first to identify barriers and facilitators to increasing the capacity of program sustainability in TCPs. This work advances the understanding of program sustainability capacity and technical assistance for public health programs.
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Affiliation(s)
- Karin Han
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Jessica Gannon
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr, MSC 1196-257-220, St. Louis, MO 63130
| | - Sarah Moreland-Russell
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, Missouri
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Stevenson LA, Maani N, Olsen JR. Introducing Critical Accounting for Governance as a Tool in Exploring the Commercial Determinants of Health. Int J Health Policy Manag 2023; 12:8128. [PMID: 38618769 PMCID: PMC10843405 DOI: 10.34172/ijhpm.2023.8128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/20/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
| | - Nason Maani
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Jonathan R. Olsen
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Perez-Lua FM, Chan-Golston AM, Burke NJ, Young MEDT. The Influence of Organizational Aspects of the U.S. Agricultural Industry and Socioeconomic and Political Conditions on Farmworkers' COVID-19 Workplace Safety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7138. [PMID: 38063568 PMCID: PMC10706775 DOI: 10.3390/ijerph20237138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023]
Abstract
Farmworkers in the U.S. experienced high rates of COVID-19 infection and mortality during the COVID-19 pandemic. Their workplace may have been a significant place of exposure to the novel coronavirus. Using political economy of health theory, this study sought to understand how organizational aspects of the agricultural industry and broader socioeconomic and political conditions shaped farmworkers' COVID-19 workplace safety during the pandemic. Between July 2020 and April 2021, we conducted and analyzed fourteen in-depth, semi-structured phone interviews with Latinx farmworkers in California. Findings show that regulatory oversight reinforced COVID-19 workplace safety. In the absence of regulatory oversight, the organization of the agricultural industry produced COVID-19 workplace risks for farmworkers; it normalized unsafe working conditions and the worker-rather than employer-responsibility for workplace safety. Under these conditions, farmworkers enacted personal COVID-19 preventative practices but were limited by financial hardships that were exacerbated by the precarious nature of agricultural employment and legal status exclusions from pandemic-related aid. Unsafe workplace conditions negatively impacted workplace camaraderie. Study findings have implications for farmworkers' individual and collective agency to achieve safe working conditions. Occupational safety interventions must address the organizational aspects that produce workplace health and safety inequities and disempower farmworkers in the workplace.
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Affiliation(s)
- Fabiola M. Perez-Lua
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, 5200 N Lake Road, Merced, CA 95343, USA; (A.M.C.-G.); (N.J.B.)
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Karatekin C, Marshall Mason S, Latner M, Gresham B, Corcoran F, Hing A, Barnes AJ. Is fair representation good for children? effects of electoral partisan bias in state legislatures on policies affecting children's health and well-being. Soc Sci Med 2023; 339:116344. [PMID: 37984179 DOI: 10.1016/j.socscimed.2023.116344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/12/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
Increasing evidence suggests that state policies impact constituents' health, but political determinants of health and health inequities remain understudied. Using state and year fixed-effects models, we determined the extent to which changes in electoral partisan bias in lower chambers of U.S. state legislatures (i.e., discrepancy between statewide vote share and seat share) were followed by changes in five state policies affecting children and families (1980-2019) and a composite of safety net programs (1999-2018). We examined effects on each policy and whether the effect was modified when bias was accompanied by unified party control. Next, we determined whether the effect differed depending on which party it favored. Less bias resulted only in higher AFDC/TANF benefits. Both pro-Democratic and pro-Republican bias was followed by decreased AFDC/TANF benefits and increased Medicaid benefits. AFDC/TANF recipients, unemployment benefits, minimum wage, and pre-K-12 education spending increased following pro-Democratic bias and decreased following pro-Republican bias. Estimated effects on the composite measure of safety net policies were all close to null. Some effects were modulated by unified party control. Results demonstrate that increasing fairness in elections is not a panacea by itself for increasing generosity of programs affecting children's well-being. Indeed, bias can be somewhat beneficial for the expansiveness of some policies. Furthermore, with the exception of unemployment benefits and AFDC/TANF recipients, Democrats have not been using the additional power that comes with electoral bias to spend more on major programs that benefit children. Finally, after decades in which electoral bias was in Democrats' favor, bias has started to shift toward Republicans in the last decade. This trend forecasts more cuts in almost all the policies in this study, especially education and AFDC/TANF recipients. There is a need for more research and advocacy emphasis on the political determinants of social determinants of health, especially at the state level.
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Affiliation(s)
- Canan Karatekin
- Institute of Child Development, University of Minnesota, 51 E. River Road, Minneapolis, MN, 55416, USA.
| | - Susan Marshall Mason
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S 2nd St. Room 300 West Bank Office Building Minneapolis, MN, 55454, USA
| | - Michael Latner
- California Polytechnic State University, Union of Concerned Scientists, Building 47, Room 11L, San Luis Obispo, CA, 93407, USA.
| | - Bria Gresham
- Institute of Child Development, University of Minnesota, 51 E. River Road, Minneapolis, MN, 55416, USA.
| | - Frederique Corcoran
- Institute of Child Development, University of Minnesota, 51 E. River Road, Minneapolis, MN, 55416, USA.
| | - Anna Hing
- Center for Antiracism Research for Health Equity, University of Minnesota, 2001 Plymouth Ave N, Suite 106, Minneapolis, MN, 55411, USA.
| | - Andrew J Barnes
- Department of Pediatrics, Medical School, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
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Wind K, Poland B, HakemZadeh F, Jackson S, Tomlinson G, Jadad A. Using self-reported health as a social determinants of health outcome: a scoping review of reviews. Health Promot Int 2023; 38:daad165. [PMID: 38041807 DOI: 10.1093/heapro/daad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023] Open
Abstract
Reducing disease prevalence rather than promoting health has long been the objective of significant population health initiatives, such as the social determinants of health (SDH) framework. However, empirical evidence suggests that people with diagnosed diseases often answer the self-reported health (SRH) question positively. In pursuit of a better proxy to understand, measure and improve health, this scoping review of reviews examines the potential of SRH to be used as an outcome of interest in population health policies. Following PRISMA-ScR guidelines, it synthesizes findings from 77 review papers (published until 11 May 2022) and reports a robust association between SDH and SRH. It also investigates inconsistencies within and between reviews to reveal how variation in population health can be explained by studying the impact of contextual factors, such as cultural, social, economic and political elements, on structural determinants such as socioeconomic situation, gender and ethnicity. These insights provide informed hypotheses for deeper explorations of the role of SDH in improving SRH. The review detects several gaps in the literature. Notably, more evidence syntheses are required, in general, on the pathway from contextual elements to population SRH and, in particular, on the social determinants of adolescents' SRH. This study reports a disease-oriented mindset in collecting, analysing and reporting SRH across the included reviews. Future studies should utilize the capability of SRH in interconnecting social, psychological and biological dimensions of health to actualize its full potential as a central public health measure.
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Affiliation(s)
- Keiwan Wind
- DeGroote School of Business, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4M4, Canada
| | - Blake Poland
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada
| | - Farimah HakemZadeh
- Faculty of Liberal Arts and Professional Studies, School of Human Resources Management, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada
| | - Suzanne Jackson
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada
| | - George Tomlinson
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, Ontario M5T 3M7, Canada
| | - Alejandro Jadad
- Centre for Digital Therapeutics, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
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Langmann E, Weßel M. Leaving no one behind: successful ageing at the intersection of ageism and ableism. Philos Ethics Humanit Med 2023; 18:22. [PMID: 38001533 PMCID: PMC10668457 DOI: 10.1186/s13010-023-00150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The concept of 'successful ageing' has been a prominent focus within the field of gerontology for several decades. However, despite the widespread attention paid to this concept, its intersectional implications have not been fully explored yet. This paper aims to address this gap by analyzing the potential ageist and ableist biases in the discourse of successful ageing through an intersectional lens. METHOD A critical feminist perspective is taken to examine the sensitivity of the discourse of successful ageing to diversity in societies. The paper analyzes how ageist and ableist biases can manifest in the ways we conceptualize ageing, drawing on examples in the context of mental health. RESULTS We argue that the conventional approach to successful ageing is limited in its ability to account for the experiences of people who have faced intersectional discrimination throughout their lives. Drawing on examples in the context of mental health, we explore among others the link between depression and disabilities. Furthermore, we shed light on the negative impact of ageist and ableist attitudes concerning the diagnosis and treatment of dementia. DISCUSSION We demonstrate how diversity is often overlooked in discussions of ageing well, and how ageist and ableist biases can manifest in the ways we conceptualize ageing. We argue that focusing solely on the health status as a means of achieving success fails to adequately counter ageism for all people. We further emphasize the role of structural factors, such as ageist attitudes, in shaping the experience of ageing and exacerbating health inequalities. CONCLUSION Overall, our findings emphasize the need for a more nuanced and inclusive understanding of ageing and therefore an intersectional approach to conceptions of ageing well that recognizes and addresses the biases and limitations of current discourses. Thereby, this paper offers valuable insights into the complex intersections between age and disabilities from a bioethical perspective, highlighting the need for a more inclusive and intersectional approach to ageing.
