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Nash KA, Weerahandi H, Yu H, Venkatesh AK, Holaday LW, Herrin J, Lin Z, Horwitz LI, Ross JS, Bernheim SM. Measuring Equity in Readmission as a Distinct Assessment of Hospital Performance. JAMA 2024; 331:111-123. [PMID: 38193960 PMCID: PMC10777266 DOI: 10.1001/jama.2023.24874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/13/2023] [Indexed: 01/10/2024]
Abstract
Importance Equity is an essential domain of health care quality. The Centers for Medicare & Medicaid Services (CMS) developed 2 Disparity Methods that together assess equity in clinical outcomes. Objectives To define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value). Design, Setting, and Participants Cross-sectional study of US hospitals eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019. Main Outcomes and Measures We created a definition of equitable readmissions using CMS Disparity Methods, which evaluate hospitals on 2 methods: outcomes for populations at risk for disparities (across-hospital method); and disparities in care within hospitals' patient populations (within-a-single-hospital method). Exposures Hospital patient demographics; hospital characteristics; and 3 measures of hospital performance-quality, cost, and value (quality relative to cost). Results Of 4638 hospitals, 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% [IQR, 0.2%-8.8%] vs 3.3% [IQR, 0.7%-10.8%], P < .01; race, 7.6% [IQR, 3.2%-16.6%] vs 9.3% [IQR, 4.0%-19.0%], P = .01), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size; P < .01). In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions (odds ratio, 1.57 [95% CI, 1.38-1.77), and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions (odds ratio, 1.14 [95% CI, 1.03-1.26]), and there was no relationship between cost and value, and equity. Conclusion and Relevance A minority of hospitals achieved equitable readmissions. Notably, hospitals with equitable readmissions were characteristically different from those without. For example, hospitals with equitable readmissions served fewer Black patients, reinforcing the role of structural racism in hospital-level inequities. Implementation of an equitable readmission measure must consider unequal distribution of at-risk patients among hospitals.
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Affiliation(s)
- Katherine A. Nash
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Himali Weerahandi
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco
| | - Huihui Yu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Arjun K. Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Louisa W. Holaday
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeph Herrin
- Flying Buttress Associates, Charlottesville, Virginia
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Zhenqiu Lin
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Leora I. Horwitz
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, New York
| | - Joseph S. Ross
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Division of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Deputy Editor, JAMA
| | - Susannah M. Bernheim
- Division of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
- Now with Centers for Medicaid and Medicare Services, Baltimore, Maryland
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Carnahan LR, Hallock C, Soto B, Kasebier L, Dracos E, Martinez E, Newsome J, Mersha T, Pluta D, Henderson V, Khare M. Creating and Implementing a Community Engagement Strategy for the 2022-2027 Illinois Comprehensive Cancer Control Plan Through an Academic-State Public Health Department Partnership. Prev Chronic Dis 2023; 20:E69. [PMID: 37562068 PMCID: PMC10431926 DOI: 10.5888/pcd20.220422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Comprehensive cancer control (CCC) plans are state-level blueprints that identify regional cancer priorities and health equity strategies. Coalitions are encouraged to engage with community members, advocacy groups, people representing multiple sectors, and working partners throughout the development process. We describe the community and legislative engagement strategy developed and implemented during 2020-2022 for the 2022-2027 Illinois CCC plan. METHODS The engagement strategies were grounded in theory and evidence-based tools and resources. It was developed and implemented by coalition members representing the state health department and an academic partner, with feedback from the larger coalition. The strategy included a statewide town hall, 8 focus groups, and raising awareness of the plan among state policy makers. RESULTS A total of 112 people participated in the town hall and focus groups, including 40 (36%) cancer survivors, 31 (28%) cancer caregivers, and 18 (16%) Latino and 26 (23%) African American residents. Fourteen of 53 (26%) focus group participants identified as rural. Participants identified drivers of cancer disparities (eg, lack of a comprehensive health insurance system, discrimination, transportation access) and funding and policy priorities. Illinois House Resolution 0675, the Illinois Cancer Control Plan, was passed in March 2022. CONCLUSION The expertise and voices of community members affected by cancer can be documented and reflected in CCC plans. CCC plans can be brought to the attention of policy makers. Other coalitions working on state plans may consider replicating our strategy. Ultimately, CCC plans should reflect health equity principles and prioritize eliminating cancer disparities.
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Affiliation(s)
- Leslie R Carnahan
- University of Illinois Cancer Center, 818 S Wolcott Ave (MC709), Chicago, IL 60612
- School of Public Health, University of Illinois Chicago, Chicago, Illinois
| | - Colleen Hallock
- School of Public Health, University of Illinois Chicago, Chicago, Illinois
| | - Brenda Soto
- University of Illinois Cancer Center, Chicago, Illinois
- School of Public Health, University of Illinois Chicago, Chicago, Illinois
| | - Linda Kasebier
- Illinois Department of Public Health, Springfield, Illinois
| | - Elise Dracos
- Illinois Department of Public Health, Springfield, Illinois
| | | | - Jennifer Newsome
- Foundation for the National Institutes of Health, North Bethesda, Maryland
| | - Tigist Mersha
- University of Illinois Cancer Center, Chicago, Illinois
- School of Public Health, University of Illinois Chicago, Chicago, Illinois
| | - David Pluta
- Department of Family and Community Medicine, University of Illinois College of Medicine Rockford, Rockford, Illinois
| | - Vida Henderson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Manorama Khare
- Department of Family and Community Medicine, University of Illinois College of Medicine Rockford, Rockford, Illinois
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Abstract
This Medical News article is an interview by JAMA Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, about maternal deaths and disparities in the US.
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Mangione CM, Nicholson W, Davidson KW. Addressing Gaps in Research to Reduce Disparities and Advance Health Equity: The USPSTF Incorporation of the NASEM Taxonomy on Closing Evidence Gaps in Clinical Prevention. JAMA 2022; 328:1803-1804. [PMID: 36251304 DOI: 10.1001/jama.2022.19154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This Viewpoint reviews the evidence gaps reported to Congress by the US Preventive Services Task Force (USPSTF) in 2021 on improving health inequities in prevention and uses the 3 taxonomies provided by National Academies of Sciences, Engineering, and Medicine (NASEM) to classify these gaps.
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Affiliation(s)
- Carol M Mangione
- University of California, Los Angeles
- Chair, US Preventive Services Task Force
| | - Wanda Nicholson
- University of North Carolina, Chapel Hill
- Vice chair, US Preventive Services Task Force
| | - Karina W Davidson
- Feinstein Institutes for Medical Research, Northwell Health, New York, New York
- Immediate past chair, US Preventive Services Task Force
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Lamprea-Montealegre JA, Madden E, Tummalapalli SL, Peralta C, Neilands TB, Garcia PK, Muiru A, Karliner L, Shlipak MG, Estrella MM. Association of Race and Ethnicity With Prescription of SGLT2 Inhibitors and GLP1 Receptor Agonists Among Patients With Type 2 Diabetes in the Veterans Health Administration System. JAMA 2022; 328:861-871. [PMID: 36066519 PMCID: PMC9449794 DOI: 10.1001/jama.2022.13885] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Novel therapies for type 2 diabetes can reduce the risk of cardiovascular disease and chronic kidney disease progression. The equitability of these agents' prescription across racial and ethnic groups has not been well-evaluated. OBJECTIVE To investigate differences in the prescription of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) among adult patients with type 2 diabetes by racial and ethnic groups. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional analysis of data from the US Veterans Health Administration's Corporate Data Warehouse. The sample included adult patients with type 2 diabetes and at least 2 primary care clinic visits from January 1, 2019, to December 31, 2020. EXPOSURES Self-identified race and self-identified ethnicity. MAIN OUTCOMES AND MEASURES The primary outcomes were prevalent SGLT2i or GLP-1 RA prescription, defined as any active prescription during the study period. RESULTS Among 1 197 914 patients (mean age, 68 years; 96% men; 1% American Indian or Alaska Native, 2% Asian, Native Hawaiian, or Other Pacific Islander, 20% Black or African American, 71% White, and 7% of Hispanic or Latino ethnicity), 10.7% and 7.7% were prescribed an SGLT2i or a GLP-1 RA, respectively. Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 8.4% among American Indian or Alaska Native patients; 11.8% and 8% among Asian, Native Hawaiian, or Other Pacific Islander patients; 8.8% and 6.1% among Black or African American patients; and 11.3% and 8.2% among White patients, respectively. Prescription rates for SGLT2i and GLP-1 RA, respectively, were 11% and 7.1% among Hispanic or Latino patients and 10.7% and 7.8% among non-Hispanic or Latino patients. After accounting for patient- and system-level factors, all racial groups had significantly lower odds of SGLT2i and GLP-1 RA prescription compared with White patients. Black patients had the lowest odds of prescription compared with White patients (adjusted odds ratio, 0.72 [95% CI, 0.71-0.74] for SGLT2i and 0.64 [95% CI, 0.63-0.66] for GLP-1 RA). Patients of Hispanic or Latino ethnicity had significantly lower odds of prescription (0.90 [95% CI, 0.88-0.93] for SGLT2i and 0.88 [95% CI, 0.85-0.91] for GLP-1 RA) compared with non-Hispanic or Latino patients. CONCLUSIONS AND RELEVANCE Among patients with type 2 diabetes in the Veterans Health Administration system during 2019 and 2020, prescription rates of SGLT2i and GLP-1 RA medications were low, and individuals of several different racial groups and those of Hispanic ethnicity had statistically significantly lower odds of receiving prescriptions for these medications compared with individuals of White race and non-Hispanic ethnicity. Further research is needed to understand the mechanisms underlying these differences in rates of prescribing and the potential relationship with differences in clinical outcomes.
