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Brownell NK, Ziaeian B, Jackson NJ, Richards AK. Trends in Income Inequities in Cardiovascular Health Among US Adults, 1988-2018. Circ Cardiovasc Qual Outcomes 2024; 17:e010111. [PMID: 38567505 PMCID: PMC11104495 DOI: 10.1161/circoutcomes.123.010111] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 02/01/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Mean cardiovascular health has improved over the past several decades in the United States, but it is unclear whether the benefit is shared equitably. This study examined 30-year trends in cardiovascular health using a suite of income equity metrics to provide a comprehensive picture of cardiovascular income equity. METHODS The study evaluated data from the 1988-2018 National Health and Nutrition Examination Survey. Survey groupings were stratified by poverty-to-income ratio (PIR) category, and the mean predicted 10-year risk of a major cardiovascular event or death based on the pooled cohort equations (PCE) was calculated (10-year PCE risk). Equity metrics including the relative and absolute concentration indices and the achievement index-metrics that assess both the prevalence and the distribution of a health measure across different socioeconomic categories-were calculated. RESULTS A total of 26 633 participants aged 40 to 75 years were included (mean age, 53.0-55.5 years; women, 51.9%-53.0%). From 1988-1994 to 2015-2018, the mean 10-year PCE risk improved from 7.8% to 6.4% (P<0.05). The improvement was limited to the 2 highest income categories (10-year PCE risk for PIR 5: 7.7%-5.1%, P<0.05; PIR 3-4.99: 7.6%-6.1%, P<0.05). The 10-year PCE risk for the lowest income category (PIR <1) did not significantly change (8.1%-8.7%). In 1988-1994, the 10-year PCE risk for PIR <1 was 6% higher than PIR 5; by 2015-2018, this relative inequity increased to 70% (P<0.05). When using metrics that account for all income categories, the achievement index improved (8.0%-7.1%, P<0.05); however, the achievement index was consistently higher than the mean 10-year PCE risk, indicating the poor persistently had a greater share of adverse health. CONCLUSIONS In this serial cross-sectional survey of US adults spanning 30 years, the population's mean 10-year PCE risk improved, but the improvement was not felt equally across the income spectrum.
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Affiliation(s)
| | - Boback Ziaeian
- Division of Cardiology (B.Z.), University of California, Los Angeles
| | - Nicholas J. Jackson
- Division of General Internal Medicine and Health Services Research (N.J.J.), University of California, Los Angeles
| | - Adam K. Richards
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington (A.K.R.)
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Kim H, Drake B. Has the relationship between community poverty and child maltreatment report rates become stronger or weaker over time? Child Abuse Negl 2023; 143:106333. [PMID: 37379728 PMCID: PMC10651183 DOI: 10.1016/j.chiabu.2023.106333] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/06/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Poverty is among the most powerful predictors of child maltreatment risk and reporting. To date, however, there have been no studies assessing the stability of this relationship over time. OBJECTIVE To examine whether the county-level relationship between child poverty rates and child maltreatment report (CMR) rates changed over time in the United States in 2009-2018, overall and across of child age, sex, race/ethnicity, and maltreatment type. PARTICIPANTS AND SETTING U.S. Counties in 2009-2018. METHODS Linear multilevel models estimated this relationship and its longitudinal change, while controlling for potential confounding variables. RESULTS We found that the county-level relationship between child poverty rates and CMR rates had intensified almost linearly from 2009 to 2018. Per one-percentage-point increase in child poverty rates, CMR rates significantly increased by 1.26 per 1000 children in 2009 and by 1.74 per 1000 children in 2018, indicating an almost 40 % increase in the poverty-CMR relationship. This increasing trend was also found within all subgroups of child age and sex. This trend was found among White and Black children, but not among Latino children. This trend was strong among neglect reports, weaker among physical abuse reports, and not found among sexual abuse reports. CONCLUSIONS Our findings highlight the continued, perhaps increasing importance of poverty as a predictor of CMR. To the degree that our findings can be replicated, they could be interpreted as supporting an increased emphasis on reducing child maltreatment incidents and reports through poverty amelioration efforts and the provision of material family supports.
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Affiliation(s)
- Hyunil Kim
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America.
| | - Brett Drake
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, United States of America
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Opoku ST, Apenteng BA, Kimsey L, Peden A, Owens C. COVID-19 and social determinants of health: Medicaid managed care organizations' experiences with addressing member social needs. PLoS One 2022; 17:e0264940. [PMID: 35271632 PMCID: PMC8912251 DOI: 10.1371/journal.pone.0264940] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background The significant adverse social and economic impact of the COVID-19 pandemic has cast broader light on the importance of addressing social determinants of health (SDOH). Medicaid Managed Care Organizations (MMCOs) have increasingly taken on a leadership role in integrating medical and social services for Medicaid members. However, the experiences of MMCOs in addressing member social needs during the pandemic has not yet been examined. Aim The purpose of this study was to describe MMCOs’ experiences with addressing the social needs of Medicaid members during the COVID-19 pandemic. Methods The study was a qualitative study using data from 28 semi-structured interviews with representatives from 14 MMCOs, including state-specific markets of eight national and regional managed care organizations. Data were analyzed using thematic analysis. Results Four themes emerged: the impact of the pandemic, SDOH response efforts, an expanding definition of SDOH, and managed care beyond COVID-19. Specifically, participants discussed the impact of the pandemic on enrollees, communities, and healthcare delivery, and detailed their evolving efforts to address member nonmedical needs during the pandemic. They reported an increased demand for social services coupled with a significant retraction of community social service resources. To address these emerging social service gaps, participants described mounting a prompt and adaptable response that was facilitated by strong existing relationships with community partners. Conclusion Among MMCOs, the COVID-19 pandemic has emphasized the importance of addressing member social needs, and the need for broader consideration of what constitutes SDOH from a healthcare delivery standpoint.
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Affiliation(s)
- Samuel T. Opoku
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, United States of America
- * E-mail:
| | - Bettye A. Apenteng
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, United States of America
| | - Linda Kimsey
- Department of Health Policy and Community Health, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, United States of America
| | - Angie Peden
- Center for Public Health Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, United States of America
| | - Charles Owens
- Center for Public Health Practice and Research, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, United States of America
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Singh S, Shekhar C, Bankole A, Acharya R, Audam S, Akinade T. Key drivers of fertility levels and differentials in India, at the national, state and population subgroup levels, 2015-2016: An application of Bongaarts' proximate determinants model. PLoS One 2022; 17:e0263532. [PMID: 35130319 PMCID: PMC8820640 DOI: 10.1371/journal.pone.0263532] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/20/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The transition to small family size is at an advanced phase in India, with a national TFR of 2.2 in 2015-16. This paper examines the roles of four key determinants of fertility-marriage, contraception, abortion and postpartum infecundability-for India, all 29 states and population subgroups. METHODS Data from the most recent available national survey, the National Family Health Survey, conducted in 2015-16, were used. The Bongaarts proximate determinants model was used to quantify the roles of the four key factors that largely determine fertility. Methodological contributions of this analysis are: adaptations of the model to the Indian context; measurement of the role of abortion; and provision of estimates for sub-groups nationally and by state: age, education, residence, wealth status and caste. RESULTS Nationally, marriage is the most important determinant of the reduction in fertility from the biological maximum, contributing 36%, followed by contraception and abortion, contributing 24% and 23% respectively, and post-partum infecundability contributed 16%. This national pattern of contributions characterizes most states and subgroups. Abortion makes a larger contribution than contraception among young women and better educated women. Findings suggest that sterility and infertility play a greater than average role in Southern states; marriage practices in some Northeastern states; and male migration for less-educated women. The absence of stronger relationships between the key proximate fertility determinants and geography or socio-economic status suggests that as family size declined, the role of these determinants is increasingly homogenous. CONCLUSIONS Findings argue for improvements across all states and subgroups, in provision of contraceptive care and safe abortion services, given the importance of these mechanisms for implementing fertility preferences. In-depth studies are needed to identify policy and program needs that depend on the barriers and vulnerabilities that exist in specific areas and population groups.