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Affiliation(s)
- Elisabeth Langmann
- Institute of Ethics and History of Medicine, University of Tübingen, Gartenstraße 47, Tübingen, 72074, Germany.
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Gudi-Mindermann H, White M, Roczen J, Riedel N, Dreger S, Bolte G. Integrating the social environment with an equity perspective into the exposome paradigm: A new conceptual framework of the Social Exposome. ENVIRONMENTAL RESEARCH 2023; 233:116485. [PMID: 37352954 DOI: 10.1016/j.envres.2023.116485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023]
Abstract
The importance of the social environment and social inequalities in disease etiology is well-known due to the profound research and conceptual framework on social determinants of health. For a long period, in exposome research with its classical orientation towards detrimental health effects of biological, chemical, and physical exposures, this knowledge remained underrepresented. But currently it gains great awareness and calls for innovations in rethinking the role of social environmental health determinants. To fill this gap that exists in terms of the social domain within exposome research, we propose a novel conceptual framework of the Social Exposome, to integrate the social environment in conjunction with the physical environment into the exposome concept. The iterative development process of the Social Exposome was based on a systematic compilation of social exposures in order to achieve a holistic portrayal of the human social environment - including social, psychosocial, socioeconomic, sociodemographic, local, regional, and cultural aspects, at individual and contextual levels. In order to move the Social Exposome beyond a mere compilation of exposures, three core principles are emphasized that underly the interplay of the multitude of exposures: Multidimensionality, Reciprocity, and Timing and continuity. The key focus of the conceptual framework of the Social Exposome is on understanding the underlying mechanisms that translate social exposures into health outcomes. In particular, insights from research on health equity and environmental justice have been incorporated to uncover how social inequalities in health emerge, are maintained, and systematically drive health outcomes. Three transmission pathways are presented: Embodiment, Resilience and Susceptibility or Vulnerability, and Empowerment. The Social Exposome conceptual framework may serve as a strategic map for, both, research and intervention planning, aiming to further explore the impact of the complex social environment and to alter transmission pathways to minimize health risks and health inequalities and to foster equity in health.
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Affiliation(s)
- Helene Gudi-Mindermann
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany.
| | - Maddie White
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Jana Roczen
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Natalie Riedel
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Stefanie Dreger
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Gabriele Bolte
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
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Hajjar K, Lillo L, Martinez DA, Hermosilla M, Risko N. Association between universal health coverage and the disease burden of acute illness and injury at the global level. BMC Public Health 2023; 23:735. [PMID: 37085801 PMCID: PMC10120184 DOI: 10.1186/s12889-023-15671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND This study examines the relationship between universal health coverage (UHC) and the burden of emergency diseases at a global level. METHODS Data on Disability-Adjusted Life Years (DALYs) from emergency conditions were extracted from the Institute for Health Metrics and Evaluation (IHME) database for the years 2015 and 2019. Data on UHC, measured using two variables 1) coverage of essential health services and 2) proportion of the population spending more than 10% of household income on out-of-pocket health care expenditure, were extracted from the World Bank Database for years preceding our outcome of interest. A linear regression was used to analyze the association between UHC variables and DALYs for emergency diseases, controlling for other variables. RESULTS A total of 132 countries were included. The median national coverage of essential health services index was 67.5/100, while the median national prevalence of catastrophic spending in the sample was 6.74% of households. There was a strong significant relationship between health service coverage and the burden of emergency diseases, with an 11.5-point reduction in DALYs of emergency medical diseases (95% CI -9.5, -14.8) for every point increase in the coverage of essential health services index. There was no statistically significant relationship between catastrophic expenditures and the burden of emergency diseases, which may be indicative of inelastic demand in seeking services for health emergencies. CONCLUSION Increasing the coverage of essential health services, as measured by the essential health services index, is strongly correlated with a reduction in the burden of emergency conditions. In addition, data affirms that financial protection remains inadequate in many parts of the globe, with large numbers of households experiencing significant economic duress related to seeking healthcare. This evidence supports a strategy of strengthening UHC as a means of combating death and disability from health emergencies, as well as extending protection against impoverishment related to healthcare expenses.
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Affiliation(s)
- Karim Hajjar
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Luis Lillo
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Diego A Martinez
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | | | - Nicholas Risko
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
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Johnson EA, Johnson MT, Kypridemos C, Villadsen A, Pickett KE. Designing a generic, adaptive protocol resource for the measurement of health impact in cash transfer pilot and feasibility studies and trials in high-income countries. Pilot Feasibility Stud 2023; 9:51. [PMID: 36959682 PMCID: PMC10034903 DOI: 10.1186/s40814-023-01276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION In the context of the COVID-19 pandemic, upstream interventions that tackle social determinants of health inequalities have never been more important. Evaluations of upstream cash transfer trials have failed to capture comprehensively the impacts that such systems might have on population health through inadequate design of the interventions themselves and failure to implement consistent, thorough research measures that can be used in microsimulations to model long-term impact. In this article, we describe the process of developing a generic, adaptive protocol resource to address this issue and the challenges involved in that process. The resource is designed for use in high-income countries (HIC) but draws on examples from a UK context to illustrate means of development and deployment. The resource is capable of further adaptation for use in low- and middle-income countries (LMIC). It has particular application for trials of Universal Basic Income but can be adapted to those covering other kinds of cash transfer and welfare system changes. METHODS We outline two types of prospective intervention based on pilots and trials currently under discussion. In developing the remainder of the resource, we establish six key principles, implement a modular approach based on types of measure and their prospective resource intensity, and source (validated where possible) measures and baseline data primarily from routine collection and large, longitudinal cohort studies. Through these measures, we seek to cover all areas of health impact identified in our theoretical model for use in pilot and feasibility studies. RESULTS We find that, in general, self-reported measures alongside routinely collected linked respondent data may provide a feasible means of producing data capable of demonstrating comprehensive health impact. However, we also suggest that, where possible, physiological measures should be included to elucidate underlying biological effects that may not be accurately captured through self-reporting alone and can enable modelling of long-term health outcomes. In addition, accurate self-reported objective income data remains a challenge and requires further development and testing. A process of development and implementation of the resource in pilot and feasibility studies will support assessment of whether or not our proposed health outcome measures are acceptable, feasible and can be used with validity and reliability in the target population. DISCUSSION We suggest that while Open Access evaluation instruments are available and usable to measure most constructs of interest, there remain some areas for which further development is necessary. This includes self-reported wellbeing measures that require paid licences but are used in a range of nationally important longitudinal studies instead of Open Access alternatives.
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Affiliation(s)
| | - Matthew Thomas Johnson
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
| | | | | | - Kate E. Pickett
- Epidemiology in the Department of Health Sciences, University of York, York, UK
- Centre for Future Health, University of York, York, UK
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24
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McFarland MJ, Hill TD, Montez JK. Income Inequality and Population Health: Examining the Role of Social Policy. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:2-20. [PMID: 35848112 DOI: 10.1177/00221465221109202] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Studies of the relationship between income inequality and life expectancy often speculate about the role of policy, but direct empirical research is limited. Drawing on the neo-materialist perspective, we examine whether the longitudinal association between income inequality and life expectancy is mediated and moderated by policy liberalism in U.S. states (2000-2014). More liberal policy contexts are characterized by greater efforts to regulate the economy, redistribute income, and protect vulnerable groups and lesser efforts to penalize deviant social behavior. We find that state-level income inequality is inversely associated with policy liberalism and life expectancy. The association between income inequality and life expectancy was not mediated by policy liberalism but was moderated by it. The association is attenuated in states with more liberal policy contexts, supporting the neo-materialist perspective. This finding illustrates how states like New York and California (with liberal policy contexts) can exhibit high income inequality and high life expectancy.
