The impact of the cost-of-living crisis on population health in the UK: rapid evidence review.

BACKGROUND: In the UK, unique and unforeseen factors, including COVID-19, Brexit, and Ukraine-Russia war, have resulted in an unprecedented cost of living crisis, creating a second health emergency. We present, one of the first rapid reviews with the aim of examining the impact of this current crisis, at a population level. We reviewed published literature, as well as grey literature, examining a broad range of physical and mental impacts on health in the short, mid, and long term, identifying those most at risk, impacts on system partners, including emergency services and the third sector, as well as mitigation strategies. METHODS: We conducted a rapid review by searching PubMed, Embase, MEDLINE, and HMIC (2020 to 2023). We searched for grey literature on Google and hand-searched the reports of relevant public health organisations. We included interventional and observational studies that reported outcomes of interventions aimed at mitigating against the impacts of cost of living at a population level. RESULTS: We found that the strongest evidence was for the impact of cold and mouldy homes on respiratory-related infections and respiratory conditions. Those at an increased risk were young children (0-4 years), the elderly (aged 75 and over), as well as those already vulnerable, including those with long-term multimorbidity. Further short-term impacts include an increased risk of physical pain including musculoskeletal and chest pain, and increased risk of enteric infections and malnutrition. In the mid-term, we could see increases in hypertension, transient ischaemic attacks, and myocardial infarctions, and respiratory illnesses. In the long term we could see an increase in mortality and morbidity rates from respiratory and cardiovascular disease, as well as increase rates of suicide and self-harm and infectious disease outcomes. Changes in behaviour are likely particularly around changes in food buying patterns and the ability to heat a home. System partners are also impacted, with voluntary sectors seeing fewer volunteers, an increase in petty crime and theft, alternative heating appliances causing fires, and an increase in burns and burn-related admissions. To mitigate against these impacts, support should be provided, to the most vulnerable, to help increase disposable income, reduce energy bills, and encourage home improvements linked with energy efficiency. Stronger links to bridge voluntary, community, charity and faith groups are needed to help provide additional aid and support. CONCLUSION: Although the CoL crisis affects the entire population, the impacts are exacerbated in those that are most vulnerable, particularly young children, single parents, multigenerational families. More can be done at a community and societal level to support the most vulnerable, and those living with long-term multimorbidity. This review consolidates the current evidence on the impacts of the cost of living crisis and may enable decision makers to target limited resources more effectively.

Social Risk and Dialysis Facility Performance in the First Year of the ESRD Treatment Choices Model.

Importance: The End-Stage Renal Disease Treatment Choices (ETC) model randomly selected 30% of US dialysis facilities to receive financial incentives based on their use of home dialysis, kidney transplant waitlisting, or transplant receipt. Facilities that disproportionately serve populations with high social risk have a lower use of home dialysis and kidney transplant raising concerns that these sites may fare poorly in the payment model. Objective: To examine first-year ETC model performance scores and financial penalties across dialysis facilities, stratified by their incident patients' social risk. Design, Setting, and Participants: A cross-sectional study of 2191 US dialysis facilities that participated in the ETC model from January 1 through December 31, 2021. Exposure: Composition of incident patient population, characterized by the proportion of patients who were non-Hispanic Black, Hispanic, living in a highly disadvantaged neighborhood, uninsured, or covered by Medicaid at dialysis initiation. A facility-level composite social risk score assessed whether each facility was in the highest quintile of having 0, 1, or at least 2 of these characteristics. Main Outcomes and Measures: Use of home dialysis, waitlisting, or transplant; model performance score; and financial penalization. Results: Using data from 125 984 incident patients (median age, 65 years [IQR, 54-74]; 41.8% female; 28.6% Black; 11.7% Hispanic), 1071 dialysis facilities (48.9%) had no social risk features, and 491 (22.4%) had 2 or more. In the first year of the ETC model, compared with those with no social risk features, dialysis facilities with 2 or more had lower mean performance scores (3.4 vs 3.6, P = .002) and lower use of home dialysis (14.1% vs 16.0%, P < .001). These facilities had higher receipt of financial penalties (18.5% vs 11.5%, P < .001), more frequently had the highest payment cut of 5% (2.4% vs 0.7%; P = .003), and were less likely to achieve the highest bonus of 4% (0% vs 2.7%; P < .001). Compared with all other facilities, those in the highest quintile of treating uninsured patients or those covered by Medicaid experienced more financial penalties (17.4% vs 12.9%, P = .01) as did those in the highest quintile in the proportion of patients who were Black (18.5% vs 12.6%, P = .001). Conclusions: In the first year of the Centers for Medicare & Medicaid Services' ETC model, dialysis facilities serving higher proportions of patients with social risk features had lower performance scores and experienced markedly higher receipt of financial penalties.