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Affiliation(s)
- Susheela Singh
- Guttmacher Institute, New York, New York, United States of America
| | - Chander Shekhar
- Department of Fertility Studies, International Institute for Population Sciences (IIPS), Mumbai, India
| | | | | | - Suzette Audam
- Guttmacher Institute, New York, New York, United States of America
| | - Temitope Akinade
- Guttmacher Institute, New York, New York, United States of America
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He J, Zhu Z, Bundy JD, Dorans KS, Chen J, Hamm LL. Trends in Cardiovascular Risk Factors in US Adults by Race and Ethnicity and Socioeconomic Status, 1999-2018. JAMA 2021; 326:1286-1298. [PMID: 34609450 PMCID: PMC8493438 DOI: 10.1001/jama.2021.15187] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [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: 05/23/2021] [Accepted: 08/20/2021] [Indexed: 12/14/2022]
Abstract
Importance After decades of decline, the US cardiovascular disease mortality rate flattened after 2010, and racial and ethnic differences in cardiovascular disease mortality persisted. Objective To examine 20-year trends in cardiovascular risk factors in the US population by race and ethnicity and by socioeconomic status. Design, Setting, and Participants A total of 50 571 participants aged 20 years or older from the 1999-2018 National Health and Nutrition Examination Surveys, a series of cross-sectional surveys in nationally representative samples of the US population, were included. Exposures Calendar year, race and ethnicity, education, and family income. Main Outcomes and Measures Age- and sex-adjusted means or proportions of cardiovascular risk factors and estimated 10-year risk of atherosclerotic cardiovascular disease were calculated for each of 10 two-year cycles. Results The mean age of participants ranged from 49.0 to 51.8 years and the proportion of women from 48.2% to 51.3% in the surveys. From 1999-2000 to 2017-2018, age- and sex-adjusted mean body mass index increased from 28.0 (95% CI, 27.5-28.5) to 29.8 (95% CI, 29.2-30.4); mean hemoglobin A1c increased from 5.4% (95% CI, 5.3%-5.5%) to 5.7% (95% CI, 5.6%-5.7%) (both P < .001 for linear trends). Mean serum total cholesterol decreased from 203.3 mg/dL (95% CI, 200.9-205.8 mg/dL) to 188.5 mg/dL (95% CI, 185.2-191.9 mg/dL); prevalence of smoking decreased from 24.8% (95% CI, 21.8%-27.7%) to 18.1% (95% CI, 15.4%-20.8%) (both P < .001 for linear trends). Mean systolic blood pressure decreased from 123.5 mm Hg (95% CI, 122.2-124.8 mm Hg) in 1999-2000 to 120.5 mm Hg (95% CI, 119.6-121.3 mm Hg) in 2009-2010, then increased to 122.8 mm Hg (95% CI, 121.7-123.8 mm Hg) in 2017-2018 (P < .001 for nonlinear trend). Age- and sex-adjusted 10-year atherosclerotic cardiovascular disease risk decreased from 7.6% (95% CI, 6.9%-8.2%) in 1999-2000 to 6.5% (95% CI, 6.1%-6.8%) in 2011-2012, then did not significantly change. Age- and sex-adjusted body mass index, systolic blood pressure, and hemoglobin A1c were consistently higher, while total cholesterol was lower in non-Hispanic Black participants compared with non-Hispanic White participants (all P < .001 for group differences). Individuals with college or higher education or high family income had consistently lower levels of cardiovascular risk factors. The mean age- and sex-adjusted 10-year risk of atherosclerotic cardiovascular disease was significantly higher in non-Hispanic Black participants compared with non-Hispanic White participants (difference, 1.4% [95% CI, 1.0%-1.7%] in 1999-2008 and 2.0% [95% CI, 1.7%-2.4%] in 2009-2018]). This difference was attenuated (-0.3% [95% CI, -0.6% to 0.1%] in 1999-2008 and 0.7% [95% CI, 0.3%-1.0%] in 2009-2018) after further adjusting for education, income, home ownership, employment, health insurance, and access to health care. Conclusions and Relevance In this serial cross-sectional survey study that estimated US trends in cardiovascular risk factors from 1999 through 2018, differences in cardiovascular risk factors persisted between Black and White participants; the difference may have been moderated by social determinants of health.
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Affiliation(s)
- Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Zhengbao Zhu
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Joshua D. Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Kirsten S. Dorans
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - L. Lee Hamm
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
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Abstract
BACKGROUND Considered globally, prostate cancer is a disease of the aging male that increases in prevalence with exposure to screening and diagnostic testing, and which requires a population with the health and longevity to encounter it. The Global Burden of Disease (GBD) dataset is an aggregation of worldwide registries and health data systems that reports global and regional assessment of disease impact. METHODS Using the GBD database, 1171 worldwide registries and health registration systems from 1990 to 2016 were aggregated for prostate cancer disease codes and outcomes. Disease-Adjusted Life Years (DALYs) were calculated and segregated by sociodemographic index (SDI) quintile, and compared to other urologic diseases and tuberculosis (TB). RESULTS Prostate cancer exerts a burden of disease that is vastly higher in the top quintile of SDI. The three lowest SDI quintiles represent the majority of global population but are currently less impacted by prostate cancer. Conversely, TB has its highest impact on the lowest SDI levels, although these rates are declining. CONCLUSIONS As a global disease, prostate cancer predominantly affects high SDI men who enjoy a longer life expectancy in which to suffer from this disease and a greater exposure to screening and diagnosis. As lower SDI men are elevated in health and income, reallocation of DALYs will occur, and a greater burden of prostate cancer can be expected. These epidemiologic trends have great implications for the allocation of resources, as the population of men affected by prostate cancer outpaces urologic workforce growth.
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Affiliation(s)
- Bryn M Launer
- Department of Surgery, Division of Urology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Granville L Lloyd
- Department of Surgery, Division of Urology, Rocky Mountain Regional VA Medical Center, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
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Schmidt NM, Glymour MM, Osypuk TL. Does the Temporal Pattern of Moving to a Higher-Quality Neighborhood Across a 5-Year Period Predict Psychological Distress Among Adolescents? Results From a Federal Housing Experiment. Am J Epidemiol 2021; 190:998-1008. [PMID: 33226075 PMCID: PMC8248973 DOI: 10.1093/aje/kwaa256] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 11/06/2019] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 12/22/2022] Open
Abstract
Using data from the Moving to Opportunity (MTO) experiment (1994-2002), this study examined how a multidimensional measure of neighborhood quality over time influenced adolescent psychological distress, using instrumental variable (IV) analysis. Neighborhood quality was operationalized with the independently validated 19-indicator Child Opportunity Index (COI), linked to MTO family addresses over 4-7 years. We examined whether being randomized to receive a housing subsidy (versus remaining in public housing) predicted neighborhood quality across time. Using IV analysis, we tested whether experimentally induced differences in COI across time predicted psychological distress on the Kessler Screening Scale for Psychological Distress (n = 2,829; mean β = -0.04 points (standard deviation, 1.12)). The MTO voucher treatment improved neighborhood quality for children as compared with in-place controls. A 1-standard-deviation change in COI since baseline predicted a 0.32-point lower psychological distress score for girls (β = -0.32, 95% confidence interval: -0.61, -0.03). Results were comparable but less precisely estimated when neighborhood quality was operationalized as simply average post-random-assignment COI (β = -0.36, 95% confidence interval: -0.74, 0.02). Effect estimates based on a COI excluding poverty and on the most recent COI measure were slightly larger than other operationalizations of neighborhood quality. Improving a multidimensional measure of neighborhood quality led to reductions in low-income girls' psychological distress, and this was estimated with high internal validity using IV methods.