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Schiavo R, Arana M, Levy N, Grijalva Y, Ravenhall S, DiManno M, Murrman M. Barriers to Meeting Community Needs in New York State during COVID-19: Results From a Pilot Survey of Nongovernmental Population and Community Health Professionals. Health Promot Pract 2023; 24:332-339. [PMID: 34963360 PMCID: PMC9931878 DOI: 10.1177/15248399211065412] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Capacity building and training help empower the community and population health organizations to partner with local health departments and collaboratively design multisectoral interventions that account for the complexity of public health and health promotion challenges in the era of COVID-19 and beyond. Ideally, training programs should be informed by an understanding of the needs and priorities of the professionals for whom they are intended. This brief report focuses on the results of a pilot online survey conducted as part of a larger pilot study by the New York State Association of County Health Officials and the Region 2 Public Health Training Center among population and community health professionals (n = 27) from four counties in New York State during the COVID-19 pandemic. Survey participants included a diverse group of staff members from various large and small nonprofit organizations, federally qualified health centers, academic institutions, hospitals, and insurers. Survey findings provide preliminary insights into the extent to which these organizations have been involved in the COVID-19 response in partnership with LHDs, barriers they faced in responding to the needs of the populations they serve and adjusting their work routines/operations to COVID-19 guidelines, and their top emerging organizational and training needs. Lessons learned from conducting an online survey during a public health emergency and implications for future training interventions for population and community health professionals are also discussed within the context of promoting multisectoral collaboration with local health departments, solving complex public health problems, and advancing health equity.
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Affiliation(s)
- Renata Schiavo
- Columbia University Mailman School of Public Health, New York, NY, USA.,Health Equity Initiative, New York, NY, USA.,Strategies for Equity and Communication Impact, New York, NY, USA
| | - Mayela Arana
- Columbia University Mailman School of Public Health, New York, NY, USA.,Region 2 Public Health Training Center, New York, NY, USA
| | - Nicole Levy
- Columbia University Mailman School of Public Health, New York, NY, USA.,Region 2 Public Health Training Center, New York, NY, USA
| | - Yesenia Grijalva
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sarah Ravenhall
- New York State Association of County Health Officials, Albany, NY, USA
| | - Margaret DiManno
- New York State Association of County Health Officials, Albany, NY, USA
| | - Marita Murrman
- Columbia University Mailman School of Public Health, New York, NY, USA.,Region 2 Public Health Training Center, New York, NY, USA
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Tsakos G, Watt RG, Guarnizo-Herreño CC. Reflections on oral health inequalities: Theories, pathways and next steps for research priorities. Community Dent Oral Epidemiol 2023; 51:17-27. [PMID: 36744970 DOI: 10.1111/cdoe.12830] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/29/2022] [Accepted: 12/05/2022] [Indexed: 02/07/2023]
Abstract
Health inequalities, including those in oral health, are a critical problem of social injustice worldwide, while the COVID-19 pandemic has magnified previously existing inequalities and created new ones. This commentary offers a summary of the main frameworks used in the literature of oral health inequalities, reviews the evidence and discusses the potential role of different pathways/mechanisms to explain inequalities. Research in this area needs now to move from documenting oral health inequalities, towards explaining them, understanding the complex mechanisms underlying their production and reproduction and looking at interventions to tackle them. In particular, the importance of interdisciplinary theory-driven research, intersectionality frameworks and the use of the best available analytical methodologies including qualitative research is discussed. Further research on understanding the role of structural determinants on creating and shaping inequalities in oral health is needed, such as a focus on political economy analysis. The co-design of interventions to reduce oral health inequalities is an area of priority and can highlight the critical role of context and inform decision-making. The evaluation of such interventions needs to consider their public health impact and employ the wider range of methodological tools available rather than focus entirely on the traditional approach, based primarily on randomized controlled trials. Civil society engagement and various advocacy strategies are also necessary to make progress in the field.
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Affiliation(s)
- Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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27
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Augustin J, Andrees V, Walsh D, Reintjes R, Koller D. Spatial Aspects of Health-Developing a Conceptual Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1817. [PMID: 36767185 PMCID: PMC9914219 DOI: 10.3390/ijerph20031817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
Numerous studies and models address the determinants of health. However, in existing models, the spatial aspects of the determinants are not or only marginally taken into account and a theoretical discussion of the association between space and the determinants of health is missing. The aim of this paper is to generate a framework that can be used to place the determinants of health in a spatial context. A screening of the current first serves to identify the relevant determinants and describes the current state of knowledge. In addition, spatial scales that are important for the spatial consideration of health were developed and discussed. Based on these two steps, the conceptual framework on the spatial determinants of health was derived and subsequently discussed. The results show a variety of determinants that are associated with health from a spatial point of view. The overarching categories are global driving forces, policy and governance, living and physical environment, socio-demographic and economic conditions, healthcare services and cultural and working conditions. Three spatial scales (macro, meso and micro) are further subdivided into six levels, such as global (e.g., continents), regional (e.g., council areas) or neighbourhood (e.g., communities). The combination of the determinants and spatial scales are presented within a conceptual framework as a result of this work. Operating mechanisms and pathways between the spatial levels were added schematically. This is the first conceptual framework that links the determinants of health with the spatial perspective. It can form the working basis for future analyses in which spatial aspects of health are taken into account.
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Affiliation(s)
- Jobst Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Valerie Andrees
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - David Walsh
- Glasgow Centre for Population Health, Glasgow G40 2QH, UK
| | - Ralf Reintjes
- Department of Health Sciences, Faculty of Life Sciences, Hamburg University of Applied Sciences, 20999 Hamburg, Germany
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland
| | - Daniela Koller
- IBE—Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
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Patterson AC. Is Economic Growth Good for Population Health? A Critical Review. CANADIAN STUDIES IN POPULATION 2023; 50:1. [PMID: 36938118 PMCID: PMC10009865 DOI: 10.1007/s42650-023-00072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/17/2023] [Indexed: 03/16/2023]
Abstract
A large multidisciplinary literature discusses the relationship between economic growth and population health. The idea that economic growth is good for societies has inspired extensive academic debate, but conclusions have been mixed. To help shed light on the subject, this paper focuses on opportunities for consensus in this large literature. Much scholarship finds that the health-growth relationship varies according to (1) which aspect of "health" is under consideration, (2) shape (e.g., positive linear or logarithmic), (3) issues of timing (e.g., growth over the short or long term), (4) a focus on health inequalities as opposed to population averages, and (5) multivariable relationships with additional factors. After reflecting upon these findings, I propose that economic growth promotes health in some respects, for some countries, and in conjunction with other life-supporting priorities, but does not by itself improve population health generally speaking. I then argue there is already wide, interdisciplinary consensus to support this stance. Moreover, policies focusing exclusively on economic growth threaten harm to both population health and growth, which is to say that political dynamics are also implicated. Yet multivariable approaches can help clarify the bigger picture of how growth relates to health. For moving this literature forward, the best opportunities may involve the simultaneous analysis of multiple factors. The recognition of consensus around these issues would be welcome, and timely. Supplementary Information The online version contains supplementary material available at 10.1007/s42650-023-00072-y.
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29
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Thomson RM, Kopasker D, Leyland A, Pearce A, Katikireddi SV. Effects of poverty on mental health in the UK working-age population: causal analyses of the UK Household Longitudinal Study. Int J Epidemiol 2022; 52:512-522. [PMID: 36479855 PMCID: PMC10114108 DOI: 10.1093/ije/dyac226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Addressing poverty through taxation or welfare policies is likely important for public mental health; however, few studies assess poverty's effects using causal epidemiology. We estimated the effect of poverty on mental health. METHODS We used data on working-age adults (25-64 years) from nine waves of the UK Household Longitudinal Survey (2009-19; n = 45 497/observations = 202 207 following multiple imputation). We defined poverty as a household equivalized income <60% median, and the outcome likely common mental disorder (CMD) as a General Health Questionnaire-12 score ≥4. We used double-robust marginal structural modelling with inverse probability of treatment weights to generate absolute and relative effects. Supplementary analyses separated transitions into/out of poverty, and stratified by gender, education, and age. We quantified potential impact through population attributable fractions (PAFs) with bootstrapped standard errors. RESULTS Good balance of confounders was achieved between exposure groups, with 45 830 observations (22.65%) reporting poverty. The absolute effect of poverty on CMD prevalence was 2.15% [%-point change; 95% confidence interval (CI) 1.45, 2.84]; prevalence in those unexposed was 20.59% (95% CI 20.29%, 20.88%), and the odds ratio was 1.17 (95% CI 1.12, 1.24). There was a larger absolute effect for transitions into poverty [2.46% (95% CI 1.56, 3.36)] than transitions out of poverty [-1.49% (95% CI -2.46, -0.53)]. Effects were also slightly larger in women than men [2.34% (95% CI 1.41, 3.26) versus 1.73% (95% CI 0.72, 2.74)]. The PAF for moving into poverty was 6.34% (95% CI 4.23, 8.45). CONCLUSIONS PAFs derived from our causal estimates suggest moves into poverty account for just over 6% of the burden of CMD in the UK working-age population, with larger effects in women.