In a First-of-Its-Kind Program, Physicians at This Medical Center Now Write "Power Prescriptions".

This Medical News article discusses a new Boston Medical Center initiative that helps patients with financial hardship pay their utility bills.

Actividades físico-recreativas e integración social en el adulto mayor / Physical-recreational activities and social integration in the elderly

Introducción: La integración social es un proceso dinámico que mejora la inclusión de sujetos en riesgos de exclusión, requiriendo de estrategias especializadas, como pueden ser los programas aplicados de actividad física. Objetivo: Valorar los efectos de la actividad física en la integración social del adulto mayor jubilado de la Espoch. Métodos: Se estudian a 34 exservidores públicos jubilados de la Escuela Superior Politécnica de Chimborazo (Espoch), con un nivel moderado auto percibido de depresión/ansiedad, sometiéndolos a un proceso de intervención con actividades físico-recreativas que incluyen 7 unidades con sesiones de 90min. Los adultos mayores fueron evaluados con la Escala Auto Aplicada de Adaptación Social-SASS en dos momentos del proceso de intervención. Resultados: El pretest determinó una media de 2.24puntos (≈2: Desadaptación social patente), incrementándose el puntaje promedio como parte del posttest a 2.76 (≈3: Normalidad), existiendo diferencias significativas a favor del posttest (p=0.000). Conclusiones: Se demuestra un incremento de la adaptación social basada en un equilibrio de los niveles de integración con el entorno conocido (universidad), logrados con la implementación de la propuesta de intervención. En tal sentido, los programas físico-recreativo especializados pueden ser complementos efectivos para potenciar la integración de un grupo social determinado, como es el caso de adultos mayores jubilados de un centro de educación superior(AU)

Introduction: Social integration is a dynamic process that improves the subject's inclusion at exclusion risk, requiring specialized strategies, such as physical activity programs. Objective: to assess the physical activity effects on the social integration of the retired older adult from Espoch. Methods: 34 former retired public servants from the Escuela Superior Politécnica de Chimborazo (Espoch), with a self-perceived moderate level of depression/anxiety, were studied, subjecting them to an intervention process with physical-recreational activities that included 7 units with 90-min sessions. The older adults were evaluated with the Self-Applied Scale of Social Adaptation-SASS at two moments of the intervention process. Results: The pretest determined an average of 2.24 points (≈2: patent social maladjustment), increasing the score as part of the posttest to 2.76 (≈3: Normality), with significant differences in posttest favor (p=0.000). Conclusions: an increase in social adaptation is demonstrated based on a balance level of integration with the known environment (university), achieved with the implementation of the intervention proposal. In this sense, specialized physical-recreational programs can be effective complements to promote the integration of a specific social group, as is the case of older adults retired from a higher education center(AU)

Desigualdades sociales en la mortalidad de niños menores de cinco años: revisión sistemática / Social inequalities in under-five mortality: a systematic review