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Affiliation(s)
- Nicole M Schmidt
- Correspondence to Dr. Nicole M. Schmidt, Minnesota Population
Center, University of Minnesota, 225 19th Avenue South, 50 Willey Hall,
Minneapolis, MN 55455 (e-mail: )
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Backholer K, Baum F, Finlay SM, Friel S, Giles-Corti B, Jones A, Patrick R, Shill J, Townsend B, Armstrong F, Baker P, Bowen K, Browne J, Büsst C, Butt A, Canuto K, Canuto K, Capon A, Corben K, Daube M, Goldfeld S, Grenfell R, Gunn L, Harris P, Horton K, Keane L, Lacy-Nichols J, Lo SN, Lovett RW, Lowe M, Martin JE, Neal N, Peeters A, Pettman T, Thoms A, Thow AMT, Timperio A, Williams C, Wright A, Zapata-Diomedi B, Demaio S. Australia in 2030: what is our path to health for all? Med J Aust 2021; 214 Suppl 8:S5-S40. [PMID: 33934362 DOI: 10.5694/mja2.51020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/11/2022]
Abstract
CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.
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McKown T, Schletzbaum M, Unnithan R, Wang X, Ezeh N, Bartels CM. The effect of smoking on cumulative damage in systemic lupus erythematosus: An incident cohort study. Lupus 2021; 30:620-629. [PMID: 33470148 PMCID: PMC7969411 DOI: 10.1177/0961203320988603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/16/2022]
Abstract
OBJECTIVES To investigate the relationship between smoking history and pack-year exposure on the rate of end-organ damage in systemic lupus erythematosus (SLE). METHODS The SLE incident cohort included patients who met American College of Rheumatology (ACR) 1997 or SLE International Collaborating Clinics (SLICC) 2012 SLE criteria and had rheumatology encounters at a US academic institution (2008-16). The primary outcome was median time to SLICC/ACR damage index (SLICC/ACR-DI) increase or death. Main explanatory variables were smoking status and pack-years. Covariates included age, sex, race, ethnicity, receipt of Medicaid, neighborhood area deprivation index, and baseline SLE damage. Damage increase-free survival was evaluated by smoking status and pack-years using Kaplan-Meier and Cox proportional hazards methods. RESULTS Patients of Black race and Medicaid recipients were more commonly current smokers (p's < 0.05). Former smokers were older and more likely to have late-onset SLE (54% versus 33% of never and 29% of current smokers, p = 0.001). Median time to SLICC/ACR-DI increase or death was earlier in current or former compared to never smokers (4.5 and 3.4 versus 9.0 yrs; p = 0.002). In multivariable models, the rate of damage accumulation was twice as fast in current smokers (HR 2.18; 1.33, 3.57) and smokers with a >10 pack-year history (HR 2.35; 1.15, 3.64) versus never smokers. CONCLUSIONS In this incident SLE cohort, past or current smoking predicted new SLE damage 4-5 years earlier. After adjustment, current smokers and patients with a pack-year history of >10 years accumulated damage at twice the rate of never smokers.
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Affiliation(s)
- Trevor McKown
- Department of Medicine, University of Wisconsin School of Medicine and Public Health (UW-SMPH), Madison, USA
- William S. Middleton Memorial Veterans Hospital, Madison, USA
| | | | - Rachna Unnithan
- Department of Medicine, University of Wisconsin School of Medicine and Public Health (UW-SMPH), Madison, USA
| | - Xing Wang
- Department of Biostatistics and Medical Informatics, UW-SMPH, Madison, USA
- Seattle Children's Hospital, Seattle, USA
| | - Nnenna Ezeh
- Department of Medicine, University of Wisconsin School of Medicine and Public Health (UW-SMPH), Madison, USA
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Snowden LR, Graaf G. COVID-19, Social Determinants Past, Present, and Future, and African Americans' Health. J Racial Ethn Health Disparities 2021; 8:12-20. [PMID: 33230737 PMCID: PMC7682952 DOI: 10.1007/s40615-020-00923-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/09/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
As the COVID-19 pandemic progresses, more African Americans than whites are falling ill and dying from the virus and more are losing livelihoods from the accompanying recession. The virus thereby exploits structural disadvantages, rooted partly in historical and contemporary anti-Black sentiments, working against African Americans. These include higher rates of comorbid illness and more limited health care access, higher rates of disadvantageous labor market positioning and community and housing conditions, greater exposure to long-term care residence, and higher incarceration rates. COVID-19 also exposes African Americans' greater vulnerability to recession, and possibly greater susceptibility to accompanying behavioral health problems. If they are left unaddressed, the very vulnerabilities COVID-19 exploits may perpetuate themselves. However, continuing and supplementing health and economic COVID mitigation policies can disproportionately benefit African Americans and reduce short- and long-term adverse effects. The greater impact of COVID-19 on African Americans demonstrates the consequences of pervasive social and economic inequality and marks this as a critical time to prevent further compounding of adverse effects.
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Affiliation(s)
- Lonnie R. Snowden
- School of Public Health, University of California, Berkeley, University Hall #235, Berkeley, CA 94720 USA
| | - Genevieve Graaf
- School of Social Work, University of Texas, Arlington, Arlington, TX USA
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11
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Rethorn ZD, Garcia AN, Cook CE, Gottfried ON. Quantifying the collective influence of social determinants of health using conditional and cluster modeling. PLoS One 2020; 15:e0241868. [PMID: 33152044 PMCID: PMC7644039 DOI: 10.1371/journal.pone.0241868] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 09/03/2020] [Accepted: 10/21/2020] [Indexed: 12/31/2022] Open
Abstract
Objectives Our objective was to analyze the collective effect of social determinants of health (SDoH) on lumbar spine surgery outcomes utilizing two different statistical methods of combining variables. Methods This observational study analyzed data from the Quality Outcomes Database, a nationwide United States spine registry. Race/ethnicity, educational attainment, employment status, insurance payer, and gender were predictors of interest. We built two models to assess the collective influence of SDoH on outcomes following lumbar spine surgery—a stepwise model using each number of SDoH conditions present (0 of 5, 1 of 5, 2 of 5, etc) and a clustered subgroup model. Logistic regression analyses adjusted for age, multimorbidity, surgical indication, type of lumbar spine surgery, and surgical approach were performed to identify the odds of failing to demonstrate clinically meaningful improvements in disability, back pain, leg pain, quality of life, and patient satisfaction at 3- and 12-months following lumbar spine surgery. Results Stepwise modeling outperformed individual SDoH when 4 of 5 SDoH were present. Cluster modeling revealed 4 distinct subgroups. Disparities between the younger, minority, lower socioeconomic status and the younger, white, higher socioeconomic status subgroups were substantially wider compared to individual SDoH. Discussion Collective and cluster modeling of SDoH better predicted failure to demonstrate clinically meaningful improvements than individual SDoH in this cohort. Viewing social factors in aggregate rather than individually may offer more precise estimates of the impact of SDoH on outcomes.