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Affiliation(s)
| | | | | | | | - S Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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30
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Perez FP, Perez CA, Chumbiauca MN. Insights into the Social Determinants of Health in Older Adults. JOURNAL OF BIOMEDICAL SCIENCE AND ENGINEERING 2022; 15:261-268. [PMID: 36419938 PMCID: PMC9681180 DOI: 10.4236/jbise.2022.1511023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this paper, we review the social determinants of health in older adults and their complex interrelationship with medical diseases. Also, we provide recommendations to address these determinants in the integrated healthcare plan. The social determinants in older adults and its influence in health outcomes have been studied for decades. There is solid evidence for the interrelationship between social factors and the health of individuals and populations; however, these studies are unable to define their complex interrelatedness. Health is quite variable and depends on multiple biological and social factors such as genetics, country of origin, migrant status, etc. On the other hand, health status can affect social factors such as job or education. Addressing social determinants of health in the integrated healthcare plan is important for improving health outcomes and decreasing existing disparities in older adult health. We recommend a person-centered approach in which individualized interventions should be adopted by organizations to improve the health status of older adults at the national and global level. Some of our practical recommendations to better address the social determinants of health in clinical practice are EHR documentation strategies, screening tools, and the development of linkages to the world outside of the clinic and health system, including social services, community activities, collaborative work, and roles for insurance companies.
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Affiliation(s)
- Felipe P. Perez
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Carmen A. Perez
- School of Social Work, Indiana University, Indianapolis, IN, USA
| | - Magali N. Chumbiauca
- Richard L. Roudebush Veterans Affairs Medical Center, Home Based Primary Care, Indianapolis, IN, USA
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Whitley E, McCartney G, Bartley M, Benzeval M. Examining the impact of different social class mechanisms on health inequalities: A cross-sectional analysis of an all-age UK household panel study. Soc Sci Med 2022; 312:115383. [PMID: 36155357 DOI: 10.1016/j.socscimed.2022.115383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/24/2022] [Accepted: 09/16/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Socioeconomic inequalities are well established across health, morbidity and mortality measures. Social class theory describes how social groups relate, interact and accrue advantages/disadvantages relative to one another, with different theorists emphasising different dimensions. In the context of health inequalities, different social class measures are used interchangeably to rank population groups in terms of health rather than directly exploring the role of social class in creating inequalities. We aim to better understand how four distinct social class mechanisms explain differences in a range of self-reported and biological health outcomes. METHODS We use data from the UK Household Longitudinal Study, a representative population survey of UK adults, to identify measures pertaining to Early years, Bourdieusian, Marxist, and Weberian social class mechanisms. Using logistic and least-squares regression we consider the relative extent to which these mechanisms explain differences in health (Self-reported health, SF12 Physical (PCS) and Mental (MCS) Component Scores, General Health Questionnaire; N = 21,446) and allostatic load, a biomarker-based measure of cumulative stress (N = 5003). RESULTS Respondents with higher social position according to all social class measures had better self-rated, physical and mental health, and lower allostatic load. Associations with Marxist social class were among the strongest (e.g. Relative Index of Inequality for very good/excellent self-rated health comparing highest versus lowest Marxist social class: 4.96 (4.45, 5.52), with the Weberian measure also strongly associated with self-rated (4.35 (3.90, 4.85)) and physical health (Slope Index of Inequality for SF12-PCS: 7.94 (7.39, 8.48)). Health outcome associations with Bourdieusian and Marxist measures were generally stronger for women and older respondents, and physical health associations with all measures were stronger among those aged 50+ years. CONCLUSIONS The impact of social class on health is multi-faceted. Policies to reduce health inequalities should focus more on unequal capital ownership, economic democracy and educational inequalities, reflecting Marxist and Weberian mechanisms.
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Affiliation(s)
- Elise Whitley
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G3 7HR, UK.
| | - Gerard McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, G12 8RT, UK
| | - Mel Bartley
- Institute of Epidemiology & Health, University College London, London, WC1E 7HB, UK
| | - Michaela Benzeval
- Institute for Social and Economic Research, University of Essex, Colchester, CO4 3SQ, UK; Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
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Ullah F, Harrigan NM. A natural experiment in social security as public health measure: Experiences of international students as temporary migrant workers during two Covid-19 lockdowns. Soc Sci Med 2022; 313:115196. [PMID: 36244108 PMCID: PMC9272684 DOI: 10.1016/j.socscimed.2022.115196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 01/26/2023]
Abstract
What is the impact of social security on public health? And what mechanisms does it operate through? To answer these questions, we take advantage of the unique circumstances of temporary migrant workers two Covid-19 lockdowns in Australia - one in which they were provided with social security, and one in which they were not. We undertook 47 qualitative interviews with South Asian international students who had lost their jobs in two lockdowns in 2020-2021. In Australia, international students represent the largest group of a growing temporary migration program, with many working in low-skilled occupations, in conditions below legal minimum standards. We compare our findings to two models of social security: the self-insurance model and state-insurance model. In first lockdown, without social security, participants struggled to comply with public health orders because of the need to work for income, lack of housing suitable for isolation, and lack of medical leave. Participants tended to avoid testing, and to work while potentially contagious. Participants reported high levels of anxiety, depression and emotional distress caused by job loss and exclusion from an implicit social contract with the rest of Australian society. In contrast, during the second lockdown, where temporary migrants were provided social security payments, participants reported avoiding risky work, undertook Covid-19 testing many times, and self-isolated successfully. There was little evidence of emotional distress. Participants felt like a valued part of Australian society. These results suggest a self-insurance model of social security does not protect the physical and psychological health of vulnerable populations and can exacerbate the spread of communicable diseases. In contrast, state-insurance and social welfare payments to marginalised communities, particularly unemployment benefits and medical leave, are crucial public health policy levers for both protecting vulnerable populations and tackling outbreaks of communicable diseases such as Covid-19.
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Wolbring L, Schmidt SCE, Niessner C, Woll A, Wäsche H. Community networks of sport and physical activity promotion: an analysis of structural properties and conditions of cooperation. BMC Public Health 2022; 22:1966. [PMID: 36289498 PMCID: PMC9608923 DOI: 10.1186/s12889-022-14383-3] [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: 05/16/2022] [Revised: 09/29/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background: The importance of intersectoral cooperation networks among community organizations located in people’s immediate environments in addressing population health problems such as physical inactivity has come into focus in recent years. To date, there is limited evidence on how and why such networks emerge. Therefore, the aims of this study were (a) to analyze the structural properties and (b) to identify the conditions of cooperation in interorganizational community networks of sport and physical activity promotion. Methods: Survey data on cooperative relationships and organizational attributes of sports and physical activity providers as well as sports administrating organizations in two community networks located in urban districts in southern Germany were collected (Network I: n = 133 organizations; Network II: n = 50 organizations). Two quantitative descriptive procedures – network analysis and stochastic analyses of network modeling (exponential random graphs) – were applied. Results: Similar structures and conditions of cooperation were found in the networks (e.g. low density, centralization). The community sports administrations had the most central positions in both networks. Exponential random graph modeling showed that cooperation took place more frequently in triangular structures (closure effect) and revolved around a few central actors (preferential attachment effect). Organizations from different sectors cooperated more often than organizations from the same sector (heterophily effect). Conclusion: The study provided valid and robust findings on significant mechanisms and conditions of interorganizational cooperation in community networks focused on sport and physical activity promotion. Based on the results, implications for the development and most efficient governance of these networks can be derived. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14383-3.
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Affiliation(s)
- Laura Wolbring
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Steffen Christian Ekkehard Schmidt
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Claudia Niessner
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Alexander Woll
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Hagen Wäsche
- grid.7892.40000 0001 0075 5874Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
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Furton GL. The pox of politics: Troesken's tradeoff reexamined. PUBLIC CHOICE 2022; 195:169-191. [PMID: 36311040 PMCID: PMC9589814 DOI: 10.1007/s11127-022-01002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/01/2022] [Indexed: 05/25/2023]
Abstract
In The Pox of Liberty, Werner Troesken details the tradeoff between liberal institutions and communicable disease. According to Troesken, individual freedom presents a danger to the public health in the face of infectious disease, while constitutional constraints restrict the government's ability to implement effective policy. Contra Troesken, I argue that decision-makers, amidst a crisis of contagion, neglect intertemporal tradeoffs, thereby discounting long run costs while favoring short run policies. These policies, once implemented, are difficult to reverse due to the path dependent nature of political institutions. Irreversible and self-reinforcing growth in political institutions established to enhance health can have an unintended negative impact on health during future crises, where political agents must operate in a more cumbersome and error-prone institutional environment. Using events from the history of public health in the U.S. as support for my theory, I conclude that Troesken's alleged tradeoff ought to be met with greater skepticism.