RESUMEN Objetivo Identificar las características de los estudios sobre desigualdades sociales, en la mortalidad de niños menores de cinco años; sus perspectivas teóricas, ejes de desigualdad, métodos y resultados. Método Revisión sistemática de la literatura. Se consultaron cuatro bases de datos electrónicas y Google Scholar; se incluyeron estudios entre 2010 y 2018. Resultados Se analizaron 126 artículos. En el 62,7%, se estudió el territorio como eje de desigualdad, seguido por los determinantes socioeconómicos (27,8%). La mortalidad neonatal, infantil y en la niñez fue analizada en el 19,0%, 49,2% y 32,3%, respectivamente. Predominaron los estudios ecológicos (62,7%) y longitudinales (50,0%). Se encontró una disminución considerable en las tasas de mortalidad; sin embargo, el descenso no fue homogéneo entre subpoblaciones. Conclusiones La literatura reporta una marcada disminución de la mortalidad en niños menores de cinco años; no obstante, las brechas entre distintos ejes de desigualdad continúan y en algunos lugares se han incrementado. Las brechas entre los estratificadores variaron de acuerdo con el tiempo, lugar, eje de desigualdad y tipo de mortalidad analizada.(AU)

ABSTRACT Objective To identify the characteristics of the published studies on social inequalities in under-five mortality, their theoretical perspectives, axes of inequality, methods and results. Method We carried out a systematic literature review. We consulted four electronic databases and Google Scholar, for studies published between 2010 and 2018. Results We analyzed 126 articles. In 62.7%, territory was studied as the axis of inequality, followed by socioeconomic determinants (27.8%). Neonatal, infant and under-five mortality was analyzed as an output in health in 19.0%, 49.2% and 32.3%, respectively. It predominated ecological (62.7%) and longitudinal (50.0%) studies. Significant reductions in mortality rates were found, however, the decline was not homogeneous among subpopulations. Conclusions The literature reports a marked decrease in under-five mortality; however, the gaps between different axes of inequality continue and in some cases they have increased. Gaps varied according to time, place, axis of inequality and type of mortality analyzed.(AU)

A pandemia de COVID-19 para além das Ciências da Saúde: reflexões sobre sua determinação social / The COVID-19 pandemic beyond Health Sciences: reflections on its social determination

Resumo Este artigo possui o objetivo de realizar uma reflexão teórica sobre os fundamentos histórico-sociais da pandemia de COVID-19. A partir da matriz teórica materialista histórica, evoca-se as categorias da "mundialização do capital", "capital-imperialismo", "compressão espaço-tempo" e "crise estrutural do capital" traçando um percurso que ultrapassa os limites das Ciências da Saúde a fim de entender a saúde global, da qual a pandemia de COVID-19 é expressão. Posteriormente, faz-se o retorno ao campo da saúde, quando a categoria da "determinação social da saúde" permite elucidar as bases da pandemia estudada. Demonstra-se que, para além das características próprias do SARS-CoV-2 ou da dinâmica de rápido trânsito de pessoas e objetos pelo mundo, há outros elementos típicos da atual fase do capitalismo contemporâneo que se tornaram universais, unificando o processo de determinação social da saúde.

Abstract This paper aims to perform a theoretical reflection on the historical-social foundations of the COVID-19 pandemic. The "capital worldization", "capital-imperialism", "space-time compression", and "structural crisis of capital" categories are conjured from the historical materialistic-theoretical matrix, outlining a course that transcends the limits of Health Sciences to understand global health, of which the COVID-19 pandemic is an expression. We then return to the field of health, when the category of "social determination of health" allows elucidating the bases of the pandemic studied. We show that, other elements typical of the current phase of contemporary capitalism have become universal besides the SARS-CoV-2 characteristics or the dynamics of the rapid movement of people and objects around the world, unifying the health social determination process.

El efecto de la crisis económica sobre la salud en España según el nivel educativo y la relación con la actividad: ¿importa también la duración de la crisis? / The effect of the economic crisis on health in Spain according to educational level and employment status: Does the duration of the crisis also matter?