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Affiliation(s)
- Zachary D. Rethorn
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Alessandra N. Garcia
- Physical Therapy Program, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, North Carolina, United States of America
| | - Chad E. Cook
- Doctor of Physical Therapy Division, Duke University, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America
| | - Oren N. Gottfried
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States of America
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12
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Shah GH, Yin J, Young JL, Waterfield K. Employee Perceptions About Public Health Agencies' Desired Involvement in Impacting Health Equity and Other Social Determinants of Health. J Public Health Manag Pract 2020; 25 Suppl 2, Public Health Workforce Interests and Needs Survey 2017:S124-S133. [PMID: 30720625 PMCID: PMC6519883 DOI: 10.1097/phh.0000000000000908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Despite a growing consensus in public health to address health inequities and leverage social determinants of health (SDoH), the level of public health practitioners' readiness to become the agents of change in promoting health equity and shaping SDoH is not well researched. OBJECTIVES To examine (1) the level of public health agency employees' perceived desirability for impacting health equity and SDoH, and (2) the impact of employee characteristics such as a (PH WINS) public health degree and awareness of health in all policies on such desirability. METHODS Data from the 2017 Public Health Workforce Interests and Needs Survey were used in examining the sense of desirability among agency employees for affecting health equity and SDoH in the agency jurisdictions. RESULTS Fifty-seven percent of health agency employees believed that their agencies should be very involved in affecting health equity in their jurisdictions. Fairly smaller proportions of employees believed in the desirability of affecting SDoH, and the proportions who believed that the agency should be very involved in affecting specific SDoH were 17.8% for affecting the quality of transportation, 18.5% for affecting the economy, 22.2% for quality of housing, 22.4% for quality of the built environment, 25.4% for K-12 education system, and 34.5% for impacting the quality of social support systems. Agency employees without a public health degree had significantly lower odds (P < .05) of believing that the agency should be very involved in affecting health equity. CONCLUSIONS With increasing efforts to reduce health inequities and leverage SDoH for improved population health, gaps exist in the public health workforce's perceived desirability for their agencies to be involved in such efforts. These gaps exist among employees regardless of their demographic characteristics, length of tenure, or agency setting. Policy and practice initiatives aimed to improve health equity might benefit from our findings positing a need for education regarding SDoH and health equity. Our study findings imply the need for interventions for improving alignment between employee beliefs and organizational priorities for an effective transformation to Public Health 3.0. Fostering cross-sector partnerships with a focus on Health in All Policies (HiAP), SDoH, and health equity must be a high priority for public health agencies, which can be formalized through organizational strategic plans.
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Affiliation(s)
- Gulzar H Shah
- Department of Health Policy and Behavior (Dr Shah), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Drs Shah and Yin and Ms Waterfield); and Department of Health Studies, American University, Washington, DC (Dr Young)
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13
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Rose-Clarke K, Gurung D, Brooke-Sumner C, Burgess R, Burns J, Kakuma R, Kusi-Mensah K, Ladrido-Ignacio L, Maulik PK, Roberts T, Walker IF, Williams S, Yaro P, Thornicroft G, Lund C. Rethinking research on the social determinants of global mental health. Lancet Psychiatry 2020; 7:659-662. [PMID: 32711698 DOI: 10.1016/s2215-0366(20)30134-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Kelly Rose-Clarke
- Department of Global Health and Social Medicine, King's College London, London WC2B 4BG, UK.
| | - Dristy Gurung
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Transcultural Psychosocial Organization Nepal, Kathmandu, Nepal
| | - Carrie Brooke-Sumner
- Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Rochelle Burgess
- Institute for Global Health, University College London, London, UK
| | - Jonathan Burns
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ritsuko Kakuma
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kwabena Kusi-Mensah
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Department of Psychiatry, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Lourdes Ladrido-Ignacio
- Department of Psychiatry, College of Medicine, University of the Philippines, Manila, Philippines
| | - Pallab K Maulik
- George Institute for Global Health, New Delhi, India; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; George Institute for Global Health, Oxford University, Oxford, UK
| | - Tessa Roberts
- Economic and Social Research Council Centre for Society and Mental Health, King's College London, London WC2B 4BG, UK; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ian F Walker
- Global Public Health Division, Public Health England, UK
| | - Shehan Williams
- Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | | | - Graham Thornicroft
- Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Crick Lund
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Abstract
The indelible impacts on our nation from the Coronavirus pandemic along with high fatality rates that disproportionately burden racial and ethnic minorities necessitate long-term coordinated federal, state and local action to improve critical determinants of population health, specifically important health and public health infrastructures as well as emergency and disaster preparedness systems. While our purview as the new pandemic epicenter should be a sufficient driver, coordinated health professionals bringing thoughtful attention to our historical context may be warranted. Prompting our advocacy should be the reality that our collective ability to rebound from such crises may ultimately hinge on protecting and equipping our most vulnerable racial-ethnic minority groups and any susceptible individuals within those populations. Recent historic firsts on behalf of racial and ethnic minorities taken by U.S. Department of Health and Human Services, through the Health Resources and Services Administration, the Office of Minority Health and the Centers for Disease Control and Prevention in response to COVID-19, if proven effective, should be considered for permanency within policy, practice and funding. In addition, given the complex history of Black Americans in this country and persistent and substantial Black-white disparities on health and economic measures across the board, the ultimate solution for improving the health and status Black Americans may look slightly different. Influenced by the 400th year anniversary of the first documented arrival of unfree Africans in North America in 1619, as well as the introduction of bills S.1080 and H.R.40 into Congress (The Commission to Study and Develop Reparation Proposals for African-Americans Act), some kind of reparations for Black Americans might serve as the logical starting point for further advocacy. Nevertheless, we remain supportive allies of all organizations concerned with communities who suffer the weight of this pandemic and any future world health disasters. What is additionally needed is a thoughtful unification of efforts and a commitment to sustained progress with measurable results for as long as the need exists and certainly for the foreseeable future. Let us as humane clinicians and public health professionals capture this moment of challenge and follow through on this urgent call to action.
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Affiliation(s)
- Randall C Morgan
- W. Montague Cobb/NMA Health Institute, Washington, DC 20036, USA
| | - Tiffany N Reid
- W. Montague Cobb/NMA Health Institute, Washington, DC 20036, USA.
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15
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Feller DJ, Zucker J, Walk OBD, Yin MT, Gordon P, Elhadad N. Longitudinal analysis of social and behavioral determinants of health in the EHR: exploring the impact of patient trajectories and documentation practices. AMIA Annu Symp Proc 2020; 2019:399-407. [PMID: 32308833 PMCID: PMC7153098] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Social and behavioral determinants of health (SBDH) are environmental and behavioral factors that impede disease self-management and can exacerbate clinical conditions. While recent research in the informatics community has focused on building systems that can automatically infer SBDH from the patient record, it is unclear how such determinants change overtime. This study analyzes the longitudinal characteristics of 4 common SBDH as expressed in the patient record and compares the rates of change among distinct SBDH. In addition, manual review of patient notes was undertaken to establish whether changes in patient SBDH status reflected legitimate changes in patient status or rather potential data quality issues. Our findings suggest that a patient's SBDH status is liable to change over time and that some changes reflect poor social history taking by clinicians.