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Affiliation(s)
- Glenn L. Furton
- The Foundations of the Market Economy Program, Classical Liberal Institute, New York University, New York, USA
- Metropolitan State University of Denver, Denver, USA
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35
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Harrigan SP, Tsang VWL, Yassi A, Zungu M, Spiegel JM. Impacts of economic inequality on healthcare worker safety at the onset of the COVID-19 pandemic: cross-sectional analysis of a global survey. BMJ Open 2022; 12:e064804. [PMID: 36198468 PMCID: PMC9534779 DOI: 10.1136/bmjopen-2022-064804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To assess the extent to which protection of healthcare workers (HCWs) as COVID-19 emerged was associated with economic inequality among and within countries. DESIGN Cross-sectional analysis of associations of perceptions of workplace risk acceptability and mitigation measure adequacy with indicators of respondents' respective country's economic income level (World Bank assessment) and degree of within-country inequality (Gini index). SETTING A global self-administered online survey. PARTICIPANTS 4977 HCWs and healthcare delivery stakeholders from 161 countries responded to health and safety risk questions and a subset of 4076 (81.2%) answered mitigation measure questions. The majority (65%) of study participants were female. RESULTS While the levels of risk being experienced at the pandemic's onset were consistently deemed as unacceptable across all groupings, participants from countries with less income inequality were somewhat less likely to report unacceptable levels of risk to HCWs regarding both workplace environment (OR=0.92, p=0.012) and workplace organisational factors (OR=0.93, p=0.017) compared with counterparts in more unequal national settings. In contrast, considerable variation existed in the degree to which mitigation measures were considered adequate. Adjusting for other influences through a logistic regression analysis, respondents from lower middle-income and low-income countries were comparatively much more likely to assess both occupational health and safety (OR=10.91, p≤0.001) and infection prevention and control (IPC) (OR=6.61, p=0.001) protection measures as inadequate, despite much higher COVID-19 rates in wealthier countries at the time of the survey. Greater within-country income inequality was also associated with perceptions of less adequate IPC measures (OR=0.94, p=0.025). These associations remained significant when accounting for country-level differences in occupational and gender composition of respondents, including specifically when only female care providers, our study's largest and most at-risk subpopulation, were examined. CONCLUSIONS Economic inequality threatens resilience of health systems that rely on health workers working safely to provide needed care during emerging pandemics.
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Affiliation(s)
- Sean P Harrigan
- Global Health Research Program, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Vivian W L Tsang
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Annalee Yassi
- Global Health Research Program, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Muzimkhulu Zungu
- National Institute for Occupational Health, Johannesburg, Gauteng, South Africa
- School of Health Systems and Public Health, University of Pretoria Faculty of Health Sciences, Pretoria, Gauteng, South Africa
| | - Jerry M Spiegel
- Global Health Research Program, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
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Davey F, McGowan V, Birch J, Kuhn I, Lahiri A, Gkiouleka A, Arora A, Sowden S, Bambra C, Ford J. Levelling up health: A practical, evidence-based framework for reducing health inequalities. PUBLIC HEALTH IN PRACTICE 2022; 4:100322. [PMID: 36164497 PMCID: PMC9494865 DOI: 10.1016/j.puhip.2022.100322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022] Open
Abstract
There are substantial inequalities in health across society which have been exacerbated by the COVID-19 pandemic. The UK government have committed to a programme of levelling-up to address geographical inequalities. Here we undertake rapid review of the evidence base on interventions to reduce such health inequalities and developed a practical, evidence-based framework to 'level up' health across the country. This paper overviews a rapid review undertaken to develop a framework of guiding principles to guide policy. To that end and based on an initial theory, we searched one electrotonic database (MEDLINE) from 2007 to July 2021 to identify published umbrella reviews and undertook an internet search to identify relevant systematic reviews, primary studies, and grey literature. Titles and abstracts were screened according to the eligibility criteria. Key themes were extracted from the included studies and synthesised into an overarching framework of guiding principles in consultation with an expert panel. Included studies were cross checked with the initial theoretical domains and further searching undertaken to fill any gaps. We identified 16 published umbrella reviews (covering 667 individual studies), 19 grey literature publications, and 15 key systematic reviews or primary studies. Based on these studies, we develop a framework applicable at national, regional and local level which consisted of five principles - 1) healthy-by-default and easy to use initiatives; 2) long-term, multi-sector action; 3) locally designed focus; 4) targeting disadvantaged communities; and 5) matching of resources to need. Decision-makers working on policies to level up health should be guided by these five principles.
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Affiliation(s)
- Fiona Davey
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Vic McGowan
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - Jack Birch
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Isla Kuhn
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Anwesha Lahiri
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Anna Gkiouleka
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Ananya Arora
- Cambridge Public Health, University of Cambridge, United Kingdom
| | - Sarah Sowden
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - Clare Bambra
- NIHR School for Public Health Research, United Kingdom
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, United Kingdom
- NIHR Applied Research Collaboration North East and North Cumbria, United Kingdom
| | - John Ford
- Cambridge Public Health, University of Cambridge, United Kingdom
- NIHR School for Public Health Research, United Kingdom
- NIHR Applied Research Collaboration East of England, United Kingdom
- Corresponding author. Cambridge Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom.
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Zhang W, Liu S, Osgood N, Zhu H, Qian Y, Jia P. Using simulation modelling and systems science to help contain COVID-19: A systematic review. SYSTEMS RESEARCH AND BEHAVIORAL SCIENCE 2022; 40:SRES2897. [PMID: 36245570 PMCID: PMC9538520 DOI: 10.1002/sres.2897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/23/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
This study systematically reviews applications of three simulation approaches, that is, system dynamics model (SDM), agent-based model (ABM) and discrete event simulation (DES), and their hybrids in COVID-19 research and identifies theoretical and application innovations in public health. Among the 372 eligible papers, 72 focused on COVID-19 transmission dynamics, 204 evaluated both pharmaceutical and non-pharmaceutical interventions, 29 focused on the prediction of the pandemic and 67 investigated the impacts of COVID-19. ABM was used in 275 papers, followed by 54 SDM papers, 32 DES papers and 11 hybrid model papers. Evaluation and design of intervention scenarios are the most widely addressed area accounting for 55% of the four main categories, that is, the transmission of COVID-19, prediction of the pandemic, evaluation and design of intervention scenarios and societal impact assessment. The complexities in impact evaluation and intervention design demand hybrid simulation models that can simultaneously capture micro and macro aspects of the socio-economic systems involved.
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Affiliation(s)
- Weiwei Zhang
- Research Institute of Economics and ManagementSouthwestern University of Finance and EconomicsChengduChina
| | - Shiyong Liu
- Institute of Advanced Studies in Humanities and Social SciencesBeijing Normal University at ZhuhaiZhuhaiChina
| | - Nathaniel Osgood
- Department of Computer ScienceUniversity of SaskatchewanSaskatoonCanada
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonCanada
| | - Hongli Zhu
- Research Institute of Economics and ManagementSouthwestern University of Finance and EconomicsChengduChina
| | - Ying Qian
- Business SchoolUniversity of Shanghai for Science and TechnologyShanghaiChina
| | - Peng Jia
- School of Resource and Environmental SciencesWuhan UniversityWuhanHubeiChina
- International Institute of Spatial Lifecourse HealthWuhan UniversityWuhanHubeiChina
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38
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Thomson RM, Igelström E, Purba AK, Shimonovich M, Thomson H, McCartney G, Reeves A, Leyland A, Pearce A, Katikireddi SV. How do income changes impact on mental health and wellbeing for working-age adults? A systematic review and meta-analysis. Lancet Public Health 2022; 7:e515-e528. [PMID: 35660213 PMCID: PMC7614874 DOI: 10.1016/s2468-2667(22)00058-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Lower incomes are associated with poorer mental health and wellbeing, but the extent to which income has a causal effect is debated. We aimed to synthesise evidence from studies measuring the impact of changes in individual and household income on mental health and wellbeing outcomes in working-age adults (aged 16-64 years). METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, Web of Science, PsycINFO, ASSIA, EconLit, and RePEc on Feb 5, 2020, for randomised controlled trials (RCTs) and quantitative non-randomised studies. We had no date limits for our search. We included English-language studies measuring effects of individual or household income change on any mental health or wellbeing outcome. We used Cochrane risk of bias (RoB) tools. We conducted three-level random-effects meta-analyses, and explored heterogeneity using meta-regression and stratified analyses. Synthesis without meta-analysis was based on effect direction. Critical RoB studies were excluded from primary analyses. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). This study is registered with PROSPERO, CRD42020168379. FINDINGS Of 16 521 citations screened, 136 were narratively synthesised (12·5% RCTs) and 86 meta-analysed. RoB was high: 30·1% were rated critical and 47·1% serious or high. A binary income increase lifting individuals out of poverty was associated with 0·13 SD improvement in mental health measures (95% CI 0·07 to 0·20; n=42 128; 18 studies), considerably larger than other income increases (0·01 SD improvement, 0·002 to 0·019; n=216 509, 14 studies). For wellbeing, increases out of poverty were associated with 0·38 SD improvement (0·09 to 0·66; n=101 350, 8 studies) versus 0·16 for other income increases (0·07 to 0·25; n=62 619, 11 studies). Income decreases from any source were associated with 0·21 SD worsening of mental health measures (-0·30 to -0·13; n=227 804, 11 studies). Effect sizes were larger in low-income and middle-income settings and in higher RoB studies. Heterogeneity was high (I2=79-87%). GRADE certainty was low or very low. INTERPRETATION Income changes probably impact mental health, particularly where they move individuals out of poverty, although effect sizes are modest and certainty low. Effects are larger for wellbeing outcomes, and potentially for income losses. To best support population mental health, welfare policies need to reach the most socioeconomically disadvantaged. FUNDING Wellcome Trust, Medical Research Council, Chief Scientist Office, and European Research Council.