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Affiliation(s)
- Julio A. Lamprea-Montealegre
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco, California
| | - Erin Madden
- Kidney Health Research Collaborative, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco, California
| | - Sri Lekha Tummalapalli
- Kidney Health Research Collaborative, University of California, San Francisco
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Carmen Peralta
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco, California
- Cricket Health Inc, San Francisco, California
| | - Torsten B. Neilands
- Department of Medicine, University of California, San Francisco
- San Francisco Center for Aging in Diverse Communities and the Multiethnic Health Equity Research Center, University of California, San Francisco
| | - Paola K. Garcia
- Division of Nephrology, Department of Medicine, Pontificia Universidad Javeriana School of Medicine, Bogotá, Colombia
| | - Anthony Muiru
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
| | - Leah Karliner
- Department of Medicine, University of California, San Francisco
- San Francisco Center for Aging in Diverse Communities and the Multiethnic Health Equity Research Center, University of California, San Francisco
| | - Michael G. Shlipak
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco, California
| | - Michelle M. Estrella
- Department of Medicine, University of California, San Francisco
- Kidney Health Research Collaborative, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco, California
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Affiliation(s)
- Kathryn M McDonald
- Center for Diagnostic Excellence, Armstrong Institute for Patient Safety and Quality, and School of Nursing, Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Bour BK, Sosu EK, Hasford F, Gyekye PK, Achel DG, Faanu A, Amoako JK, Pitcher RD. National inventory of authorized diagnostic imaging equipment in Ghana: data as of September 2020. Pan Afr Med J 2022; 41:301. [PMID: 35855027 PMCID: PMC9250666 DOI: 10.11604/pamj.2022.41.301.30635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/03/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Bright Kwadwo Bour
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
| | - Edem Kwabla Sosu
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Accra, Ghana
| | - Francis Hasford
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Accra, Ghana
- Corresponding author: Francis Hasford, School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana.
| | - Prince Kwabena Gyekye
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiological and Non-Ionizing Radiation Directorate, Nuclear Regulatory Authority, Accra, Ghana
| | - Daniel Gyingiri Achel
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Accra, Ghana
| | - Augustine Faanu
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiological and Non-Ionizing Radiation Directorate, Nuclear Regulatory Authority, Accra, Ghana
| | - Joseph Kwabena Amoako
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiation Protection Institute, Ghana Atomic Energy Commission, Accra, Ghana
| | - Richard Denys Pitcher
- Division of Radiodiagnosis, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Daniel R, Jimenez J, Pall H. Health Equity and Social Determinants of Health in Pediatric Gastroenterology. Pediatr Clin North Am 2021; 68:1147-1155. [PMID: 34736581 DOI: 10.1016/j.pcl.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Social determinants of health (SDH) as outlined by Healthy People 2020 encompasses 5 key domains: economic, education, social and community context, health and health care, and neighborhood and built environment. This article emphasizes pediatric populations and some of the existing SDH and health care disparities seen in pediatric gastroenterology. We specifically review inflammatory bowel disease, endoscopy, bariatric surgery, and liver transplantation. We also examine the burgeoning role of telehealth that has become commonplace since the coronavirus disease 2019 era.
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Affiliation(s)
- Rhea Daniel
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, McGovern Medical School, University of Texas Health Science Center and Children's Memorial Hermann Hospital, Houston, TX 70007, USA
| | - Jennifer Jimenez
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA; Department of Pediatrics, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Harpreet Pall
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA; Department of Pediatrics, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Neptune, NJ, USA.
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O'Connor MI. Equity360: Gender, Race, and Ethnicity: Our "Best Hospitals" Rank Poorly in Health Equity. Clin Orthop Relat Res 2021; 479:2366-2368. [PMID: 34559694 PMCID: PMC8509955 DOI: 10.1097/corr.0000000000001990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 01/31/2023]
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Scaccia JP. Examining the concept of equity in community psychology with natural language processing. J Community Psychol 2021; 49:1718-1731. [PMID: 34004017 DOI: 10.1002/jcop.22603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/31/2021] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
Large amounts of text-based data, like study abstracts, often go unanalyzed because the task is laborious. Natural language processing (NLP) uses computer-based algorithms not traditionally implemented in community psychology to effectively and efficiently process text. These methods include examining the frequency of words and phrases, the clustering of topics, and the interrelationships of words. This article applied NLP to explore the concept of equity in community psychology. The COVID-19 crisis has made pre-existing health equity gaps even more salient. Community psychology has a specific interest in working with organizations, systems, and communities to address social determinants that perpetuate inequities by refocusing interventions around achieving health and wellness for all. This article examines how community psychology has discussed equity thus far to identify strengths and gaps for future research and practice. The results showed the prominence of community-based participatory research and the diversity of settings researchers work in. However, the total number of abstracts with equity concepts was lower than expected, which suggests there is a need for a continued focus on equity.
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Han HR, Miller HN, Nkimbeng M, Budhathoki C, Mikhael T, Rivers E, Gray J, Trimble K, Chow S, Wilson P. Trauma informed interventions: A systematic review. PLoS One 2021; 16:e0252747. [PMID: 34157025 PMCID: PMC8219147 DOI: 10.1371/journal.pone.0252747] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 05/23/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes. METHODS We performed database searches- PubMed, Embase, CINAHL, SCOPUS and PsycINFO-to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria. RESULTS More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). CONCLUSIONS There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.
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Affiliation(s)
- Hae-Ra Han
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hailey N. Miller
- School of Nursing, Duke University, Durham, North Carolina, United States of America
| | - Manka Nkimbeng
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Chakra Budhathoki
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Tanya Mikhael
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emerald Rivers
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ja’Lynn Gray
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kristen Trimble
- School of Nursing, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Sotera Chow
- Medstar Good Samaritan Hospital, Baltimore, Maryland, United States of America
| | - Patty Wilson
- School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America
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Allan S, Adetifa IMO, Abbas K. Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya. BMC Infect Dis 2021; 21:553. [PMID: 34112096 PMCID: PMC8192222 DOI: 10.1186/s12879-021-06271-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The global Immunisation Agenda 2030 highlights coverage and equity as a strategic priority goal to reach high equitable immunisation coverage at national levels and in all districts. We estimated inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics among children aged 12-23 months in Kenya. METHODS We analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3943 children aged 12-23 months from the 2014 Kenya Demographic and Health Survey. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics, and estimated inequities in full immunisation coverage using bivariate and multivariate logistic regression. RESULTS Immunisation coverage ranged from 82% [81-84] for the third dose of polio to 97.4% [96.7-98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66-71] in 2014. After controlling for other background characteristics through multivariate logistic regression, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings had 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43-57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children. CONCLUSIONS Children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order are associated with lower rates of full immunisation. Targeted programmes to reach under-immunised children in these subpopulations will lower the inequities in childhood immunisation coverage in Kenya.
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Affiliation(s)
- Simon Allan
- Gavi, the Vaccine Alliance, Geneva, Switzerland
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ifedayo M. O. Adetifa
- London School of Hygiene and Tropical Medicine, London, UK
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kaja Abbas
- London School of Hygiene and Tropical Medicine, London, UK
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Marron JM, Charlot M, Gaddy J, Rosenberg AR. The Ethical Imperative of Equity in Oncology: Lessons Learned From 2020 and a Path Forward. Am Soc Clin Oncol Educ Book 2021; 41:e13-e19. [PMID: 34061560 DOI: 10.1200/edbk_100029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic and the simultaneous increased focus on structural racism and racial/ethnic disparities across the United States have shed light on glaring inequities in U.S. health care, both in oncology and more generally. In this article, we describe how, through the lens of fundamental ethical principles, an ethical imperative exists for the oncology community to overcome these inequities in cancer care, research, and the oncology workforce. We first explain why this is an ethical imperative, centering the discussion on lessons learned during 2020. We continue by describing ongoing equity-focused efforts by ASCO and other related professional medical organizations. We end with a call to action-all members of the oncology community have an ethical responsibility to take steps to address inequities in their clinical and academic work-and with guidance to practicing oncologists looking to optimize equity in their research and clinical practice.
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Affiliation(s)
- Jonathan M Marron
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, MA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
- Center for Bioethics, Harvard Medical School, Boston, MA
| | - Marjory Charlot
- Division of Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Jacquelyne Gaddy
- Division of Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Abby R Rosenberg
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington School of Medicine, Seattle, WA
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
- Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA
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14
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Rabin TL, Mayanja-Kizza H, Barry M. Global Health Education in the Time of COVID-19: An Opportunity to Restructure Relationships and Address Supremacy. Acad Med 2021; 96:795-797. [PMID: 33394665 PMCID: PMC8140628 DOI: 10.1097/acm.0000000000003911] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Global health and its predecessors, tropical medicine and international health, have historically been driven by the agendas of institutions in high-income countries (HICs), with power dynamics that have disadvantaged partner institutions in low- and middle-income countries (LMICs). Since the 2000s, however, the academic global health community has been moving toward a focus on health equity and reexamining the dynamics of global health education (GHE) partnerships. Whereas GHE partnerships have largely focused on providing opportunities for learners from HIC institutions, LMIC institutions are now seeking more equitable experiences for their trainees. Additionally, lessons from the COVID-19 pandemic underscore already important lessons about the value of bidirectional educational exchange, as regions gain new insights from one another regarding strategies to impact health outcomes. Interruptions in experiential GHE programs due to COVID-19-related travel restrictions provide an opportunity to reflect on existing GHE systems, to consider the opportunities and dynamics of these partnerships, and to redesign these systems for the equitable benefit of the various partners. In this commentary, the authors offer recommendations for beginning this process of change, with an emphasis on restructuring GHE relationships and addressing supremacist attitudes at both the systemic and individual levels.
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Affiliation(s)
- Tracy L. Rabin
- T.L. Rabin is associate professor of medicine and director, Office of Global Health, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut; ORCID: https://orcid.org/0000-0002-4829-9051
| | - Harriet Mayanja-Kizza
- H. Mayanja-Kizza is professor of medicine, Department of Internal Medicine, Makerere School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; ORCID: https://orcid.org/0000-0002-9297-6208
| | - Michele Barry
- M. Barry is Shenson professor of medicine, Department of Medicine, Stanford University School of Medicine, and director, Center for Innovation in Global Health, Stanford University, Stanford, California; ORCID: https://orcid.org/0000-0002-1539-8109
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15
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Lawrence DS, Leeme T, Mosepele M, Harrison TS, Seeley J, Jarvis JN. Equity in clinical trials for HIV-associated cryptococcal meningitis: A systematic review of global representation and inclusion of patients and researchers. PLoS Negl Trop Dis 2021; 15:e0009376. [PMID: 34043617 PMCID: PMC8158913 DOI: 10.1371/journal.pntd.0009376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background It is essential that clinical trial participants are representative of the population under investigation. Using HIV-associated cryptococcal meningitis (CM) as a case study, we conducted a systematic review of clinical trials to determine how inclusive and representative they were both in terms of the affected population and the involvement of local investigators. Methods We searched Medline, EMBASE, Cochrane, Africa-Wide, CINAHL Plus, and Web of Science. Data were extracted for 5 domains: study location and design, screening, participants, researchers, and funders. Data were summarised and compared over 3 time periods: pre-antiretroviral therapy (ART) (pre-2000), early ART (2000 to 2009), and established ART (post-2010) using chi-squared and chi-squared for trend. Comparisons were made with global disease burden estimates and a composite reference derived from observational studies. Results Thirty-nine trials published between 1990 and 2019 were included. Earlier studies were predominantly conducted in high-income countries (HICs) and recent studies in low- and middle-income countries (LMICs). Most recent studies occurred in high CM incidence countries, but some highly affected countries have not hosted trials. The sex and ART status of participants matched those of the general CM population. Patients with reduced consciousness and those suffering a CM relapse were underrepresented. Authorship had poor representation of women (29% of all authors), particularly as first and final authors. Compared to trials conducted in HICs, trials conducted in LMICs were more likely to include female authors (32% versus 20% p = 0.014) but less likely to have authors resident in (75% versus 100%, p < 0.001) or nationals (61% versus 93%, p < 0.001) of the trial location. Conclusions There has been a marked shift in CM trials over the course of the HIV epidemic. Trials are primarily performed in locations and populations that reflect the burden of disease, but severe and relapse cases are underrepresented. Most CM trials now take place in LMICs, but the research is primarily funded and led by individuals and institutions from HICs. It is essential that clinical trial participants are representative of the population under investigation. Similarly, research must meaningfully include researchers who are from and/or based in the location where the study is being conducted, both to ensure that the research matches the local need but also to promote equity in research. Using clinical trials in HIV-associated cryptococcal meningitis as a case study, we conducted a systematic review to determine how inclusive and representative trials have been across the course of the HIV epidemic. We identified 39 studies. There was a geographical shift with trials moving from the USA to Africa and Asia over time. We found that recent trials were conducted in areas heavily affected by cryptococcal meningitis, but we did identify geographical areas and patient groups that have been underrepresented. We also found inequality within authorship that was skewed towards male researchers from high-income countries. These findings outline areas for our discipline to focus on. We can also use this study as a benchmark from which to monitor our progress over time. This is a broad methodology that could be adopted and adapted by other research groups.