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Affiliation(s)
- Daniel J Feller
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Jason Zucker
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, NY USA
| | | | - Michael T Yin
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, NY USA
| | - Peter Gordon
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, NY USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
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16
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Wang A, Kho AN, French DD. Association of the Robert Wood Johnson Foundations' social determinants of health and Medicare hospitalisations for ischaemic strokes: a cross-sectional data analysis. Open Heart 2020; 7:e001189. [PMID: 32076565 PMCID: PMC6999678 DOI: 10.1136/openhrt-2019-001189] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/12/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022] Open
Abstract
Objective Social determinants of health (SDH) have previously demonstrated to be important risk factors in determining health outcomes. To document whether the SDH are associated with hospitalisations for ischaemic stroke. Methods This cross-sectional study examines data from fiscal year 2015. Patients from the national Medicare 100% Inpatient Limited Dataset were linked with SDH measures from the Robert Wood Johnson Foundation (RWJF) County Health Rankings. Medicare patients were included in the study group if they had either an admitting or primary diagnosis of ischaemic stroke. Counties without RWJF data were excluded from the study. Ischaemic strokes were compared with all other hospitalisations associated with characteristics of the SDH measures and benchmarked to above or below their respective national median. Estimates were performed with nested logistic regression. Results Approximately 256 766 Medicare patients had ischaemic stroke hospitalisations compared with all other Medicare patients (n=6 386 180) without ischaemic stroke hospitalisations while 30 853 patients were excluded due to residence in US territories. Significant factors included air pollution exceeding the national median (OR 1.06; 95% CI 1.05 to 1.07), per cent of children in single parent households exceeding the national median, (OR 1.02; 95% CI 1.01 to 1.03), violent crime rates exceeding the national median, (OR 1.02; 95% CI 1.01 to 1.03) and per cent smoking exceeding the national median, (OR 1.02; 95% CI 1.01 to 1.03). Conclusions When cross-sectional SDH are benchmarked to national median for ischaemic stroke hospitalisations and compared with all-cause hospitalisations, the effects remain significant. Further research on the longitudinal effects of the SDH and cardiovascular health, particularly disease-specific outcomes, is needed.
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Affiliation(s)
- Andrew Wang
- Center for Healthcare Studies, Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Abel N Kho
- Medicine, Center for Health Information Partnerships, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dustin D French
- Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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17
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Hicks CW, Wang P, Bruhn WE, Abularrage CJ, Lum YW, Perler BA, Black JH, Makary MA. Race and socioeconomic differences associated with endovascular peripheral vascular interventions for newly diagnosed claudication. J Vasc Surg 2020; 72:611-621.e5. [PMID: 31902593 DOI: 10.1016/j.jvs.2019.10.075] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 04/24/2019] [Accepted: 10/14/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite guidelines cautioning against the use of endovascular peripheral vascular interventions (PVI) for claudication, more than 1.3 million PVI procedures are performed annually in the United States. We aimed to describe national rates of PVI for claudication, and identify patient and county-level risk factors associated with a high rate of PVI. METHODS We used the Medicare claims database to identify all Medicare beneficiaries with a new diagnosis of claudication between January 2015 and June 2017. A hierarchical logistic regression model accounting for patient age, sex, comorbidities; county region and setting; and a patient race-county median income interaction was used to assess the associations of race and income with a high PVI rate. RESULTS We identified 1,201,234 patients with a new diagnosis of claudication for analysis. Of these, 15,227 (1.27%) underwent a PVI. Based on hierarchical logistic regression accounting for patient and county-level factors, black patients residing in low-income counties had a significantly higher odds of undergoing PVI than their white counterparts (odds ratio [OR], 1.30; 95% confidence interval [CI], 1.20-1.40), whereas the odds of PVI for black versus white patients was similar in high-income counties (OR, 1.06; 95% CI, 0.99-1.14). PVI rates were higher for low versus high-income counties in both the black (OR, 1.46; 95% CI, 1.31-1.64) and white (OR, 1.19; 95% CI, 1.12-1.27) groups. There were no significant associations of Hispanic, Asian, North American native, or other races with PVI in either low- or high-income counties after risk adjustment (all P ≥ .09). CONCLUSIONS In the Medicare population, the mean rate of PVI of 12.7 per 1000 claudication patients varies significantly based on race and income. Our data suggest there are racial and socioeconomic differences in the treatment of claudication across the United States.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Peiqi Wang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - William E Bruhn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ying W Lum
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Bruce A Perler
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Md
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Martin A Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
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Tierney K, Cai Y. Assisted reproductive technology use in the United States: a population assessment. Fertil Steril 2019; 112:1136-1143.e4. [PMID: 31843090 PMCID: PMC6986780 DOI: 10.1016/j.fertnstert.2019.07.1323] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/23/2019] [Accepted: 07/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To study social and demographic differentiation of assisted reproduction technology (ART) use at the population level in the United States. DESIGN Population-based study. SETTING Not applicable. PATIENT(S) Women 15-49 years old in the American Community Survey and National Vital Statistics Birth Certificate data from 2010-2017. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Birth rate after ART by major sociodemographic categories and likelihood of having an ART birth. RESULT(S) Net of education, age, period, and marital status, the incidence rates of ART births are lower for black women (0.57 times; 95% CI, 0.52-0.62) and Hispanic women (0.67 times; 95% CI, 0.57-0.62) relative to white women's rates; for Asian women, the incidence rates are 1.21 times that of white women's rates. Further, the incidence rates of ART births are higher for women with more than a 4-year degree (2.08 times; 95% CI, 1.90-2.27) relative to women with a 4-year degree, and are lower for women with less education. Women who are married have an incidence rate of ART that is 5.72 times (95% CI, 5.37-6.09) that of unmarried women. The incidence rates for 2013-2016 are statistically significantly higher than for 2010 by a factor of 1.16 (95% CI, 1.02-1.31), 1.16 (95% CI, 1.03-1.31), 1.27 (95% CI, 1.12-1.43), and 1.51 (95% CI, 1.43-1.82), respectively. The educational differences in ART exist across all age groups from 20 to 49, but are the largest among the 35-39 and 40-44 age groups. CONCLUSION(S) Large differences in the risk of an ART birth and the proportion of births and the total fertility rate due to ART exist across period, age, race, education, and marital status groups in the United States. Current measures of ART births may disguise an unmet need for ART.
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Affiliation(s)
- Katherine Tierney
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Yong Cai
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Elfassy T, Swift SL, Glymour MM, Calonico S, Jacobs DR, Mayeda ER, Kershaw KN, Kiefe C, Al Hazzouri AZ. Associations of Income Volatility With Incident Cardiovascular Disease and All-Cause Mortality in a US Cohort. Circulation 2019; 139:850-859. [PMID: 30612448 PMCID: PMC6370510 DOI: 10.1161/circulationaha.118.035521] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Income volatility is on the rise and presents a growing public health problem. Because in many epidemiological studies income is measured at a single point in time, the association of long-term income volatility with incident cardiovascular disease (CVD) and mortality has not been adequately explored. The goal of this study was to examine associations of income volatility from 1990 to 2005 with incident CVD and all-cause mortality in the subsequent 10 years. METHODS The Coronary Artery Risk Development in Young Adults Study is an ongoing prospective cohort study conducted within urban field centers in Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA. We studied 3937 black and white participants 23 to 35 years of age in 1990 (our study baseline). Income volatility was defined as the intraindividual SD of the percent change in income across 5 assessments from 1990 to 2005. An income drop was defined as a decrease of ≥25% from the previous visit and less than the participant's average income from 1990 to 2005. CVD events (fatal and nonfatal) and all-cause mortality between 2005 and 2015 were adjudicated with the use of medical records and death certificates. CVD included primarily acute events related to heart disease and stroke. RESULTS A total of 106 CVD events and 164 deaths occurred between 2005 and 2015 (incident rate, 2.76 and 3.66 per 1000 person-years, respectively). From Cox models adjusted for sociodemographic, behavioral, and CVD risk factors, higher income volatility and more income drops were associated with greater CVD risk (high versus low volatility: hazard ratio, 2.07; 95% CI, 1.10-3.90; ≥2 versus 0 income drops: hazard ratio, 2.54; 95% CI, 1.24-5.19) and all-cause mortality (high versus low volatility: hazard ratio, 1.78; 95% CI,1.03-3.09; ≥2 versus 0 income drops: hazard ratio, 1.92; 95% CI, 1.07-3.44). CONCLUSIONS In a cohort of relatively young adults, income volatility and drops during a 15-year period of formative earning years were independently associated with a nearly 2-fold risk of CVD and all-cause mortality.