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Affiliation(s)
- Rachel M Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Erik Igelström
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Amrit Kaur Purba
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Michal Shimonovich
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Hilary Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK; Public Health Scotland, Edinburgh, UK
| | - Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Alastair Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK; Public Health Scotland, Edinburgh, UK
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Cantor P, Polakowska M, Proietti A, Tran V, Lebire J, Roy L. Leisure Possibilities of Adults Experiencing Poverty: A Community-Based Participatory Study. Can J Occup Ther 2022; 89:103-114. [PMID: 35157540 PMCID: PMC9136379 DOI: 10.1177/00084174211073266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Poverty disproportionally affects persons with disabilities, elderly individuals and racialized groups. Leisure, play and rest are not prioritized in either services for or research with people living in poverty. Purpose. This study aims to examine the facilitators and barriers to participation in meaningful leisure activities for adults living in poverty. Method. We used community-based participatory research and art-based elicitation strategies with 39 service users at a food security organization. Findings. Individuals experiencing poverty value and engage in a variety of free and affordable leisure activities, but they are not afforded the necessary leisure opportunities, accommodations and supports as the general population. We co-created a map of local leisure resources to foster collective capacity in leisure planning, and to support organizations working with this population. Implications. Occupational therapists can work alongside members of underserved communities to uncover and address the systemic and local contextual barriers to engagement in leisure activities.
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Affiliation(s)
| | | | | | | | | | - Laurence Roy
- Laurence Roy, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada.
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40
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Destri K, Alves J, Gregório MJ, Dias SS, Henriques AR, Mendonça N, Canhão H, Rodrigues AM. Obesity- attributable costs of absenteeism among working adults in Portugal. BMC Public Health 2022; 22:978. [PMID: 35568836 PMCID: PMC9107744 DOI: 10.1186/s12889-022-13337-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/25/2022] [Indexed: 12/23/2022] Open
Abstract
Background Obesity leads to poor health outcomes and may adversely affect work productivity. This study, aimed to investigate the obesity- attributable costs of absenteeism among working adults in Portugal. Methods The study population included individuals actively working at baseline from the Epidemiology of Chronic Diseases Cohort (EpiDoC), a large Portuguese population-based prospective study. Body mass index was measured at baseline and in two follow-up interviews. Absenteeism in each wave of the EpiDoC was assessed by the question “Did you have a sick leave in the previous 12 months? yes/no”, followed by “How many days did you miss work due to sickness in the previous twelve months?”. Body mass index (BMI) was classified into underweight, normal weight, overweight, and obese, based on the standard World Health Organization definition. Association between obesity and absenteeism was estimated with the negative binomial regression model adjusted for BMI, chronic diseases, and lifestyle. Obesity- attributable costs were calculated using lost gross income during the time absent from work, through the human-capital approach. Results The EpiDoC included 4338 working adults at baseline. Of these, 15.2% were obese at the beginning of the study and 22.7% of the population had been absent from work in the last 12 months. Participants with obesity missed 66% more days at work (IRR: 1.66; CI 95%:1.13–2.44; (p = 0.009.) than those with normal weight. The odds of having been absent from work were 1.4 times higher in obese compared to non-obese individuals (CI 95%: 1.18–1.67; p < 0.01) adjusted to sex and type of work. Obese individuals missed 3.8 more days per year than those with normal weight (95%CI: 3.1–4.5). Extrapolating to the entire Portuguese working population, absenteeism due to obesity incurred an additional cost of €238 million per year. Conclusion Obesity imposes a financial burden due to absenteeism in Portugal. Employers and national health regulators should seek effective ways to reduce these costs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13337-z.
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Affiliation(s)
- Kelli Destri
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal. .,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Joana Alves
- Comprehensive Health Research Center (CHRC), NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria João Gregório
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,Programa Nacional Para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, Lisbon, Portugal.,Faculdade de Ciências da Nutrição E Alimentação, Universidade Do Porto, Porto, Portugal
| | - Sara Simões Dias
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,Center for Innovative Care and Health Technology, CiTechCare, Instituto Politécnico de Leiria/Escola Superior de Saúde, Leiria, Portugal
| | - Ana Rita Henriques
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Nuno Mendonça
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,National School of Public Health, UNL, Lisboa, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Hospital Dos Lusíadas, Lisboa, Portugal
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41
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Salehnia N, Karimi Alavijeh N, Hamidi M. Analyzing the impact of energy consumption, the democratic process, and government service delivery on life expectancy: evidence from a global sample. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:36967-36984. [PMID: 35066848 DOI: 10.1007/s11356-021-18180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/14/2021] [Indexed: 06/14/2023]
Abstract
Life expectancy is one of the crucial criteria for determining the quality of life in today's societies. As such, the study of factors affecting life expectancy is a key issue for policymakers. This study aims to investigate the impact of energy consumption, the democratic process, and government service delivery on life expectancy in 100 countries during 2000-2018, using panel quantile regression. The impact of these factors on life expectancy has been estimated in quantiles of 0.05, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, and 0.95. Also, the impact of GDP, CO2 emission, and Gini coefficient variables has been explored as controlling variables on life expectancy. The results show that the impact of CO2 emissions and the democratic process on life expectancy is negative in all quantiles, and the impact of GDP is negative in all quantiles except 0.95. Moreover, the relationship between hydroelectricity consumption and life expectancy in the 0.05, 0.1, 0.2, 0.8, and 0.9 quantiles is negative and significant. Accordingly, based on the results, the impact of petroleum and other liquids consumption, government service delivery, and Gini coefficient on life expectancy in all quantiles is positive and only the impact of the Gini coefficient on life expectancy in all quantiles is significant.
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Affiliation(s)
- Narges Salehnia
- Department of Economics, Faculty of Economics and Administrative Sciences, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Nooshin Karimi Alavijeh
- Department of Economics, Faculty of Economics and Administrative Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mina Hamidi
- Department of Economics, Faculty of Economics and Administrative Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
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Tsui EK, Franzosa E, Vignola EF, Cuervo I, Landsbergis P, Zelnick J, Baron S. Recognizing careworkers' contributions to improving the social determinants of health: A call for supporting healthy carework. New Solut 2022; 32:9-18. [PMID: 34913377 DOI: 10.1177/10482911211066963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Workers engaged in reproductive labor-the caring work that maintains society and supports its growth-contribute to societal health while also enduring the harms of precarious labor and substantial work stress. How can we conceptualize the effects of reproductive labor on workers and society simultaneously? In this commentary, we analyze four types of more relational and less relational careworkers-homeless shelter workers, school food workers, home care aides, and household cleaners-during the COVID-19 pandemic. We then make a case for a new model of societal health that recognizes the contributions of careworkers and healthy carework. Our model includes multi-sectoral social policies supporting both worker health and societal health and acknowledges several dimensions of work stress for careworkers that have received insufficient attention. Ultimately, we argue that the effects of reproductive labor on workers and society must be considered jointly, a recognition that offers an urgent vision for repairing and advancing societal health.