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Affiliation(s)
- David S. Lawrence
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Tshepo Leeme
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mosepele Mosepele
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- University of Botswana, Gaborone, Botswana
| | - Thomas S. Harrison
- Institute for Infection and Immunity, St George’s University of London, and St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
- MRC Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Janet Seeley
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Joseph N. Jarvis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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16
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Sayani A, Vahabi M, O’Brien MA, Liu G, Hwang S, Selby P, Nicholson E, Giuliani M, Eng L, Lofters A. Advancing health equity in cancer care: The lived experiences of poverty and access to lung cancer screening. PLoS One 2021; 16:e0251264. [PMID: 33956861 PMCID: PMC8101716 DOI: 10.1371/journal.pone.0251264] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
Background Individuals living with low income are more likely to smoke, have a higher risk of lung cancer, and are less likely to participate in preventative healthcare (i.e., low-dose computed tomography (LDCT) for lung cancer screening), leading to equity concerns. To inform the delivery of an organized pilot lung cancer screening program in Ontario, we sought to contextualize the lived experiences of poverty and the choice to participate in lung cancer screening. Methods At three Toronto academic primary-care clinics, high-risk screen-eligible patients who chose or declined LDCT screening were consented; sociodemographic data was collected. Qualitative interviews were conducted. Theoretical thematic analysis was used to organize, describe and interpret the data using the morphogenetic approach as a guiding theoretical lens. Results Eight participants chose to undergo screening; ten did not. From interviews, we identified three themes: Pathways of disadvantage (social trajectories of events that influence lung-cancer risk and health-seeking behaviour), lung-cancer risk and early detection (upstream factors that shape smoking behaviour and lung-cancer screening choices), and safe spaces of care (care that is free of bias, conflict, criticism, or potentially threatening actions, ideas or conversations). We illuminate how ‘choice’ is contextual to the availability of material resources such as income and housing, and how ‘choice’ is influenced by having access to spaces of care that are free of judgement and personal bias. Conclusion Underserved populations will require multiprong interventions that work at the individual, system and structural level to reduce inequities in lung-cancer risk and access to healthcare services such as cancer screening.
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Affiliation(s)
- Ambreen Sayani
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- * E-mail:
| | - Mandana Vahabi
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Mary Ann O’Brien
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Stephen Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Campbell Family Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Erika Nicholson
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | | | - Lawson Eng
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Aisha Lofters
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
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17
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Gamble CR, Huang Y, Wright JD, Hou JY. Precision medicine testing in ovarian cancer: The growing inequity between patients with commercial vs medicaid insurance. Gynecol Oncol 2021; 162:18-23. [PMID: 33958212 DOI: 10.1016/j.ygyno.2021.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Precision medicine technologies have significant impact in the care of patients with ovarian cancer. Compared to affluent patients, socioeconomically vulnerable patients are less likely to have access to this testing. There is little data that demonstrate this inequity over time. METHODS We used the IBM Truven Health MarketScan Research Database to identify patients in the United States who underwent surgery for ovarian cancer between 2011 and 2017. The presence of claims for precision medicine testing within six months of surgery was assessed for each patient. Precision medicine testing included both molecular genetic testing (BRCA limited or full sequencing, somatic and germline testing) as well as ancillary pathology tests (immunohistochemistry, microsatellite instability). Demographic data was extracted. RESULTS We identified 27,181 patients who met eligibility. Of these, 88.6% had commercial insurance, and 11.4% had Medicaid. While the proportion of patients who underwent precision medicine testing increased over time for both cohorts (47.0% to 66.6% for commercially insured, 41.4% to 57.6% for Medicaid insured, p < 0.0001), the inequity in testing rates widened (5.6% disparity to 9.0%, p < 0.0001). This was driven by growing inequity in germline and somatic genetic testing (7.6% disparity to 21.3%, p < 0.0001). CONCLUSIONS There is widening inequity in precision medicine testing rates between commercially insured and Medicaid insured poate patients with ovarian cancer.
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Affiliation(s)
- Charlotte R Gamble
- Columbia University College of Physicians and Surgeons, United States of America; New York Presbyterian Hospital, United States of America.
| | - Yongmei Huang
- Columbia University College of Physicians and Surgeons, United States of America; Joseph L. Mailman School of Public Health, Columbia University, United States of America
| | - Jason D Wright
- Columbia University College of Physicians and Surgeons, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - June Y Hou
- Columbia University College of Physicians and Surgeons, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
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18
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Sweeney S, Capeding TPJ, Eggo R, Huda M, Jit M, Mudzengi D, Naylor NR, Procter S, Quaife M, Serebryakova L, Torres-Rueda S, Vargas V, Vassall A. Exploring equity in health and poverty impacts of control measures for SARS-CoV-2 in six countries. BMJ Glob Health 2021; 6:e005521. [PMID: 34039588 PMCID: PMC8159665 DOI: 10.1136/bmjgh-2021-005521] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/30/2021] [Accepted: 04/29/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Policy makers need to be rapidly informed about the potential equity consequences of different COVID-19 strategies, alongside their broader health and economic impacts. While there are complex models to inform both potential health and macro-economic impact, there are few tools available to rapidly assess potential equity impacts of interventions. METHODS We created an economic model to simulate the impact of lockdown measures in Pakistan, Georgia, Chile, UK, the Philippines and South Africa. We consider impact of lockdown in terms of ability to socially distance, and income loss during lockdown, and tested the impact of assumptions on social protection coverage in a scenario analysis. RESULTS In all examined countries, socioeconomic status (SES) quintiles 1-3 were disproportionately more likely to experience income loss (70% of people) and inability to socially distance (68% of people) than higher SES quintiles. Improving social protection increased the percentage of the workforce able to socially distance from 48% (33%-60%) to 66% (44%-71%). We estimate the cost of this social protection would be equivalent to an average of 0.6% gross domestic product (0.1% Pakistan-1.1% Chile). CONCLUSIONS We illustrate the potential for using publicly available data to rapidly assess the equity implications of social protection and non-pharmaceutical intervention policy. Social protection is likely to mitigate inequitable health and economic impacts of lockdown. Although social protection is usually targeted to the poorest, middle quintiles will likely also need support as they are most likely to suffer income losses and are disproportionately more exposed.
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Affiliation(s)
- Sedona Sweeney
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Rosalind Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- University of Hong Kong School of Public Health, Hong Kong, China
| | - Don Mudzengi
- The Aurum Institute for Health Research, Johannesburg, South Africa
| | - Nichola R Naylor
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Procter
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew Quaife
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Lela Serebryakova
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Sergio Torres-Rueda
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Veronica Vargas
- Facultad de Economía y Negocios, Universidad Alberto Hurtado, Santiago, Chile
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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19
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Affiliation(s)
- Erika G Martin
- Rockefeller College of Public Affairs and Policy (Dr Martin), Center for Collaborative HIV Research in Practice and Policy (Drs Martin, Birkhead, and Holtgrave), and School of Public Health (Drs Birkhead and Holtgrave), University at Albany, Albany, New York
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20
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Newman CE, Smith AKJ, Duck-Chong E, Vivienne S, Davies C, Robinson KH, Aggleton P. Waiting to be seen: social perspectives on trans health. Health Sociol Rev 2021; 30:1-8. [PMID: 33622203 DOI: 10.1080/14461242.2020.1868900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Son Vivienne
- Thorne Harbour Health, Melbourne, Australia
- Transgender Victoria, Melbourne, Australia
| | - Cristyn Davies
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kerry H Robinson
- School of Social Sciences, Western Sydney University, Sydney, Australia
| | - Peter Aggleton
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- School of Sociology, The Australian National University, Canberra, Australia
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21
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McCarthy ML, Zheng Z, Wilder ME, Elmi A, Kulie P, Johnson S, Zeger SL. Latent Class Analysis to Represent Social Determinant of Health Risk Groups in the Medicaid Cohort of the District of Columbia. Med Care 2021; 59:251-258. [PMID: 33273298 PMCID: PMC7878329 DOI: 10.1097/mlr.0000000000001468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop distinct social risk profiles based on social determinants of health (SDH) information and to determine whether these social risk groups varied in terms of health, health care utilization, and costs. METHODS We prospectively enrolled 8943 beneficiaries insured by the District of Columbia Medicaid program between September 2017 and December 2018. Participants completed a SDH survey and we obtained their Medicaid claims data for a 2-year period before study enrollment. We used latent class analysis (LCA) to identify distinct social risk profiles based on their SDH responses. We assessed the relationship among different SDH as well as the relationship among the social risk classes and health, health care use and costs. RESULTS The majority of SDH were moderately to strongly correlated with one another. LCA yielded 4 distinct social risk groups. Group 1 reported the least social risks with the most employed. Group 2 was distinguished by financial strain and housing instability with fewer employed. Group 3 were mostly unemployed with limited car and internet access. Group 4 had the most social risks and most unemployed. The social risk groups demonstrated meaningful differences in health, acute care utilization, and health care costs with group 1 having the best health outcomes and group 4 the worst (P<0.05). CONCLUSIONS LCA is a practical method of aggregating correlated SDH data into a finite number of distinct social risk groups. Understanding the constellation of social challenges that patients face is critical when attempting to address their social needs and improve health outcomes.
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Affiliation(s)
- Melissa L. McCarthy
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Zhaonian Zheng
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Marcee E. Wilder
- Department of Emergency Medicine, George Washington University, Medical Faculty Associates, Washington, District of Columbia
| | - Angelo Elmi
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Paige Kulie
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Samuel Johnson
- Tulane University School of Medicine, Tulane University, New Orleans, LA
| | - Scott L. Zeger
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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22
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Mansour A, Sirichotiratana N, Viwatwongkasem C, Khan M, Srithamrongsawat S. District division administrative disaggregation data framework for monitoring leaving no one behind in the National Health Insurance Fund of Sudan: achieving sustainable development goals in 2030. Int J Equity Health 2021; 20:5. [PMID: 33407542 PMCID: PMC7789368 DOI: 10.1186/s12939-020-01338-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 11/30/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim of this study is to monitor the concept of 'leaving no one behind' in the Sustainable Development Goals (SDGs) to track the implications of the mobilization of health care resources by the National Health Insurance Fund (NHIF) of Sudan. METHODS A cross-sectional study was used to monitor 'leaving no one behind' in NHIF by analyzing the secondary data of the information system for the year 2016. The study categorized the catchment areas of health care centers (HCCS) according to district administrative divisions, which are neighborhood, subdistrict, district, and zero. The District Division Administrative Disaggregation Data (DDADD) framework was developed and investigated with the use of descriptive statistics, maps of Sudan, the Mann-Whitney test, the Kruskal-Wallis test and health equity catchment indicators. SPSS ver. 18 and EndNote X8 were also used. RESULTS The findings show that the NHIF has mobilized HCCs according to coverage of the insured population. This mobilization protected the insured poor in high-coverage insured population districts and left those living in very low-coverage districts behind. The Mann-Whitney test presented a significant median difference in the utilization rate between catchment areas (P value < 0.001). The results showed that the utilization rate of the insured poor who accessed health care centers by neighborhood was higher than that of the insured poor who accessed by more than neighborhood in each state. The Kruskal-Wallis test of the cost of health care services per capita in each catchment area showed a difference (P value < 0.001) in the median between neighborhoods. The cost of health care services in low-coverage insured population districts was higher than that in high-coverage insured population districts. CONCLUSION The DDADD framework identified the inequitable distribution of health care services in low-density population districts leaves insured poor behind. Policymakers should restructure the equation of health insurance schemes based on equity and probability of illness, to distribute health care services according to needs and equity, and to remobilize resources towards districts left behind.