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Affiliation(s)
- Tali Elfassy
- Department of Public Health Sciences, School of Medicine, University of Miami, Miami, FL
| | - Samuel L. Swift
- Department of Public Health Sciences, School of Medicine, University of Miami, Miami, FL
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Sebastian Calonico
- Department of Economics, School of Business, Department of Economics, University of Miami, Miami, FL
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Elizabeth R. Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL
| | - Catarina Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Adina Zeki Al Hazzouri
- Department of Public Health Sciences, School of Medicine, University of Miami, Miami, FL
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20
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Coindre JP, Crochette R, Breuer C, Piccoli GB. Why are hospitalisations too long? A simple checklist for identifying the main social barriers to hospital discharge from a nephrology ward. BMC Nephrol 2018; 19:227. [PMID: 30208851 PMCID: PMC6134783 DOI: 10.1186/s12882-018-1023-1] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/28/2018] [Indexed: 12/14/2022] Open
Abstract
The present increase in life span has been accompanied by an even higher increase in the burden of comorbidity. The challenges to healthcare systems are enormous and performance measures have been introduced to make the provision of healthcare more cost-efficient. Performance of hospitalisation is basically defined by the relationship between hospital stay, use of hospital resources, and main diagnosis/diagnoses and complication(s), adjusted for case mix. These factors, combined in different indexes, are compared with the performance of similar hospitals in the same and other countries. The reasons why an approach like this is being employed are clear.Cutting costs cannot be the only criteria, in particular in elderly, high-comorbidity patients: in this population, although social issues are important determinants of hospital stay, they are rarely taken into account or quantified in evaluations. Quantifying the impact of the "social barriers" to care can serve as a marker of the overall quality of treatment a network provides, and point to specific out-of-hospital needs, necessary to improve in-hospital performance. We therefore propose a simple, empiric medico-social checklist that can be used in nephrology wards to assess the presence of social barriers to hospital discharge and quantify their weight.Using the checklist should allow: identifying patients with social frailty that could complicate hospitalisation and/or discharge; evaluating the social needs of patient and entourage at the beginning of hospitalisation, adopting timely procedures, within the partnership with out-of-hospital teams; facilitating prioritization of interventions by social workers.The following ten items were empirically identified: reason for hospitalisation; hospitalisation in relation to the caregiver's problems; recurrent unplanned hospitalisations or early re-hospitalisation; social/family isolation; presence of a dependent relative in the patient's household; lack of housing or unsuitable housing/accommodation; loss of autonomy; lack of economic resources; lack of a safe environment; evidence of physical or psychological abuse.The simple tool here described needs validation; the present proposal is aimed at raising attention on the importance of non-medical issues in medical organisation in our specialty, and is open to discussion, to allow its refinement.
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Affiliation(s)
- Jean Philippe Coindre
- Néphrologie, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000 le Mans, France
| | - Romain Crochette
- Néphrologie, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000 le Mans, France
| | - Conrad Breuer
- Direction des Finances, du Système d’Information et du Contrôle de Gestion, Centre Hospitalier Le Mans, 72000 le Mans, France
| | - Giorgina Barbara Piccoli
- Néphrologie, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000 le Mans, France
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy
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Kataoka SH, Ijadi-Maghsoodi R, Figueroa C, Castillo EG, Bromley E, Patel H, Wells KB. Stakeholder Perspectives on the Social Determinants of Mental Health in Community Coalitions. Ethn Dis 2018; 28:389-396. [PMID: 30202192 PMCID: PMC6128346 DOI: 10.18865/ed.28.s2.389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/18/2022] Open
Abstract
Objective Although evidence supports the potential for community coalitions to positively address social determinants of mental health, little is known about the views of stakeholders involved in such efforts. This study sought to understand county leaders' perspectives about social determinants related to the Health Neighborhood Initiative (HNI), a new county effort to support community coalitions. Design Descriptive, qualitative study, 2014. Setting Community coalitions, located in a large urban city, across eight service planning areas, that serve under-resourced, ethnic minority populations. Procedures We conducted key informant interviews with 49 health care and community leaders to understand their perspectives about the HNI. As part of a larger project, this study focused on leaders' views about social determinants of health related to the HNI. All interviews were audio-recorded and transcribed. An inductive approach to coding was used, with text segments grouped by social determinant categories. Results County leaders described multiple social determinants of mental health that were relevant to the HNI community coalitions: housing and safety, community violence, and employment and education. Leaders discussed how social determinants were interconnected with each other and the need for efforts to address multiple social determinants simultaneously to effectively improve mental health. Conclusions Community coalitions have an opportunity to address multiple social determinants of health to meet social and mental health needs of low-resourced communities. Future research should examine how community coalitions, like those in the HNI, can actively engage with community members to identify needs and then deliver evidence-based care.
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Affiliation(s)
- Sheryl H. Kataoka
- Center for Health Services and Society, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Roya Ijadi-Maghsoodi
- Division of Population Behavioral Health, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, VA Greater Los Angeles Health care System, Los Angeles, CA
| | - Chantal Figueroa
- Center for Health Services and Society, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Enrico G. Castillo
- David Geffen School of Medicine, University of California, Los Angeles; Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Elizabeth Bromley
- Center for Health Services and Society, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Heather Patel
- Center for Health Services and Society, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Kenneth B. Wells
- Center for Health Services and Society, Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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Abstract
The social determinants of health (SDOH) are receiving increased attention due to their influence on health disparities, health outcomes, and overall quality of life. Nurse leaders must take an active role in advocating for strategies that address these important issues. The purpose of this descriptive study was to explore nurses' knowledge, attitudes, and behaviors related to SDOH. A sample of 107 registered nurses completed the SDOH survey. Findings revealed that nurses experience personal discomfort and anticipate patient discomfort related to addressing the SDOH in their practice. They also voice a lack of skill, lack of time, and a dependency on other professionals to address these issues. The findings highlight the need for nurse leaders to advocate for nurses and those they care for through policy development, collaboration, and education. Based on the findings of this study, multiple strategies for nurse leaders serving as advocates are presented.
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Affiliation(s)
- Sabita Persaud
- School of Nursing, Notre Dame of Maryland University, Baltimore
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Schmidt S, Higgins S, George M, Stone A, Bussey-Jones J, Dillard R. An Experiential Resident Module for Understanding Social Determinants of Health at an Academic Safety-Net Hospital. MedEdPORTAL 2017; 13:10647. [PMID: 30800848 PMCID: PMC6338147 DOI: 10.15766/mep_2374-8265.10647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 09/28/2017] [Indexed: 05/14/2023]
Abstract
Introduction Half of the U.S. population has chronic illness. Many disparities exist in health care for management of chronic disease among poorer individuals, including decreased access to healthy foods, homelessness, and difficulty navigating large hospital systems due to low health literacy. A survey of resident physicians found significant gaps in preparedness to provide cross-cultural care. Education is needed to promote consideration of patients' social and cultural barriers in managing disease and navigating the health care system. This module was created as an introduction to social determinants of health, and highlights disparities in access to healthy food, water, shelter, and medical care in a sample of the residents' own continuity clinic patient panel. Methods We designed this experiential module to help internal medicine residents at an urban institution better understand how social constructs might hinder patient health. Activities were chosen by learners from a list of options, and carried out in small groups during a half day of protected time. We used reflective writing exercises to elicit resident thoughts about the module. Results Thirty-nine second-year residents participated in the module. Following the course, 41% of residents submitted reflective statements about their experience. Reflective responses suggest an enhanced appreciation for social determinants of health, a sense of empowerment to advocate for better patient resources, and an appreciation for systems-level factors that play a role in social determinants of health. Discussion Our results demonstrate that a short, experience-based module can impact resident attitudes about social determinants and improve advocacy around identifying community resources.