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Affiliation(s)
- Emma K Tsui
- CUNY Graduate School of Public Health & Health Policy, New York, USA
| | - Emily Franzosa
- 20071James J Peters VA Medical Center, New York, USA
- 5925Icahn School of Medicine at Mount Sinai, New York, USA
| | - Emilia F Vignola
- CUNY Graduate School of Public Health & Health Policy, New York, USA
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Peterson CL, Walker C. Universal health care and political economy, neoliberalism and effects of COVID-19: A view of systems and complexity. J Eval Clin Pract 2022; 28:338-340. [PMID: 34647671 PMCID: PMC8656626 DOI: 10.1111/jep.13631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 01/23/2023]
Abstract
Sturmberg and Martin's application of systems and complexity theory to understanding Universal Health Care (UHC) and Primary Health Care (PHC) is evaluated in the light of the influence of political economy on health systems. Furthermore, the role that neoliberal approaches to governance have had in creating increased inequities is seen as a key challenge for UHC. COVID-19 has emphasized long standing discrepancies in health and these disadvantages require government will and cooperation together with adequate social services to redress these discrepancies in UHC.
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Affiliation(s)
- Chris L Peterson
- Department of Social Inquiry, Bundoora, La Trobe University, Melbourne, Victoria, Australia
| | - Christine Walker
- Department of Medicine, University of Medicine, Parkville, Melbourne, Victoria, Australia.,Epilepsy Foundation, Surrey Hills, Melbourne, Victoria, Australia
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44
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Brand-Correa L, Brook A, Büchs M, Meier P, Naik Y, O'Neill DW. Economics for people and planet-moving beyond the neoclassical paradigm. Lancet Planet Health 2022; 6:e371-e379. [PMID: 35397225 PMCID: PMC9226380 DOI: 10.1016/s2542-5196(22)00063-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 05/26/2023]
Abstract
Despite substantial attention within the fields of public and planetary health on developing an economic system that benefits both people's health and the environment, heterodox economic schools of thought have received little attention within these fields. Ecological economics is a school of thought with particular relevance to public and planetary health. In this article, we discuss implications of key ecological economics ideas for public and planetary health, especially those related to critiques of gross domestic product as a measure of progress and economic growth as the dominant goal for economic and policy decision making. We suggest that ecological economics aligns well with public health goals, including concern for equality and redistribution. Ecological economics offers an opportunity to make the transition to an economic system that is designed to promote human and planetary health from the outset, rather than one where social and environmental externalities must be constantly corrected after the fact. Important ideas from ecological economics include the use of a multidimensional framework to evaluate economic and social performance, the prioritisation of wellbeing and environmental goals in decision making, policy design and evaluation that take complex relationships into account, and the role of provisioning systems (the physical and social systems that link resource use and social outcomes). We discuss possible interventions at the national scale that could promote public health and that align with the prioritisation of social and ecological objectives, including universal basic income or services and sovereign money creation. Overall, we lay the foundations for additional integration of ecological economics principles and pluralist economic thinking into public and planetary health scholarship and practice.
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Affiliation(s)
- Lina Brand-Correa
- Faculty of Environmental and Urban Change, York University, Toronto, ON, Canada; Sustainability Research Institute, School of Earth and Environment, University of Leeds, Leeds, UK
| | - Anna Brook
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Milena Büchs
- Sustainability Research Institute, School of Earth and Environment, University of Leeds, Leeds, UK
| | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Yannish Naik
- School of Health and Related Research, University of Sheffield, Sheffield, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Daniel W O'Neill
- Sustainability Research Institute, School of Earth and Environment, University of Leeds, Leeds, UK
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Barlow P. COVID-19, Trade, and Health: This Changes Everything? Comment on "What Generates Attention to Health in Trade Policy-Making? Lessons From Success in Tobacco Control and Access to Medicines: A Qualitative Study of Australia and the (Comprehensive and Progressive) Trans-Pacific Partnership". Int J Health Policy Manag 2022; 11:525-528. [PMID: 33233035 PMCID: PMC9309943 DOI: 10.34172/ijhpm.2020.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/24/2020] [Indexed: 11/24/2022] Open
Abstract
Townsend and colleagues highlighted the myriad political forces which fostered attention to health issues during negotiations to establish a new trans-pacific trade deal in Australia (the CP-TPP [Comprehensive and Progressive Agreement for Trans-Pacific Partnership], formerly known as TPP). Among the factors they identify, exporter interests and exogenous events helped to generate attention to trade-related concerns about tobacco and access medicines, and limited attention to nutrition and alcohol. These are important considerations as the United Kingdom negotiates a trade deal with the United States in haste, whilst at the same time attempting to manage the ongoing coronavirus disease 2019 (COVID-19) pandemic. In this commentary, I reflect on changing attention to trade and nutrition during the COVID-19 pandemic in light of Townsend and colleagues' analysis. I explore scope for greater attention to nutrition in US-UK trade negotiations, and the challenges created by the vested interests of major UK and US processed food exporters. I further discuss the utility of the theoretical tools employed by Townsend and colleagues for wider debates in the political economy of health.
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Affiliation(s)
- Pepita Barlow
- Department of Health Policy, London School of Economics and Political Science, London, UK
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Shimonovich M, Pearce A, Thomson H, McCartney G, Katikireddi SV. Assessing the causal relationship between income inequality and mortality and self-rated health: protocol for systematic review and meta-analysis. Syst Rev 2022; 11:20. [PMID: 35115055 PMCID: PMC8815171 DOI: 10.1186/s13643-022-01892-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Income inequality has been linked to health and mortality. While there has been extensive research exploring the relationship, the evidence for whether the relationship is causal remains disputed. We describe the methods for a systematic review that will transparently assess whether a causal relationship exists between income inequality and mortality and self-rated health. METHODS We will identify relevant studies using search terms relating to income inequality, mortality, and self-rated health (SRH). Four databases will be searched: MEDLINE, ISI Web of Science, EMBASE, and the National Bureau of Economic Research. The inclusion criteria have been developed to identify the study designs best suited to assess causality: multilevel studies that have conditioned upon individual income (or a comparable measure, such as socioeconomic position) and natural experiment studies. Risk of bias assessment of included studies will be conducted using ROBINS-I. Where possible, we will convert all measures of income inequality into Gini coefficients and standardize the effect estimate of income inequality on mortality/SRH. We will conduct random-effects meta-analysis to estimate pooled effect estimates when possible. We will assess causality using modified Bradford Hill viewpoints and assess certainty using GRADE. DISCUSSION This systematic review protocol lays out the complexity of the relationship between income inequality and individual health, as well as our approach for assessing causality. Understanding whether income inequality impacts the health of individuals within a population has major policy implications. By setting out our methods and approach as transparently as we can, we hope this systematic review can provide clarity to an important topic for public policy and public health, as well as acting as an exemplar for other "causal reviews".
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Affiliation(s)
- Michal Shimonovich
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom.
| | - Anna Pearce
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Hilary Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Gerry McCartney
- College of Social Sciences, University of Glasgow, Glasgow, United Kingdom
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Ilangovan K, Muthappan S, Govindarajan K, Vairamani V, Venkatasamy V, Ponnaiah M. Transdisciplinarity of India's master's level public health programmes: evidence from admission criteria of the programmes offered since 1995. HUMAN RESOURCES FOR HEALTH 2022; 20:14. [PMID: 35109861 PMCID: PMC8809628 DOI: 10.1186/s12960-022-00713-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In the Indian subcontinent, Master's-level Public Health (MlPH) programmes attract graduates of diverse academic disciplines from health and non-health sciences alike. Considering the current and futuristic importance of the public health cadre, we described them and reviewed their transdisciplinarity status based on MlPH admissibility criteria 1995 to 2021. METHODS Using a search strategy, we abstracted information available in the public domain on MlPH programmes and their admissibility criteria. We categorized the admission criteria based on specified disciplines into Health science, Non-health science and Non-health non-science categories. We described the MlPH programmes by location, type of institution, course duration, curriculum, pedagogical methods, specializations offered, and nature of admission criteria statements. We calculated descriptive statistics for eligible educational qualifications for MlPH admission. RESULTS Overall, 76 Indian institutions (Medical colleges-21 and Non-medical coleges-55) offered 92 MlPH programmes (Private-58 and Public-34). We included 89 for review. These programmes represent a 51% increase (n = 47) from 2016 to 2021. They are mostly concentrated in 21 Indian provinces. These programmes stated that they admit candidates of but not limited to "graduation in any life sciences", "3-year bachelor's degree in any discipline", "graduation from any Indian universities", and "graduation in any discipline". Among the health science disciplines, Modern medicine (n = 89; 100%), Occupational therapy (n = 57; 64%) is the least eligible. Among the non-health science disciplines, life sciences and behavioural sciences (n = 53; 59%) and non-health non-science disciplines, humanities and social sciences (n = 62; 72%) are the topmost eligible disciplines for admission in the MPH programmes. CONCLUSION Our review suggests that India's MlPH programmes are less transdisciplinary. Relatively, non-medical institutions offer admission to various academic disciplines than the medical institutions in their MlPH programmes. India's Master's level public health programmes could be more inclusive by opening to graduates from trans-disciplinary backgrounds.