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Affiliation(s)
- Ashraf Mansour
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
| | - Nithat Sirichotiratana
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok, 10400 Thailand
| | - Chukiat Viwatwongkasem
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Mahmud Khan
- Arnold School of Public Health, University of South Carolina, Columbia, USA
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23
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Glover RE, van Schalkwyk MCI, Akl EA, Kristjannson E, Lotfi T, Petkovic J, Petticrew MP, Pottie K, Tugwell P, Welch V. A framework for identifying and mitigating the equity harms of COVID-19 policy interventions. J Clin Epidemiol 2020; 128:35-48. [PMID: 32526461 PMCID: PMC7280094 DOI: 10.1016/j.jclinepi.2020.06.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/29/2020] [Accepted: 06/02/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a global pandemic. Governments have implemented combinations of "lockdown" measures of various stringencies, including school and workplace closures, cancellations of public events, and restrictions on internal and external movements. These policy interventions are an attempt to shield high-risk individuals and to prevent overwhelming countries' healthcare systems, or, colloquially, "flatten the curve." However, these policy interventions may come with physical and psychological health harms, group and social harms, and opportunity costs. These policies may particularly affect vulnerable populations and not only exacerbate pre-existing inequities but also generate new ones. METHODS We developed a conceptual framework to identify and categorize adverse effects of COVID-19 lockdown measures. We based our framework on Lorenc and Oliver's framework for the adverse effects of public health interventions and the PROGRESS-Plus equity framework. To test its application, we purposively sampled COVID-19 policy examples from around the world and evaluated them for the potential physical, psychological, and social harms, as well as opportunity costs, in each of the PROGRESS-Plus equity domains: Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, and disability). RESULTS We found examples of inequitably distributed adverse effects for each COVID-19 lockdown policy example, stratified by a low- or middle-income country and high-income country, in every PROGRESS-Plus equity domain. We identified the known policy interventions intended to mitigate some of these adverse effects. The same harms (anxiety, depression, food insecurity, loneliness, stigma, violence) appear to be repeated across many groups and are exacerbated by several COVID-19 policy interventions. CONCLUSION Our conceptual framework highlights the fact that COVID-19 policy interventions can generate or exacerbate interactive and multiplicative equity harms. Applying this framework can help in three ways: (1) identifying the areas where a policy intervention may generate inequitable adverse effects; (2) mitigating the policy and practice interventions by facilitating the systematic examination of relevant evidence; and (3) planning for lifting COVID-19 lockdowns and policy interventions around the world.
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Affiliation(s)
- Rebecca E Glover
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH.
| | - May C I van Schalkwyk
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Elie A Akl
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Elizabeth Kristjannson
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario L8S 4L8, Canada
| | - Tamara Lotfi
- Department of Health Research Methods, Evidence & Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | | | - Mark P Petticrew
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH
| | - Kevin Pottie
- Department of Family Medicine, Bruyere Research Institute, University of Ottawa, Ottawa, Ontario L8S 4L8, Canada
| | - Peter Tugwell
- Department of Medicine, Bruyere Research Institute, University of Ottawa, Ottawa, Ontario L8S 4L8, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario L8S 4L8, Canada
| | - Vivian Welch
- Bruyere Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario L8S 4L8, Canada
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24
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Shibre G. Social inequality in infant mortality in Angola: Evidence from a population based study. PLoS One 2020; 15:e0241049. [PMID: 33091077 PMCID: PMC7580929 DOI: 10.1371/journal.pone.0241049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Within country inequality in infant mortality poses a big challenge for countries moving towards the internationally agreed upon targets on child mortality by 2030. There is a lack of high-quality evidence on infant mortality measured through different dimensions of social inequality in Angola. Thus, this paper was carried out to address the knowledge gap by conducting in-depth examination of infant mortality rate (IMR) inequality among population subgroups to provide more nuanced evidence to help end IMR disparity in the country. METHODS The World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) was used to analyze IMR inequality. HEAT is a software application that facilitates examination of disparities in reproductive, maternal, neonatal and child health indicators using the WHO Health Equity Monitor (HEM) database. Inequality of IMR was analyzed through disaggregation by five equity stratifiers: education, wealth, gender, subnational region and residence. These were analyzed through three inequality measures: Population Attributable Risk, Ratio and Slope Index of Inequality. A 95% confidence Interval (CI) was built around point estimates to determine statistical significance. RESULTS A notable disadvantage was found for children born to poor (Population Attributable Risk (PAR): -27.0; -28.4, -26.0) and uneducated (PAR: -17.0; -17.9, -16.0), women who live in rural areas (PAR: -7.3;-7.8, -6.7) and those residing in certain regions of the country (PAR: -43.0; 45.3, -4). Male infants had a higher risk of death than female infants (PAR: -6.8;-7.5, -6.2). The subnational regional variation of IMR had been the most evident when compared with the disparities in the other equity stratifers. CONCLUSIONS Policymakers and planners need to address the disproportionately higher clustering of IMR among infants born to disadvantaged subpopulations through interventions that benefit such subgroups.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
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Frizelle F, Brennan M. Could comprehensive cancer centres improve cancer outcomes and equity in New Zealand? N Z Med J 2020; 133:9-14. [PMID: 32994611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Frank Frizelle
- Department of Surgery, Christchurch Hospital, Christchurch
| | - Murray Brennan
- Chairman Emeritus of Surgery, Memorial Sloan Kettering Cancer Center, New York
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Alhassan JAK, Wariri O, Onuwabuchi E, Mark G, Kwarshak Y, Dase E. Access to skilled attendant at birth and the coverage of the third dose of diphtheria-tetanus-pertussis vaccine across 14 West African countries - an equity analysis. Int J Equity Health 2020; 19:78. [PMID: 32487158 PMCID: PMC7268225 DOI: 10.1186/s12939-020-01204-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Universal Health Coverage (UHC) remains a critical public health goal that continues to elude many countries of the global south. As countries strive for its attainment, it is important to track progress in various subregions of the world to understand current levels and mechanisms of progress for shared learning. Our aim was to compare multidimensional equity gaps in access to skilled attendant at birth (SAB) and coverage of the third dose of Diphtheria-Tetanus-Pertussis (DTP3) across 14 West African countries. METHODS The study was a cross sectional comparative analysis that used publicly available, nationally representative health surveys. We extracted data from Demographic and Health Surveys, and Multiple Indicator Cluster Surveys conducted between 2010 and 2017 in Benin, Burkina Faso, Cote d' Ivoire, The Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo. The World Health Organization's Health Equity Assessment Toolkit (HEAT Plus) software was used to evaluate current levels of intra-country equity in access to SAB and DTP3 coverage across four equity dimensions (maternal education, location of residence, region within a country and family wealth status). RESULTS There was a general trend of higher levels of coverage for DTP3 compared to access to SAB in the subregion. Across the various dimensions of equity, more gaps appear to have been closed in the subregion for DTP3 compared to SAB. The analysis revealed that countries such as Sierra Leone, Liberia and Ghana have made substantial progress towards equitable access for the two outcomes compared to others such as Nigeria, Niger and Guinea. CONCLUSION In the race towards UHC, equity should remain a priority and comparative progress should be consistently tracked to enable the sharing of lessons. The West African subregion requires adequate government financing and continued commitment to move toward UHC and close health equity gaps.
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Affiliation(s)
- Jacob Albin Korem Alhassan
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
- African Population and Health Policy Initiative, Gombe, Nigeria
| | - Oghenebrume Wariri
- African Population and Health Policy Initiative, Gombe, Nigeria
- Medical Research Council (MRC) Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Egwu Onuwabuchi
- African Population and Health Policy Initiative, Gombe, Nigeria
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Gombe, Nigeria
| | - Godwin Mark
- Department of One Health, The University of Edinburgh, Royal (Dick) School of Veterinary Studies, Edinburgh, Scotland UK
| | - Yakubu Kwarshak
- Department of Global Health and Management, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland UK
| | - Eseoghene Dase
- African Population and Health Policy Initiative, Gombe, Nigeria
- Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Gombe, Nigeria
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O'Donovan J, Namanda AS, Hamala R, Winters N, Bhutta MF. Exploring perceptions, barriers, and enablers for delivery of primary ear and hearing care by community health workers: a photovoice study in Mukono District, Uganda. Int J Equity Health 2020; 19:62. [PMID: 32381090 PMCID: PMC7203865 DOI: 10.1186/s12939-020-01158-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/09/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hearing loss is a prevalent but neglected disease, especially in low- or middle-income countries. The role of Community Health Workers (CHWs) to deliver primary ear and hearing care has been explored in several studies from a technical standpoint, but understanding perceptions, barriers, and enablers of such an approach from the perspective of CHWs themselves through a health equity lens has been less well documented. METHODS This qualitative study used photovoice to explore the views and experiences of CHWs in the Seeta Nazigo Parish of Mukono District in the delivery of ear and hearing care in the community. CHWs were trained in ear and hearing care, and provided with digital cameras to capture photographs related to their work in the community over the following 3 months. Individual interviews regarding the photographs were held at the end of each month, in addition to one focus group discussion. A community workshop was convened at the end of the study to display the photos. Thematic analysis of photographs was conducted using Braune and Clarkes six-step framework. We also used the data to explore potential roles for key stakeholders in primary ear and hearing care, and how photovoice may facilitate their engagement. RESULTS 13 CHWs participated in the study. Several themes were generated from analysis. CHWs perceived a high burden of ear and hearing disorders in their community and recognised the role they could play in tackling that burden. Potential barriers identified included a lack of equipment, training, and supervision of CHWs; logistical, financial, or psychological barriers to community participation; and the widespread use of traditional medicine. CHWs identified roles for the government and NGO bodies to enable and support delivery of ear and hearing care in the community. The community workshop was a useful method to engage key stakeholders in this topic. CONCLUSIONS Photovoice is a powerful method to capture issues affecting CHWs. Here it was used to identify a number of perceptions, barriers and enablers to the delivery of ear and hearing care. Our results may inform future strategy in the field of ear and hearing care, and the potential use of photovoice to enact sociocultural change.
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Affiliation(s)
- James O'Donovan
- Department of Education, The University of Oxford, Norham Gardens, Oxford, OX2 6PS, UK.