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Affiliation(s)
- Stacie Schmidt
- Assistant Professor, Department of General Medicine and Geriatrics, Emory University
| | - Stacy Higgins
- Associate Professor, Department of General Medicine and Geriatrics, Emory University
| | - Maura George
- Assistant Professor, Department of General Medicine and Geriatrics, Emory University
| | - Alanna Stone
- Assistant Professor, Department of General Medicine and Geriatrics, Emory University
| | - Jada Bussey-Jones
- Section Chief at Grady, Department of General Medicine and Geriatrics, Emory University
| | - Rebecca Dillard
- Assistant Program Director, Emory Center for Health in Aging, Emory University
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Abstract
Social and economic disadvantage and civil rights infringement, worsens overall health (Adler, Glymour, & Fielding, 2016; McGowan, Lee, Meneses, Perkins, & Youdelman, 2016; Teitelbaum, 2005). While addressing these challenges is not new, there is reason to believe that the administration of Donald Trump and a republican majority in congress will exacerbate these challenges and their effects. How can collaborative family health care (CFHC) practitioners and our field help? The editors pondered this question and also asked a selection of leaders in the field. The editors will first share their ideas about the potential of CFHC to make a difference in daily interactions with patients. Next, they will identify key areas of risk and vulnerability. Finally, using the contributions of respected colleagues, they will propose a partial agenda for CFHC clinicians and the field. (PsycINFO Database Record
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Abstract
INTRODUCTION Literacy is linked to a range of health outcomes, but its association with reproductive health in high-income countries is not well understood. We assessed the relationship between early-life literacy and childbearing across the reproductive lifecourse in the USA. STUDY DESIGN A prospective cohort design was employed to assess early-life literacy and subsequent childbearing, using data from the National Longitudinal Survey of Youth 1979. The US youth aged 14-22 years in 1979, including 6283 women, were surveyed annually through 1994 and biannually thereafter. Literacy was assessed in 1980 using the Armed Services Vocational Aptitude Battery Reading Grade Level (RGL). Cumulative childbearing and grand multiparity (≥5 births) were assessed in 2010. Summary statistics, χ2, Kruskal-Wallis, test for trend and logistic regression, were used. RESULTS Of 6283 women enrolled, 4025 (64%) had complete data and were included in the analyses. In 1980, these women were on average 18 years old and in 2010 they were 45. Median cumulative parity decreased for each RGL and ranged from 3.0 (<5th grade) to 2.0 (>12th grade) (p=0.001). Adjusting for race/ethnicity, poverty status, whether a woman had had a child in 1980, and age in 1980, odds of grand multiparity were 1.9 (95% CI 1.1 to 3.5) and 1.8 (95% CI 1.0 to 3.3), greater among women with <5th or 5-6th grade literacy compared with those ≥12th literacy. DISCUSSION In the USA, early-life literacy is associated with total parity over a woman's lifecourse. Literacy is a powerful social determinant of reproductive health in this high-income nation just as it has been shown to be in low-income nations.
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Affiliation(s)
- Jane W Seymour
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Rosemary Frasso
- Master of Public Health Program, Center for Public Health Initiatives, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances S Shofer
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ian M Bennett
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
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Benach J, Vives A, Tarafa G, Delclos C, Muntaner C. What should we know about precarious employment and health in 2025? Framing the agenda for the next decade of research. Int J Epidemiol 2016; 45:232-8. [PMID: 26744486 DOI: 10.1093/ije/dyv342] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The generalization of flexible labour markets, the declining influence of unions and the degradation of social protection has led to the emergence of new forms of employment at the expense of the Standard Employment Relationship, as well as a considerable amount of research across social and scientific disciplines. Years ago we suggested the urgent need to disentangle the consequences of new types of employment for the health and well-being of workers, contending that the study of precarious employment and health is in its infancy. Today, research challenges include clearer, more precise definitions of the original concepts, a more detailed understanding of the pathways and mechanisms through which precarious employment harms worker health, stronger information systems for monitoring the problem and a complex systems approach to employment conditions and health research. All of these must be guided by the theoretical and policy debates linking precarious employment and health, and be geared towards developing better tools for the design, implementation and evaluation of policies intended to minimize precariousness in the labour market and its effects on public health and health inequalities. Our aim in this paper is to outline an agenda for the next decade of research on precarious employment and health, establishing a compelling programme that expands our understanding of complex causes and links.
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Addressing the social determinants of health in young people. Lancet 2016; 387:1134. [PMID: 27025317 DOI: 10.1016/S0140-6736(16)30004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Horner J. From Exceptional to Liminal Subjects: Reconciling Tensions in the Politics of Tuberculosis and Migration. J Bioeth Inq 2016; 13:65-73. [PMID: 26757725 DOI: 10.1007/s11673-016-9700-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/24/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
Controlling the movement of potentially infectious bodies has been central to Australian immigration law. Nowhere is this more evident than in relation to tuberculosis (TB), which is named as a ground for refusal of a visa in the Australian context. In this paper, I critically examine the "will to knowledge" that this gives rise to. Drawing on a critical analysis of texts, including interviews with migrants diagnosed with TB and healthcare professionals engaged in their care (n=19), I argue that this focus on border policing, rather than resettlement and the broader social determinants of health that drive current rates of TB, paradoxically renders migrants diagnosed with TB as liminal subjects in the post-arrival phase. This raises ethical issues about who "matters," as well as dilemmas about what constitutes adequate care for the "Other," both of which go to the heart of the political economy of migration.
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Affiliation(s)
- Jed Horner
- Australian Human Rights Centre, Faculty of Law, UNSW Australia, UNSW Law Building, University of New South Wales, Sydney, NSW, 2052, Australia.
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Yamada S, Riklon S, Maskarinec GG. Ethical Responsibility for the Social Production of Tuberculosis. J Bioeth Inq 2016; 13:57-64. [PMID: 26715047 DOI: 10.1007/s11673-015-9681-1] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/26/2015] [Indexed: 06/05/2023]
Abstract
Approximately one in two hundred persons in the Marshall Islands have active tuberculosis (TB). We examine the historical antecedents of this situation in order to assign ethical responsibility for the present situation. Examining the antecedents in terms of Galtung's dialectic of personal versus structural violence, we can identify instances in the history of the Marshall Islands when individual subjects made decisions (personal violence) with large-scale ecologic, social, and health consequences. The roles of medical experimenters, military commanders, captains of the weapons industry in particular, and industrial capitalism in general (as the cause of global warming) are examined. In that, together with Lewontin, we also identify industrial capitalism as the cause of tuberculosis, we note that the distinction between personal versus structural violence is difficult to maintain. By identifying the cause of the tuberculosis in the Marshall Islands, we also identify what needs be done to treat and prevent it.