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Affiliation(s)
| | | | | | - Vignesh Vairamani
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu 600077 India
| | | | - Manickam Ponnaiah
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu 600077 India
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Simon MC, Hart JE, Levy JI, VoPham T, Malwitz A, Nguyen D, Bozigar M, Cupples LA, James P, Laden F, Peters JL. Sociodemographic Patterns of Exposure to Civil Aircraft Noise in the United States. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:27009. [PMID: 35167327 PMCID: PMC8846369 DOI: 10.1289/ehp9307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Communities with lower socioeconomic status and higher prevalence of racial/ethnic minority populations are often more exposed to environmental pollutants. Although studies have shown associations between aircraft noise and property values and various health outcomes, little is known about how aircraft noise exposures are sociodemographically patterned. OBJECTIVE Our aim was to describe characteristics of populations exposed to aviation noise by race/ethnicity, education, and income in the United States. METHODS Aircraft noise contours characterized as day-night average sound level (DNL) were developed for 90 U.S. airports in 2010 for DNL ≥45 dB(A) in 1-dB(A) increments. We compared characteristics of exposed U.S. Census block groups at three thresholds (≥45, ≥55, and ≥65 dB(A)), assigned on the basis of the block group land area being ≥50% within the threshold, vs. unexposed block groups near study airports. Comparisons were made across block group race/ethnicity, education, and income categories within the study areas (n=4,031-74,253). We performed both multinomial and other various multivariable regression approaches, including models controlling for airport and models with random intercepts specifying within-airport effects and adjusting for airport-level means. RESULTS Aggregated across multiple airports, block groups with a higher Hispanic population had higher odds of being exposed to aircraft noise. For example, the multinomial analysis showed that a 10-percentage point increase in a block group's Hispanic population was associated with an increased odds ratio of 39% (95% CI: 25%, 54%) of being exposed to ≥65 dB(A) compared with block groups exposed to <45 dB(A). Block groups with higher proportions of residents with only a high school education had higher odds of being exposed to aircraft noise. Results were robust across multiple regression approaches; however, there was substantial heterogeneity across airports. DISCUSSION These results suggest that across U.S. airports, there is indication of sociodemographic disparities in noise exposures. https://doi.org/10.1289/EHP9307.
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Affiliation(s)
- Matthew C. Simon
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- John A. Volpe National Transportation Systems Center, U.S. Department of Transportation, Cambridge, Massachusetts, USA
| | - Jaime E. Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jonathan I. Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Trang VoPham
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrew Malwitz
- John A. Volpe National Transportation Systems Center, U.S. Department of Transportation, Cambridge, Massachusetts, USA
| | - Daniel Nguyen
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Matthew Bozigar
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - L. Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Peter James
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Francine Laden
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Junenette L. Peters
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
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COVID-19 in Latin America and the Caribbean Region: Symptoms and Morbidities in the Epidemiology of Infection. Curr Opin Pharmacol 2022; 63:102203. [PMID: 35255454 PMCID: PMC8896761 DOI: 10.1016/j.coph.2022.102203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/21/2022] [Accepted: 02/01/2022] [Indexed: 01/06/2023]
Abstract
The COVID-19 pandemic has widespread economic and social effects on Latin America (LA) and the Caribbean (CA). This region, which has a high prevalence of chronic diseases, has been one of the most affected during the pandemic. Multiple symptoms and comorbidities are related to distinct COVID-19 outcomes. However, there has been no explanation as to why different patients present with different arrays of clinical presentations. Studies report that similar to comorbidities, each country in LA and the CA has its own particular health issues. Moreover, economic and social features have yet to be studied in detail to obtain a complete perspective of the disease in the region. Herein, the impact of demographic and economic characteristics in LA and the CA on COVID-19 are presented in combination with symptoms and comorbidities related to the disease as important aspects that can influence management and treatment.
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Orsholits D, Cullati S, Ghisletta P, Aartsen MJ, Oris M, Studer M, Maurer J, Perna L, Gouveia ÉR, Gouveia BR, Marques A, Peralta M, Marconcin P, Kliegel M, Ihle A. How Welfare Regimes Moderate the Associations Between Cognitive Aging, Education, and Occupation. J Gerontol B Psychol Sci Soc Sci 2022; 77:1615-1624. [PMID: 35090001 PMCID: PMC9757157 DOI: 10.1093/geronb/gbac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Previous studies have shown the importance of individual markers of cognitive reserve, such as education and occupation, for cognitive health in old age. However, there has been only little investigation so far on how this relationship varies across contexts. METHODS We analyzed data from the Survey of Health, Ageing, and Retirement in Europe, using second-order latent growth models, to assess the moderating role of welfare regimes on the relationship between education and occupation skill level in explaining overall cognitive functioning and decline in old age. Our sample includes 13 European countries using data from 5 regular waves of the survey (2004-2007 and 2011-2015) and 2 retrospective ones (2008-2009 and 2017). Cognitive functioning was modeled as a latent variable measured by immediate and delayed recall, verbal fluency, and numeracy. RESULTS 74,193 participants were included from the survey. Our analysis showed that the association of education with cognition was weaker overall in Scandinavian countries, but stronger in Southern European countries, relative to Bismarckian ones. However, educational differences in the decline of cognition were more pronounced only in Scandinavian compared to Bismarckian countries. Additionally, higher-skilled occupations in Scandinavian countries had better overall functioning compared to the same occupations in Bismarckian countries, but there was no difference in the decline in cognitive functioning. DISCUSSION Our findings indicate that the associations of cognitive functioning and its decline with individuals' cognitive reserve markers (education and occupational skill level) vary according to welfare regimes, showing the importance of contextual factors in cognitive aging processes.
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Affiliation(s)
- Dan Orsholits
- Address correspondence to: Dan Orsholits, PhD, Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland. E-mail:
| | - Stéphane Cullati
- Population Health Laboratory, Department of Community Health, University of Fribourg, Fribourg, Switzerland,Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Paolo Ghisletta
- Swiss National Centre of Competence in Research LIVES—Overcoming vulnerability: Life Course Perspectives, Lausanne and Geneva, Switzerland,Department of Psychology, University of Geneva, Geneva, Switzerland,UniDistance Suisse, Brig, Switzerland
| | - Marja J Aartsen
- NOVA, Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
| | - Michel Oris
- Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland,Swiss National Centre of Competence in Research LIVES—Overcoming vulnerability: Life Course Perspectives, Lausanne and Geneva, Switzerland
| | - Matthias Studer
- Swiss National Centre of Competence in Research LIVES—Overcoming vulnerability: Life Course Perspectives, Lausanne and Geneva, Switzerland,Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
| | - Jürgen Maurer
- Swiss National Centre of Competence in Research LIVES—Overcoming vulnerability: Life Course Perspectives, Lausanne and Geneva, Switzerland,Department of Economics, University of Lausanne, Lausanne, Switzerland
| | - Laura Perna
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany,Division of Mental Health of Older Adults, Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Élvio R Gouveia
- Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland,Department of Physical Education and Sport, University of Madeira, Funchal, Portugal,LARSyS, Interactive Technologies Institute, Funchal, Portugal
| | - Bruna R Gouveia
- Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland,LARSyS, Interactive Technologies Institute, Funchal, Portugal,Health Administration Institute, Secretary of Health of the Autonomous Region of Madeira, Funchal, Portugal,Saint Joseph of Cluny Higher School of Nursing, Funchal, Portugal
| | - Adilson Marques
- CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal,ISAMB, University of Lisbon, Lisbon, Portugal
| | - Miguel Peralta
- CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal,ISAMB, University of Lisbon, Lisbon, Portugal
| | - Priscila Marconcin
- CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Matthias Kliegel
- Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland,Swiss National Centre of Competence in Research LIVES—Overcoming vulnerability: Life Course Perspectives, Lausanne and Geneva, Switzerland,Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Andreas Ihle
- Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland,Swiss National Centre of Competence in Research LIVES—Overcoming vulnerability: Life Course Perspectives, Lausanne and Geneva, Switzerland,Department of Psychology, University of Geneva, Geneva, Switzerland
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