- Division of Research and Health Equity, Omni Med Uganda, Makata, Mukono District, Mukono, Uganda.
| | - Allan S Namanda
- Division of Research and Health Equity, Omni Med Uganda, Makata, Mukono District, Mukono, Uganda
| | - Rebecca Hamala
- Division of Research and Health Equity, Omni Med Uganda, Makata, Mukono District, Mukono, Uganda
| | - Niall Winters
- Department of Education, The University of Oxford, Norham Gardens, Oxford, OX2 6PS, UK
| | - Mahmood F Bhutta
- Department of ENT, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Riley CB, Gardiner MM. Examining the distributional equity of urban tree canopy cover and ecosystem services across United States cities. PLoS One 2020; 15:e0228499. [PMID: 32045427 PMCID: PMC7012407 DOI: 10.1371/journal.pone.0228499] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/16/2020] [Indexed: 11/26/2022] Open
Abstract
Examining the distributional equity of urban tree canopy cover (UTCC) has increasingly become an important interdisciplinary focus of ecologists and social scientists working within the field of environmental justice. However, while UTCC may serve as a useful proxy for the benefits provided by the urban forest, it is ultimately not a direct measure. In this study, we quantified the monetary value of multiple ecosystem services (ESD) provisioned by urban forests across nine U.S. cities. Next, we examined the distributional equity of UTCC and ESD using a number of commonly investigated socioeconomic variables. Based on trends in the literature, we predicted that UTCC and ESD would be positively associated with the variables median income and percent with an undergraduate degree and negatively associated with the variables percent minority, percent poverty, percent without a high school degree, percent renters, median year home built, and population density. We also predicted that there would be differences in the relationships between each response variable (UTCC and ESD) and the suite of socioeconomic predictor variables examined because of differences in how each response variable is derived. We utilized methods promoted within the environmental justice literature, including a multi-city comparative analysis, the incorporation of high-resolution social and environmental datasets, and the use of spatially explicit models. Patterns between the socioeconomic variables and UTCC and ESD did not consistently support our predictions, highlighting that inequities are generally not universal but rather context dependent. Our results also illustrated that although the variables UTCC and ESD had largely similar relationships with the predictor variables, differences did occur between them. Future distributional equity research should move beyond the use of proxies for environmental amenities when possible while making sure to consider that the use of ecosystem service estimates may result in different patterns with socioeconomic variables of interest. Based on our findings, we conclude that understanding and remedying the challenges associated with inequities requires an understanding of the local social-ecological system if larger sustainability goals are to be achieved.
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Affiliation(s)
- Christopher B. Riley
- Department of Entomology, The Ohio State University, Columbus, Ohio, United States of America
| | - Mary M. Gardiner
- Department of Entomology, The Ohio State University, Columbus, Ohio, United States of America
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Quintal C, Antunes M. [Equity in Usage of Medical Appointments in Portugal: In Sickness and in Health, in Poverty and in Wealth?]. ACTA MEDICA PORT 2020; 33:93-100. [PMID: 32035494 DOI: 10.20344/amp.12278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/03/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Equity is a central goal of health policy in Portugal. However, empirical evidence regarding healthcare usage is scarce and there is a lack of up-to-date results. Our objective is to evaluate whether the principle of equal utilisation for equal need has been met. MATERIAL AND METHODS We use data from the National Health Survey 2014. Healthcare usage is measured by the number of visits to a Family Physician or to a hospital-based specialist. To assess the factors affecting usage we adopted a multivariate regression analysis (Negative Binomial Model). To quantify income-related inequality/inequity in utilisation we computed the concentration index. RESULTS Better self-assessed health and absence of limitations in daily activities decrease usage; suffering from chronic disease increases usage. Income is not statistically significant; education positively affects usage with a pronounced effect. Living in urban areas increases usage as well as living in Lisbon (compared to North). Living in Algarve or Madeira, or benefiting only from the National Health Service coverage negatively affects usage. The possibility for equity in Family Physician visits cannot be discarded. Regarding hospital based specialist and total visits, the evidence suggests the existence of pro-rich inequity. DISCUSSION The observed income-related inequity seems to reflect inequalities in other non-need variables. Whether the results are affected by overuse, in the case of hospital based specialist visits, is an issue open to question. CONCLUSION Portugal evolved favourably in terms of equity in healthcare usage but several challenges remain.
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Affiliation(s)
- Carlota Quintal
- Centro de Investigação em Economia e Gestão (CeBER - Centre for Business and Economics Research). Faculdade de Economia. Universidade de Coimbra. Coimbra. Portugal
| | - Micaela Antunes
- Centro de Investigação em Economia e Gestão (CeBER - Centre for Business and Economics Research). Faculdade de Economia. Universidade de Coimbra. Coimbra. Portugal
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Kerpershoek L, de Vugt M, Wolfs C, Orrell M, Woods B, Jelley H, Meyer G, Bieber A, Stephan A, Selbæk G, Michelet M, Wimo A, Handels R, Irving K, Hopper L, Gonçalves‐Pereira M, Balsinha C, Zanetti O, Portolani D, Verhey F. Is there equity in initial access to formal dementia care in Europe? The Andersen Model applied to the Actifcare cohort. Int J Geriatr Psychiatry 2020; 35:45-52. [PMID: 31647572 PMCID: PMC6916585 DOI: 10.1002/gps.5213] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In the current study, the Anderson model is used to determine equitable access to dementia care in Europe. Predisposing, enabling, and need variables were investigated to find out whether there is equitable access to dementia-specific formal care services. Results can identify which specific factors should be a target to improve access. METHODS A total of 451 People with middle-stage dementia and their informal carers from eight European countries were included. At baseline, there was no use of formal care yet, but people were expected to start using formal care within the next year. Logistic regressions were carried out with one of four clusters of service use as dependent variables (home social care, home personal care, day care, admission). The independent variables (predisposing, enabling, and need variables) were added to the regression in blocks. RESULTS The most significant predictors for the different care clusters are disease severity, a higher sum of (un)met needs, hours spent on informal care, living alone, age, region of residence, and gender. CONCLUSION The Andersen model provided for this cohort the insight that (besides need factors) the predisposing variables region of residence, gender, and age do play a role in finding access to care. In addition, it showed us that the numbers of hours spent on informal care, living alone, needs, and disease severity are also important predictors within the model's framework. Health care professionals should pay attention to these predisposing factors to ensure that they do not become barriers for those in need for care.
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Affiliation(s)
| | | | - Claire Wolfs
- Maastricht UniversityAlzheimer Centrum LimburgNLThe Netherlands
| | - Martin Orrell
- Nottingham UniversityInstitute of Mental HealthNottinghamUK
| | | | | | | | | | | | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and HealthVestfold HospitalTønsbergNorway
- Dept of Geriatric MedicineOslo University HospitalOsloNorway
- Faculty of medicineUniversity of OsloOsloNorwayNO
| | - Mona Michelet
- Norwegian National Advisory Unit on Ageing and HealthVestfold HospitalTønsbergNorway
- Dept of Geriatric MedicineOslo University HospitalOsloNorway
- Faculty of medicineUniversity of OsloOsloNorwayNO
| | - Anders Wimo
- Department of Neurobiology, Care sciences and SocietyKarolinska InstitutetStockholmSE
| | - Ron Handels
- Maastricht UniversityAlzheimer Centrum LimburgNLThe Netherlands
- Department of Neurobiology, Care sciences and SocietyKarolinska InstitutetStockholmSE
| | - Kate Irving
- School of Nursing, Psychotherapy and Community HealthDublin City UniversityIE
| | - Louise Hopper
- School of Nursing, Psychotherapy and Community HealthDublin City UniversityIE
| | | | - Conceição Balsinha
- CEDOC, Nova Medical School|Faculdade de Ciências MédicasUniversidade Nova de LisboaPT
| | - Orazio Zanetti
- IRCSS Istituto Centro S. Giovanni di Dio FatebenefratelliBresciaIT
| | - Daniel Portolani
- IRCSS Istituto Centro S. Giovanni di Dio FatebenefratelliBresciaIT
| | - Frans Verhey
- Maastricht UniversityAlzheimer Centrum LimburgNLThe Netherlands
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Perdomo J, Tolliver D, Hsu H, He Y, Nash KA, Donatelli S, Mateo C, Akagbosu C, Alizadeh F, Power-Hays A, Rainer T, Zheng DJ, Kistin CJ, Vinci RJ, Michelson CD. Health Equity Rounds: An Interdisciplinary Case Conference to Address Implicit Bias and Structural Racism for Faculty and Trainees. MedEdPORTAL 2019; 15:10858. [PMID: 32166114 PMCID: PMC7050660 DOI: 10.15766/mep_2374-8265.10858] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION The medical community recognizes the importance of confronting structural racism and implicit bias to address health inequities. Several curricula aimed at teaching trainees about these issues are described in the literature. However, few curricula exist that engage faculty members as learners rather than teachers of these topics or target interdisciplinary audiences. METHODS We developed a longitudinal case conference curriculum called Health Equity Rounds (HER) to discuss and address the impact of structural racism and implicit bias on patient care. The curriculum engaged participants across training levels and disciplines on these topics utilizing case-based discussion, evidence-based exercises, and two relevant conceptual frameworks. It was delivered quarterly as part of a departmental case conference series. We evaluated HER's feasibility and acceptability by tracking conference attendance and administering postconference surveys. We analyzed quantitative survey data using descriptive statistics and qualitatively reviewed free-text comments. RESULTS We delivered seven 1-hour HER conferences at our institution from June 2016 to June 2018. A mean of 66 participants attended each HER. Most survey respondents (88% or more) indicated that HER promoted personal reflection on implicit bias, and 75% or more indicated that HER would impact their clinical practice. DISCUSSION HER provided a unique forum for practitioners across training levels to address structural racism and implicit bias. Our aim in dissemination is to provide meaningful tools for others to adapt at their own institutions, recognizing that HER should serve as a component of larger, multifaceted efforts to decrease structural racism and implicit bias in health care.