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Affiliation(s)
- Seiji Yamada
- Department of Family Medicine and Community Health, University of Hawai'i, 95-390 Kuahelani Avenue, Mililani, HI, 96789, USA.
| | - Sheldon Riklon
- Department of Family Medicine and Community Health, University of Hawai'i, 95-390 Kuahelani Avenue, Mililani, HI, 96789, USA
| | - Gregory G Maskarinec
- Department of Family Medicine and Community Health, University of Hawai'i, 95-390 Kuahelani Avenue, Mililani, HI, 96789, USA
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Fitzpatrick SJ. Scientism as a Social Response to the Problem of Suicide. J Bioeth Inq 2015; 12:613-622. [PMID: 26615545 DOI: 10.1007/s11673-015-9662-4] [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: 12/07/2014] [Accepted: 08/29/2015] [Indexed: 06/05/2023]
Abstract
As one component of a broader social and normative response to the problem of suicide, scientism served to minimize sociopolitical and religious conflict around the issue. As such, it embodied, and continues to embody, a number of interests and values, as well as serving important social functions. It is thus comparable with other normative frameworks and can be appraised, from an ethical perspective, in light of these values, interests, and functions. This work examines the key values, interests, and functions of scientism in suicidology and argues that although scientism has had some social benefit, it primarily serves to maintain political and professional interests and has damaging implications for suicide research and prevention.
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Affiliation(s)
- Scott J Fitzpatrick
- Centre for Rural and Remote Mental Health, The University of Newcastle, Locked Bag 6005, Orange, NSW, 2800, Australia.
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de Andrade LOM, Pellegrini Filho A, Solar O, Rígoli F, de Salazar LM, Serrate PCF, Ribeiro KG, Koller TS, Cruz FNB, Atun R. Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries. Lancet 2015; 385:1343-51. [PMID: 25458716 DOI: 10.1016/s0140-6736(14)61494-x] [Citation(s) in RCA: 135] [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: 11/30/2022]
Abstract
Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies.
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Affiliation(s)
| | - Alberto Pellegrini Filho
- Center for Studies, Policies, and Information on Social Determinants of Health (CEPI-DSS), Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Orielle Solar
- Latin American Faculty of Social Sciences (FLACSO), Chile
| | - Félix Rígoli
- Health Systems Division, Pan American Health Organization, Brasília, Brazil
| | | | | | | | - Theadora Swift Koller
- Gender, Equity, and Human Rights Team, World Health Organization, Geneva, Switzerland
| | | | - Rifat Atun
- Harvard School of Public Health, Harvard University, Boston, MA, USA.
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Abstract
Policy innovations and lessons associated with the quest for universal health coverage in Latin America are the result of a complex epidemiological transition, an extended process of democratisation, and high economic growth in recent times that has facilitated additional investments in health. The goal of universal health coverage is part of a third generation of health-system reforms, which implies a comprehensive scope of policy interventions, including the introduction of explicit ethical frameworks, the enhanced attention to financial arrangements, and the transformation of major dimensions of the organisation of health systems. The call for action emphasises the next steps that could help reach the goal of universal health coverage both in the Latin American region and the rest of the developing world.
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Affiliation(s)
- Julio Frenk
- Harvard School of Public Health, Boston, MA, USA; Harvard Kennedy School of Government, Cambridge, MA, USA.
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McCoy M. Essay: leaky pipes. J Bioeth Inq 2015; 12:93-94. [PMID: 25648124 DOI: 10.1007/s11673-015-9613-0] [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] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 12/09/2014] [Indexed: 06/04/2023]
Abstract
In the face of great tragedy, the desire to pinpoint blame can be instinctual as a remedy for alleviating one's conscience in a system that causes great suffering. However, to remedy the system that causes such suffering requires a critical analysis of the factors that perpetuate inequitable power structures. This is the story of a journey that broadened my lens of analysis with which to critically evaluate the harmful structural and social determinants magnified in resource-limited settings.
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Affiliation(s)
- Melissa McCoy
- University of Minnesota Medical School, 2337 264th Ct. NW, Isanti, MN, 55050, USA,
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Peota C. Beyond the clinic. Minn Med 2015; 98:7. [PMID: 25771638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
A growing body of empirical research examines the effects of the so-called "social determinants of health" (SDH) on health and health inequalities. Several high-profile publications have issued policy recommendations to reduce health inequalities based on a specific interpretation of this empirical research as well as a set of normative assumptions. This article questions the framework defined by these assumptions by focusing on two issues: first, the normative judgments about the (un)fairness of particular health inequalities; and second, the policy recommendations issued on this basis. We argue that the normative underpinnings of the approach are insufficiently supported and that the policy recommendations do not necessarily follow from the arguments provided. Furthermore, while many of the policies recommended-such as improving people's living conditions and reducing inequalities in wealth and power-are justified in their own right, the way these recommendations are tied to health is problematic.
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Abstract
INTRODUCTION Despite the recognized importance of social determinants of health (SDH) in India, no compilation of the status of and inequities in SDH across India has been published. To address this gap, we assessed the levels and trends in major SDH in India from 1990 onwards and explored inequities by state, gender, caste, and urbanicity. METHODS Household- and individual-level SDH indicators were extracted from national household surveys conducted between 1990 and 2011 and means were computed across population subgroups and over time. The multidimensional poverty index (MPI), a composite measure of health, education, and standard of living, was calculated for all three rounds of the National Family Health Survey, adjusting the methodology to generate comparable findings from the three datasets. Data from government agencies were analyzed to assess voting patterns, political participation, and air and water pollution. RESULTS Changes in the MPI demonstrate progress in each domain over time, but high rates persist in important areas: the majority of households in India use indoor biomass fuel and have unimproved sanitation, and over one-third of households with a child under the age of 3 years have undernourished children. There are large, but narrowing, gender gaps in education indicators, but no measurable change in women's participation in governance or the labor force. Less than 25% of workers have job security and fewer than 15% have any social security benefit. Alarming rates of air pollution are observed, with particulate matter concentrations persistently above the critical level at over 50% of monitoring stations. CONCLUSIONS This assessment indicates that air pollution (indoor and outdoor), child undernutrition, unimproved sanitation, employment conditions, and gender inequality are priority areas for public policy related to SDH in India.
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Affiliation(s)
- Krycia Cowling
- Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, New Delhi, India.
| | - Rakhi Dandona
- Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, New Delhi, India.
| | - Lalit Dandona
- Public Health Foundation of India, Plot 47, Sector 44, Gurgaon, 122002, New Delhi, India.
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
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Etienne CF. Social determinants of health in the Americas. Rev Panam Salud Publica 2013; 34:375-378. [PMID: 24569964] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Carissa F Etienne
- Oficina Sanitaria Panamericana, Washington, D.C., Estados Unidos de América
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Marmot M, Pellegrini Filho A, Vega J, Solar O, Fortune K. Action on social determinants of health in the Americas. Rev Panam Salud Publica 2013; 34:379-384. [PMID: 24569965] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Michael Marmot
- Instituto de Equidad en Salud, Departamento de Epidemiología y Salud Pública de Londres, University College London, Londres, Reino Unido
| | - Alberto Pellegrini Filho
- Centro de Estudios, Políticas e Información sobre Determinantes Sociales de la Salud, Escuela Nacional de Salud Pública, Fundación Oswaldo Cruz, Brasil
| | - Jeanette Vega
- Fundación de Rockefeller, Nueva York, Nueva York, Estados Unidos de América
| | - Orielle Solar
- Facultad Latinoamericana de Ciencias Sociales, Escuela Nacional de Salud Pública, Universidad de Chile, Santiago, Chile
| | - Kira Fortune
- Organización Panamericana de la Salud, Washington, D.C., Estados Unidos de América
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Laverack G. Activism and health in hard times. Int J Public Health 2012; 58:489-90. [PMID: 23001112 DOI: 10.1007/s00038-012-0412-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/10/2012] [Indexed: 11/27/2022] Open
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