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Affiliation(s)
- Joanna Perdomo
- General Academic Pediatrics Fellow, Boston Children's Hospital
- Corresponding author:
| | - Destiny Tolliver
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Heather Hsu
- Assistant Professor, Department of Pediatrics, Boston Medical Center
- Assistant Professor, Department of Pediatrics, Boston University School of Medicine
| | - Yuan He
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Katherine A. Nash
- Instructor, Department of Pediatrics, Boston Medical Center
- Instructor, Department of Pediatrics, Boston University School of Medicine
| | | | - Camila Mateo
- Health Services Research Fellow, Boston Children's Hospital
| | - Cynthia Akagbosu
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Faraz Alizadeh
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Alexandra Power-Hays
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Tyler Rainer
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Daniel J. Zheng
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Caroline J. Kistin
- Assistant Professor, Department of Pediatrics, Boston Medical Center
- Assistant Professor, Department of Pediatrics, Boston University School of Medicine
| | - Robert J. Vinci
- Professor, Department of Pediatrics, Boston Medical Center
- Professor, Department of Pediatrics, Boston University School of Medicine
| | - Catherine D. Michelson
- Assistant Professor, Department of Pediatrics, Boston Medical Center
- Assistant Professor, Department of Pediatrics, Boston University School of Medicine
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Jonsson J, Vives A, Benach J, Kjellberg K, Selander J, Johansson G, Bodin T. Measuring precarious employment in Sweden: translation, adaptation and psychometric properties of the Employment Precariousness Scale (EPRES). BMJ Open 2019; 9:e029577. [PMID: 31551377 PMCID: PMC6773301 DOI: 10.1136/bmjopen-2019-029577] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Precarious employment (PE) is a determinant of poor health and health inequality. However, the evidence of health consequences and mechanisms underlying the associations, are still limited due to a lack of a comprehensive multidimensional definition and measurement instrument. The Employment Precariousness Scale (EPRES) is a Spanish, multidimensional scale, developed to measure degree of PE. The aim of this study was to translate the EPRES-2010 into Swedish, adapt it to the Swedish context and to assess the psychometric properties of the Swedish EPRES. METHOD EPRES was translated, adapted and implemented for data collection within the research project PRecarious EMployment in Stockholm (PREMIS). During 2016-2017, questionnaire data were collected from 483 non-standard employees in Stockholm, Sweden, sampled with web-based respondent-driven sampling. Analyses included item descriptive statistics, scale descriptive statistics and exploratory factor analysis. RESULTS The final EPRES-Se (Swedish version of the EPRES),consisted of six dimensions and 23 items. There was a high response rate to all items and response options. Global Cronbach's alpha was 0.83. Subscales 'vulnerability', 'rights' and 'exercise rights' had reliability coefficients between α=0.78-0.89 and item-subscale correlations between r=0.48-0.78. 'Temporariness' had poor reliability (α=-0.08) and inter-item correlation (r=-0.04), while 'disempowerment' showed acceptable psychometric properties (α=0.5; r=0.34). Exploratory factor analysis confirmed the original EPRES factor structure. CONCLUSIONS 'Vulnerability', 'wages', 'rights', 'exercise rights' and 'disempowerment' worked in the Swedish context; however, 'temporariness' would need revising before implementing the EPRES-Se in further research. Continued work and validation of EPRES-Se is encouraged. In order to enable international comparisons and multinational studies, similar studies in other European countries are also called for.
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Affiliation(s)
- Johanna Jonsson
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alejandra Vives
- Department of Public Health, Pontificia Universidad Catolica de Chile Escuela de Medicina, Santiago, Chile
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
| | - Joan Benach
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
- Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autonoma de Madrid, Madrid, Spain
| | - Katarina Kjellberg
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Jenny Selander
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gun Johansson
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Theo Bodin
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Abstract
Racial/ethnic disparities persist in obstetrical outcomes. In this paper, we ask how research in obstetrical quality can go beyond a purely quantitative approach to tackle the challenge of health inequity in quality and safety. This overview debriefs the use of positive deviance and mixed methods in others areas of medicine, describes the shortcomings of quantitative methods in obstetrics and presents qualitative studies carried out in obstetrics as well as the insights provided by this method. The article concludes by proposing positive deviance as a mixed methods approach to generate new knowledge for addressing racial and ethnic disparities in maternal outcomes.
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Affiliation(s)
- Elizabeth A Howell
- Blavatnik Family Women's Health Research Institute
- Departments of Population Health Science & Policy
- Obstetrics, Gynecology, and Reproductive Science
| | - Zainab N Ahmed
- Departments of Population Health Science & Policy
- Obstetrics, Gynecology, and Reproductive Science
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shoshanna Sofaer
- American Institutes for Research, Washington, District of Columbia
| | - Jennifer Zeitlin
- Departments of Population Health Science & Policy
- Icahn School of Medicine at Mount Sinai, New York, New York
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Biostatistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Russell G, Kunin M, Harris M, Levesque JF, Descôteaux S, Scott C, Lewis V, Dionne É, Advocat J, Dahrouge S, Stocks N, Spooner C, Haggerty J. Improving access to primary healthcare for vulnerable populations in Australia and Canada: protocol for a mixed-method evaluation of six complex interventions. BMJ Open 2019; 9:e027869. [PMID: 31352414 PMCID: PMC6661687 DOI: 10.1136/bmjopen-2018-027869] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/03/2019] [Accepted: 06/12/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Access to primary healthcare (PHC) has a fundamental influence on health outcomes, particularly for members of vulnerable populations. Innovative Models Promoting Access-to-Care Transformation (IMPACT) is a 5-year research programme built on community-academic partnerships. IMPACT aims to design, implement and evaluate organisational innovations to improve access to appropriate PHC for vulnerable populations. Six Local Innovation Partnerships (LIPs) in three Australian states (New South Wales, Victoria and South Australia) and three Canadian provinces (Ontario, Quebec and Alberta) used a common approach to implement six different interventions. This paper describes the protocol to evaluate the processes, outcomes and scalability of these organisational innovations. METHODS AND ANALYSIS The evaluation will use a convergent mixed-methods design involving longitudinal (pre and post) analysis of the six interventions. Study participants include vulnerable populations, PHC practices, their clinicians and administrative staff, service providers in other health or social service organisations, intervention staff and members of the LIP teams. Data were collected prior to and 3-6 months after the interventions and included interviews with members of the LIPs, organisational process data, document analysis and tools collecting the cost of components of the intervention. Assessment of impacts on individuals and organisations will rely on surveys and semistructured interviews (and, in some settings, direct observation) of participating patients, providers and PHC practices. ETHICS AND DISSEMINATION The IMPACT research programme received initial ethics approval from St Mary's Hospital (Montreal) SMHC #13-30. The interventions received a range of other ethics approvals across the six jurisdictions. Dissemination of the findings should generate a deeper understanding of the ways in which system-level organisational innovations can improve access to PHC for vulnerable populations and new knowledge concerning improvements in PHC delivery in health service utilisation.
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Affiliation(s)
- Grant Russell
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Marina Kunin
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Jean-Frédéric Levesque
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- Bureau of Health Information, Sydney, New South Wales, Australia
| | - Sarah Descôteaux
- St. Mary’s Research Centre, McGill University, Montreal, Quebec, Canada
| | - Catherine Scott
- PolicyWise for Children & Families, Calgary, Alberta, Canada
| | - Virginia Lewis
- Australian Institute for Primary Care and Ageing, La Trobe University, Melbourne, Victoria, Australia
| | - Émilie Dionne
- St. Mary’s Research Centre, McGill University, Montreal, Quebec, Canada
| | - Jenny Advocat
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Simone Dahrouge
- C.T. Lamont Primary Health Care Research Centre, Elisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Nigel Stocks
- Department of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Catherine Spooner
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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White-Means S, Gaskin DJ, Osmani AR. Intervention and Public Policy Pathways to Achieve Health Care Equity. Int J Environ Res Public Health 2019; 16:ijerph16142465. [PMID: 31373297 PMCID: PMC6679008 DOI: 10.3390/ijerph16142465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 06/30/2019] [Accepted: 06/30/2019] [Indexed: 12/28/2022]
Abstract
Health care equity reflects an equal opportunity to utilize public health and health care resources in order to maximize one's health potential. Achieving health care equity necessitates the consideration of both quantity and quality of care, as well as vertical (greater health care use by those with greater needs) and horizontal (equal health care use by those with equal needs) equity. In this paper, we summarize the approaches introduced by authors contributing to this Special Issue and how their work is captured by the National Institute of Minority Health and Health Disparities (NIMHD) framework. The paper concludes by pointing out intervention and public policy opportunities for future investigation in order to achieve health care equity.
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Affiliation(s)
- Shelley White-Means
- Department of Interprofessional Education, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
- CHEER Health Disparities Center, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
| | - Darrell J Gaskin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Purkey E, MacKenzie M. Experience of healthcare among the homeless and vulnerably housed a qualitative study: opportunities for equity-oriented health care. Int J Equity Health 2019; 18:101. [PMID: 31262310 PMCID: PMC6604349 DOI: 10.1186/s12939-019-1004-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People experiencing homelessness are often marginalized and are known to face barriers to accessing acceptable and respectful healthcare services. This study examines the experience of accessing hospital-based services of persons experiencing homelessness or vulnerable housing in southeastern Ontario and considers the potential of Equity-Oriented Health Care (EOHC) as an approach to improving care. METHODS Focus groups and in-depth interviews with people with lived experience of homelessness (n=31), as well as in-depth interviews of health and social service provider key informants (n=10) were combined with qualitative data from a survey of health and social service providers (n=136). Interview transcripts and written survey responses were analyzed using directed content analysis to examine experiences of people with lived experience of homelessness within the healthcare system. RESULTS Healthcare services were experienced as stigmatizing and shaming particularly for patients with concurrent substance use. These negative experiences could lead to avoidance or abandonment of care. Despite supposed universality, participants felt that the healthcare system was not accountable to them or to other equity-seeking populations. Participants identified a system that was inflexible, designed for a perceived middle-class population, and that failed to take into account the needs and realities of equity-seeking groups. Finally, participants did identify positive healthcare interactions, highlighting the importance of care delivered with dignity, trust, and compassion. CONCLUSIONS The experiences of healthcare services among the homeless and vulnerably housed do not meet the standards of universally accessible patient-centered care. EOHC could provide a framework for changes to the healthcare system, creating a system that is more trauma-informed, equity-enhancing, and accessible to people experiencing homelessness, thus limiting identified barriers and negative experiences of care.
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Affiliation(s)
- Eva Purkey
- Department of Family Medicine, Queen’s University, 220 Bagot street, Kingston, Ontario K7L 3G2 Canada
| | - Meredith MacKenzie
- Department of Family Medicine, Queen’s University, 220 Bagot street, Kingston, Ontario K7L 3G2 Canada
- Street Health Centre, a part of Kingston Community Health Centres, Kingston Ontario115 Barrack St, Kingston, Ontario K7L 3N6 Canada
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Kovach KA, Lutgen CB, Callen EF, Hester CM. Informing the American Academy of family Physician's Health Equity strategy - an environmental scan using the Delphi technique. Int J Equity Health 2019; 18:97. [PMID: 31227001 PMCID: PMC6588858 DOI: 10.1186/s12939-019-1007-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many organizations have prioritized health equity and the social determinants of health (SDoH). These organizations need information to inform their planning, but, relatively few quantifiable measures exist. This study was conducted as an environmental scan to inform the American Academy of Family Physician's (AAFP's) health equity strategy. The objectives of the study were to identify and prioritize a comprehensive list of strategies in four focus areas: health equity leadership, policy, research, and diversity. METHODS A Delphi study was used to identify and prioritize the most important strategies for reducing health inequities among the four aforementioned focus areas. Health equity experts were purposefully sampled. Data were collected in three rounds for each focus area separately. A comprehensive list of strategy statements was identified for each focus area in round one. The strategy statements were prioritized in round two and reprioritized in a final third round. Quantitative and qualitative data were integrated for the final analysis. RESULTS Fifty strategies were identified across the four focus areas. Commitment to health equity, knowledge of health inequities, and knowledge of effective strategies to address the drivers of health inequities were ranked the highest for leadership. Universal access to health care and health in all policies were ranked highest for policy. Multi-level interventions, the effect of policy, governance, and politics, and translating and disseminating health equity interventions into practice were ranked the highest for research. Providing financial support to students from minority or low-socioeconomic backgrounds, commitment from undergraduate and medical school leadership for educational equity, providing opportunities for students from minority or low-socioeconomic backgrounds to prepare for standardized tests, and equitable primary and secondary school funding were ranked highest for diversity. CONCLUSIONS The AAFP and other medical specialty societies have an important opportunity to advance health equity. They should develop a health equity policy agenda, equip physicians and other stakeholders, use their connections with practice-based research networks to identify and translate practical solutions to address the SDoH, and advocate for a more diverse medical workforce. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Kevin A. Kovach
- American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
| | - Cory B. Lutgen
- National Research Network, American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
| | - Elisabeth F. Callen
- National Research Network, American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
| | - Christina M. Hester
- National Research Network, American Academy of Family Physicians, 11400 Tomahawk Creek Parkway, Leawood, KS 66211 USA
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Jiang J, Chen S, Xin Y, Wang X, Zeng L, Zhong Z, Xiang L. Does the critical illness insurance reduce patients' financial burden and benefit the poor more: a comprehensive evaluation in rural area of China. J Med Econ 2019; 22:455-463. [PMID: 30744446 DOI: 10.1080/13696998.2019.1581620] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Critical illness insurance (CII) is one kind of health insurance that is gradually gaining attention worldwide. China implemented CII in 2012 to decrease patients' out-of-pocket (OOP) medical payments. The aims of this study were to determine if the project had positive impacts on relieving financial burden and improving health equity. METHODS A series of questionnaire surveys were undertaken in two counties before and after the intervention in rural China. OOP expenditure, catastrophic Health Expenditure (CHE) incidence, and associated average gap (AG) were assessed across different income groups and project durations, measuring short-term direct medical cost. Medical debt rate and amount were used to measure long-term financial burden; concentration index (CI) was calculated for equity. All data were evaluated by descriptive statistics and multi-variate variance analysis. The linear regression and logit regression with random effect analysis upon area was used to evaluate the effect of CII. RESULTS Six hundred and thirteen and 834 patients were surveyed at baseline and final evaluation. After the program, the OOP payments of hospitalizations sharply decreased from RMB 39,363.2 to RMB 28,426.1 (p < 0.001), with the largest decrease for lowest income patients (from RMB 44,507.6 to RMB 29,214.2). With longer duration of CII, more OOP medical payments decreased. The amount of medical debt was decreased by RMB 7,209.4 among all the patients, and the decrease was highest in the highest income group (RMB 8,119.9). The CI of AG changed a lot (from -0.858 to -0.670). CONCLUSION The CII has effectively reduced the financial burden of patients with high medical cost, whether in the short-term or a longer length of time. It also improved health equity in health service utilization and expenditure. However, rich householders still receive more benefits from the policy, government health insurance financing is increased, and the policy needs to further benefit the poor.
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Affiliation(s)
- Junnan Jiang
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Shanquan Chen
- b Jockey Club School of Public Health and Primary Care , Chinese University of Hong Kong , Hong Kong , China
| | - Yanjiao Xin
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Xuefeng Wang
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Li Zeng
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Zhengdong Zhong
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
| | - Li Xiang
- a School of Medicine and Health Management , Huazhong University of Science and Technology , Wuhan , China
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Abstract
OBJECTIVES Research has shown that people with physical impairment report lower utilisation of preventive services. The aim of this study was to examine whether women with mobility impairments have lower odds of using mammography compared with women with no such impairment, and explore the factors that are associated with lower utilisation. SAMPLE AND DESIGN We performed secondary analysis, using logistic regressions, of deidentified cross-sectional data from the European Health Interview Survey, Wave 2. The sample included 9491 women from across the UK, 2697 of whom had mobility impairment. The survey method involved face-to-face and telephone interviews. OUTCOME MEASURES Self-report of the last time a mammogram was undertaken. RESULTS Adjusting for various demographic and socioeconomic variables, women with mobility impairment had 1.3 times (95% CI 0.70 to 0.92) lower odds of having a mammogram than women without mobility impairment. Concerning women with mobility impairment, married women had more than twice the odds of having a mammogram than women that had never been married (OR 2.07, 95% CI 1.49 to 2.88). Women in Scotland had 1.5 times (95% CI 1.08 to 2.10) higher odds of undertaking the test than women in England. Women with upper secondary education had 1.4 times (95% CI 1.10 to 1.67) higher odds of undergoing the test than women with primary or lower secondary education. Also, women from higher quintiles (third and fifth quintiles) had higher odds of using mammography, with the women in the fifth quintile having 1.5 times (95% CI 1.02 to 2.15) higher odds than women from the first quintile. CONCLUSIONS In order to achieve equitable access to mammography for all women, it is important to acknowledge the barriers that impede women with mobility impairment from using the service. These barriers can refer to structural disadvantage, such as lower income and employment rate, transportation barriers, or previous negative experiences, among others.
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Affiliation(s)
| | - Elena S Rotarou
- Centre of Environmental and Natural Resource Economics, Faculty of Economics and Business, Universidad de Chile, Santiago de Chile, Chile
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Gimeno-Feliu LA, Calderón-Larrañaga A, Díaz E, Laguna-Berna C, Poblador-Plou B, Coscollar-Santaliestra C, Prados-Torres A. The definition of immigrant status matters: impact of nationality, country of origin, and length of stay in host country on mortality estimates. BMC Public Health 2019; 19:247. [PMID: 30819146 PMCID: PMC6394150 DOI: 10.1186/s12889-019-6555-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 02/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mortality is a robust indicator of health and offers valuable insight into the health of immigrants. However, mortality estimates can vary significantly depending on the manner in which immigrant status is defined. Here, we assess the impact of nationality, country of origin, and length of stay in the host country on mortality estimates in an immigrant population in Aragón, Spain. METHODS Cross-sectional retrospective study of all adult subjects from the EpiChron Cohort in 2011 (n = 1,102,544), of whom 146,100 were foreign-born (i.e., according to place of birth) and 127,213 were non-nationals (i.e., according to nationality). Directly standardized death proportions between years 2012-2015 were calculated, taking into account the age distribution of the European population in 2013. Binary logistic regression was used to compare the four-year probability of death. RESULTS The age- and sex-standardized number of deaths per 1000 subjects were 45.1 (95%CI 44.7-45.2) for the Spanish-born population, 29.3 (95%CI 26.7-32.1) for the foreign-born population, and 18.4 (95%CI 15.6-21.6) for non-Spanish nationals. Compared with the Spanish-born population, the age- and sex-adjusted likelihood of dying was equally reduced in the foreign-born and non-national populations (OR 0.6; 95%CI 0.5-0.7) when the length of stay was less than 10 years. No significant differences in mortality estimates were detected when the length of stay was over 10 years. CONCLUSIONS Mortality estimates in immigrant populations were lower than those of the native Spanish population, regardless of the criteria applied. However, the proportion of deaths was lower when immigrant status was defined using nationality instead of country of birth. Age- and sex-standardized death proportions tended to increase with increased length of stay in the host country.
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Affiliation(s)
- Luis Andrés Gimeno-Feliu
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Aragón Healthcare Service, San Pablo Health Centre, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain
- Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Esperanza Díaz
- Department of Global Public Health and Primary Care, Research Group for General Practice, University of Bergen, Bergen, Norway
- Norwegian Centre for Minority Health Research, Oslo, Norway
| | - Clara Laguna-Berna
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain
| | - Carlos Coscollar-Santaliestra
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Aragón Healthcare Service, San Pablo Health Centre, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Carlos III Health Institute, Madrid, Spain
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Dover DC, Belon AP. The health equity measurement framework: a comprehensive model to measure social inequities in health. Int J Equity Health 2019; 18:36. [PMID: 30782161 PMCID: PMC6379929 DOI: 10.1186/s12939-019-0935-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/31/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite the wealth of frameworks on social determinants of health (SDOH), two current limitations include the relative superficial description of factors affecting health and a lack of focus on measuring health equity. The Health Equity Measurement Framework (HEMF) addresses these gaps by providing a more encompassing view of the multitude of SDOH and drivers of health service utilisation and by guiding quantitative analysis for public health surveillance and policy development. The objective of this paper is to present the HEMF, which was specifically designed to measure the direct and indirect effects of SDOH to support improved statistical modelling and measurement of health equity. METHODS Based on a framework synthesis, the HEMF development involved initially integrating theoretical components from existing SDOH and health system utilisation frameworks. To further develop the framework, relevant publications on SDOH and health equity were identified through a literature review in major electronic databases. White and grey literatures were critically reviewed to identify strengths and gaps in the existing frameworks in order to inform the development of a unique health equity measurement framework. Finally, over a two-year period of consultation, scholars, health practitioners, and local policy influencers from municipal and provincial governments provided critical feedback on the framework regarding its components and causal relationships. RESULTS This unified framework includes the socioeconomic, cultural, and political context, health policy context, social stratification, social location, material and social circumstances, environment, biological factors, health-related behaviours and beliefs, stress, quality of care, and healthcare utilisation. Alongside the HEMF's self-exploratory diagram showing the causal pathways in-depth, a number of examples are provided to illustrate the framework's usefulness in measuring and monitoring health equity as well as informing policy-making. CONCLUSIONS The HEMF highlights intervention areas to be influenced by strategic public policy for any organisation whose purview has an effect on health, including helping non-health sectors (such as education and labour) to better understand how their policies influence population health and perceive their role in health equity promotion. The HEMF recognises the complexity surrounding the SDOH and provides a clear, overarching direction for empirical work on health equity.
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Affiliation(s)
- Douglas C. Dover
- Alberta Health, Government of Alberta, Edmonton, AB Canada
- Concordia University of Edmonton, Edmonton, AB Canada
| | - Ana Paula Belon
- School of Public Health, University of Alberta, Edmonton, AB Canada
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Milburn NG, Beatty L, Lopez SA. Understanding, unpacking, and eliminating health disparities: A prescription for health equity promotion through behavioral and psychological research-An introduction. Cultur Divers Ethnic Minor Psychol 2019; 25:1-5. [PMID: 30714761 DOI: 10.1037/cdp0000266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Research on health disparities emerged in the 1990s and has rapidly grown in scope and content. This introduction provides an overall frame for the articles presented in this special issue. The frame includes an overview of how health disparities and health equities have been defined and examined in previous research, challenges in conducting health disparities research, and the progress that has been made. The articles in this special issue address the challenges of health disparity research through new conceptual models, the expansion of diseases and health behaviors wherein disparities occur, intersectionality theory, innovative research designs, and workforce training. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Abstract
INTRODUCTION AND OBJECTIVES Statins have become an integral part of treatment to reduce cardiac events in patients with cardiovascular disease. However, their use within the public healthcare system in Brazil is unknown. Consequently, we sought to determine and characterize statin use in primary healthcare delivered by the public health system (SUS) in Brazil and evaluate associated patient factors to improve future use. METHODS Cross-sectional study with a national representative sample from five Brazilian regions, derived from the National Survey on Access, Use and Promotion of Rational Use of Medicines using a multi-stage complex sampling plan. Patients over 18 years old were interviewed from July 2014 to May 2015. The prevalences of statin use and self-reported statin adherence were determined amongst medicine users. The associations between statin use and sociodemographic/health condition variables were assessed using logistic regression. RESULTS A total of 8803 patients were interviewed, of whom 6511 were medicine users. The prevalence of statin use was 9.4% with simvastatin (90.3%), atorvastatin (4.7%) and rosuvastatin (1.9%) being the most used statins. Poor adherence was described by 6.5% of patients. Statin use was significantly associated with age ≥65 years old, higher educational level, residence in the South, metabolic and heart diseases, alcohol consumption and polypharmacy. CONCLUSIONS This is the first population based study in Brazil to assess statin use in SUS primary healthcare patients. Addressing inequalities in access and use of medicines including statins is an important step in achieving the full benefit of statins in Brazil, with the findings guiding future research and policies.
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Affiliation(s)
- R C R M do Nascimento
- a Post-graduated Program of Medicines and Pharmaceutical Assistance, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
| | - A A Guerra
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | - J Alvares
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
| | - I C Gomes
- d Faculdade de Ciências Médicas , Belo Horizonte , Minas Gerais , Brazil
| | - B Godman
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
- f Division of Clinical Pharmacology , Karolinska Institutet , Stockholm , Sweden
- g Health Economics Centre , Liverpool University Management School , Liverpool , UK
| | - M Bennie
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - A B Kurdi
- e Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - F A de Acurcio
- b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), School of Pharmacy , Federal University of Minas Gerais , Brazil
- c Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais (UFMG) , Belo Horizonte , Minas Gerais , Brazil
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Browne AJ, Varcoe C, Ford-Gilboe M, Nadine Wathen C, Smye V, Jackson BE, Wallace B, Pauly B(B, Herbert CP, Lavoie JG, Wong ST, Blanchet Garneau A. Disruption as opportunity: Impacts of an organizational health equity intervention in primary care clinics. Int J Equity Health 2018; 17:154. [PMID: 30261924 PMCID: PMC6161402 DOI: 10.1186/s12939-018-0820-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 07/10/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health care. METHODS The theoretically-informed and evidence-based intervention known as 'EQUIP' included educational components for staff, and the integration of three key dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care, and tailoring to context. The intervention was implemented at four Canadian primary health care clinics committed to serving marginalized populations including people living in poverty, those facing homelessness, and people living with high levels of trauma, including Indigenous peoples, recent immigrants and refugees. A mixed methods design was used to examine the impacts of the intervention on the clinics' organizational processes and priorities, and on staff. RESULTS Engagement with the EQUIP intervention prompted increased awareness and confidence related to equity-oriented health care among staff. Importantly, the EQUIP intervention surfaced tensions that mirrored those in the wider community, including those related to racism, the impacts of violence and trauma, and substance use issues. Surfacing these tensions was disruptive but led to focused organizational strategies, for example: working to address structural and interpersonal racism; improving waiting room environments; and changing organizational policies and practices to support harm reduction. The impact of the intervention was enhanced by involving staff from all job categories, developing narratives about the socio-historical context of the communities and populations served, and feeding data back to the clinics about key health issues in the patient population (e.g., levels of depression, trauma symptoms, and chronic pain). However, in line with critiques of complex interventions, EQUIP may not have been maximally disruptive. Organizational characteristics (e.g., funding and leadership) and characteristics of intervention delivery (e.g., timeframe and who delivered the intervention components) shaped the process and impact. CONCLUSIONS This analysis suggests that organizations should anticipate and plan for various types of disruptions, while maximizing opportunities for ownership of the intervention by those within the organization. Our findings further suggest that equity-oriented interventions be paced for intense delivery over a relatively short time frame, be evaluated, particularly with data that can be made available on an ongoing basis, and explicitly include a harm reduction lens.
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Affiliation(s)
- Annette J. Browne
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Colleen Varcoe
- School of Nursing, The University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
| | - C. Nadine Wathen
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
- Faculty of Information & Media Studies, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
| | - Victoria Smye
- Arthur Labatt Family School of Nursing, Western University, FIMS & Nursing Building, London, ON N6A 5B9 Canada
| | - Beth E. Jackson
- Public Health Agency of Canada, 785 Carling Avenue, AL 6809B, Ottawa, ON K1A 0K9 Canada
| | - Bruce Wallace
- School of Social Work, University of Victoria, PO Box 1700, STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Bernadette (Bernie) Pauly
- Canadian Institute for Substance Use Research, and School of Nursing, University of Victoria, Victoria, BC V8W 2Y2 Canada
| | - Carol P. Herbert
- School of Population and Public Health, The University of British Columbia, and Centre for Studies in Family Medicine, The Western Centre for Public Health and Family Medicine, Western University, London, ON N6A 3K7 Canada
| | - Josée G. Lavoie
- Department of Community Health Sciences and Ongomiizwin – Research, Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB MB R3E 3P5 Canada
| | - Sabrina T. Wong
- Centre for Health Services and Policy Research and School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - Amelie Blanchet Garneau
- Faculty of Nursing, Universite de Montreal, PO Box 6128, Centre-ville Station, Montreal, QC H3C 3J7 Canada
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Abstract
Hospitals have a pivotal role in reducing health inequities for indigenous people and other marginalised groups, argue Anna Matheson and colleagues
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Affiliation(s)
- Anna Matheson
- Te Pūnaha Matatini, School of Health Sciences, Massey University, Wellington, New Zealand
| | - Chris Bourke
- Australian Healthcare and Hospitals Association, Deakin West, ACT, Australia
| | - Alison Verhoeven
- Australian Healthcare and Hospitals Association, Deakin West, ACT, Australia
| | - M Imran Khan
- Maternal Newborn and Child Health, Global Health Directorate, Indus Health Network, Karachi, Pakistan
| | | | - Zaib Dahar
- People's Primary Healthcare Initiative, Karachi, Pakistan
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Maura J, Weisman de Mamani A. Mental Health Disparities, Treatment Engagement, and Attrition Among Racial/Ethnic Minorities with Severe Mental Illness: A Review. J Clin Psychol Med Settings 2018; 24:187-210. [PMID: 28900779 DOI: 10.1007/s10880-017-9510-2] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mounting evidence indicates that there are mental health disparities in the United States that disadvantage racial/ethnic minorities in medical and mental health settings. Less is known, however, about how these findings apply to a particularly vulnerable population, individuals with severe mental illness (SMI). The aim of this paper is to (1) provide a critical review of the literature on racial/ethnic disparities in mental health care among individuals with SMI; (2) identify factors which may contribute to the observed disparities; and (3) generate recommendations on how best to address these disparities. Specifically, this article provides an in-depth review of sociocultural factors that may contribute to differences in treatment engagement and rates of attrition from treatment among racial/ethnic minorities with SMI who present at medical and mental health facilities. This review is followed by a discussion of specific strategies that may promote engagement in mental health services and therefore reduce racial/ethnic disparities in SMI.
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Affiliation(s)
- Jessica Maura
- Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, 33146, USA.
| | - Amy Weisman de Mamani
- Department of Psychology, University of Miami, 5665 Ponce De Leon Blvd, Coral Gables, FL, 33146, USA
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Countdown to 2030 Collaboration. Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health. Lancet 2018; 391:1538-48. [PMID: 29395268 DOI: 10.1016/S0140-6736(18)30104-1] [Citation(s) in RCA: 259] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 01/04/2023]
Abstract
Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH.
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Afifah T, Nuryetty MT, Cahyorini, Musadad DA, Schlotheuber A, Bergen N, Johnston R. Subnational regional inequality in access to improved drinking water and sanitation in Indonesia: results from the 2015 Indonesian National Socioeconomic Survey (SUSENAS). Glob Health Action 2018; 11:1496972. [PMID: 30067161 PMCID: PMC6084489 DOI: 10.1080/16549716.2018.1496972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 06/30/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Universal and equitable access to safe and affordable drinking water and adequate sanitation and hygiene in Indonesia are vital to ensure healthy lives and promote well-being for all at all ages. OBJECTIVES To quantify subnational regional inequality in access to improved drinking water and sanitation in Indonesia. METHODS Data about access to improved drinking water and sanitation were derived from the 2015 Indonesian National Socioeconomic Survey (SUSENAS) and disaggregated by 510 districts across the 34 provinces of Indonesia. Two summary measures of inequality, mean difference from mean and weighted index of disparity, were calculated to quantify within-province absolute and relative inequality, respectively. RESULTS While the majority of Indonesian households had access to improved drinking water (71.0%) and sanitation (62.1%), there were large variations between and within provinces. Access to improved drinking water ranged from 93.4% in DKI Jakarta to 41.1% in Bengkulu, and access to improved sanitation ranged from 89.3% in Jakarta to 23.9% in East Nusa Tenggara. Provinces with similar numbers of districts and similar overall averages showed variable levels of absolute and/or relative inequality. Certain districts reported very low levels of access to improved drinking water and/or sanitation. CONCLUSIONS There are inequalities in access to improved drinking water and sanitation by subnational region in Indonesia. Monitoring within-country inequality in these indicators serves to identify underserved areas, and is useful for developing approaches to improve inequalities in access that can help Indonesia make progress towards the 2030 Agenda for Sustainable Development.
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Affiliation(s)
- Tin Afifah
- National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | | | - Cahyorini
- National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Dede Anwar Musadad
- National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Anne Schlotheuber
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Richard Johnston
- Department of Public Health, Environmental and Social Determinants of Health, World Health Organization, Geneva, Switzerland
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Arnaudo F, Lago F, Viego V. Assessing Equity in the Provision of Primary Healthcare Centers in Buenos Aires Province (Argentina): A Stochastic Frontier Analysis. Appl Health Econ Health Policy 2017; 15:425-433. [PMID: 28066863 DOI: 10.1007/s40258-016-0303-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Unequal access to healthcare between individuals or populations does not imply the existence of inequities as it must be controlled for differences in need. This is usually done either via direct or indirect standardization methods. OBJECTIVE We study the degree of equity in the availability of public primary healthcare centers between the 134 municipalities of the Buenos Aires province (Argentina) with a novel application of an existing statistical tool. METHODS Stochastic frontier analysis was applied to estimate the number of primary care facilities that should be available in each municipality according to demographic variables (population under age 4 years and above age 65 years), as they are the population groups with higher healthcare needs. RESULTS Under all specifications tried, the endowment of primary healthcare centers at the municipal level tends to increase (but less than proportionally) with the size of the population at risk. In addition, wealthier jurisdictions tend to be more equitable but also more heterogeneous. CONCLUSIONS Stochastic frontier analysis allows us to discriminate between those districts that, according to their needs, are underserved, from those who have a surplus of health facilities. This approach can also help to explore what other elements might be responsible for the observed inequities.
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Affiliation(s)
- Florencia Arnaudo
- Department of Economics, Universidad Nacional del Sur, Conicet, Bahía Blanca, Argentina
| | - Fernando Lago
- Department of Economics, Universidad Nacional del Sur, IIESS, Bahía Blanca, Argentina
| | - Valentina Viego
- Department of Economics, Universidad Nacional del Sur, IIESS, Bahía Blanca, Argentina.
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