RESUMEN El objetivo del trabajo es explorar el posible efecto que la crisis económica ha tenido sobre la salud de la población nacida en España en edad adulta previa a la jubilación (entre 30 y 59 años). Específicamente, a partir de los datos de la European Union Statistics on Income and Living Conditions (EU-SILC) para los años 2006, 2010 y 2014 analizamos diferencias en la salud autopercibida según su perfil socioeconómico y la posición que ocupan en el hogar. Nuestros resultados muestran que la salud de los hombres y las mujeres tienen niveles de asociación similares con ciertos factores (por ejemplo, nivel educativo) y diferenciados con otros (la salud de la mujer es ligeramente más sensible al nivel de los ingresos del hogar, mientras la salud de los hombres a su propio estado de empleo). Finalmente, mientras que en el primer periodo se observan mejoras sustanciales en la salud autopercibida en casi todos los grupos socioeconómicos, en el segundo periodo no hay casi ningún cambio e incluso, para algunos hombres con un perfil más desfavorecido (inactivos con educación baja), la salud empeoró.

ABSTRACT The objective of this study is to explore the possible impact of the economic crisis on the health of the Spanish-born population not of retirement age (between 30 and 59 years). Specifically, using data from the European Union Statistics on Income and Living Conditions (EU-SILC) for the years 2006, 2010 and 2014, we analyze differences in self-perceived health by socioeconomic profile and position occupied in the household. According to our results, the health of men and women show similar levels of association with certain factors (such as education) and different levels with others (women's health is more sensitive to household income level while men's is more sensitive to employment status). Finally, while substantial improvements in self-perceived health were observed during the first period in almost all socioeconomic groups, during the second period there was almost no change, and for the most disadvantaged men (inactive in the labor market and with low educational levels), health worsened.

Demandas de cuidado domiciliar da criança nascida exposta ao HIV na ótica da teoria ambientalista / Demandas de cuidados en casa del niño nacido expuesto al VIH en la óptica de la teoría ambientalista / Demands of home care of children born exposed to HIV in the perspective of the environmental theory

Objetivou-se identificar as demandas de cuidado domiciliar da criança nascida exposta ao HIV, sob a perspectiva da teoria ambientalista. Trata-se de estudo qualitativo exploratório-descritivo realizado de janeiro a abril de 2011. Participaram dez mães infectadas pelo HIV, com crianças nascidas expostas ao vírus, em Fortaleza, Ceará. Constituíram-se como instrumentos de coleta de dados: câmera fotográfica descartável e digital e formulários para captação de informações em saúde associadas ao ambiente domiciliar. Os resultados foram contextualizados de acordo com a teoria e organizados em categorias: "vulnerabilidades associadas à estrutura física da moradia"; "ar intradomiciliar e peridomiciliar impuro"; "água utilizada para consumo"; "rede de esgoto e saneamento"; "iluminação e ventilação da residência". Conclui-se que o ambiente domiciliar oferece condições ambientais desfavoráveis para a criança. Urge a realização de intervenções focalizadas no ambiente domiciliar, para promover a saúde da criança nascida exposta ao HIV.

Se objetivó identificar las demandas de atención en el hogar de los niños nacidos expuestos al VIH en la perspectiva de la teoría ambientalista. Estudio cualitativo exploratorio-descriptivo realizado entre enero y abril de 2011. Participaron diez madres VIH-positivas con bebés expuestos al virus, en Fortaleza, Ceará. Fueron instrumentos de recolección de datos: cámara desechable y digital y formularios para capturar información sobre la salud asociada con el ambiente del hogar. Los resultados fueron contextualizados de acuerdo a la teoría y organizado en categorías: vulnerabilidades asociadas con la estructura física de la casa; aire intra y peridoméstico impuro; agua utilizada para el consumo; saneamiento y alcantarillado; iluminación y ventilación de la residencia. Se concluye que el hogar ofrece condiciones ambientales desfavorables para el niño. Hay necesidad de intervenciones específicas en el entorno del hogar para promover la salud de los niños nacidos expuestos al VIH.

The purpose of this study was to identify the demands of home care of children born exposed to HIV in the perspective of the environmental theory. It consists of an exploratory descriptive qualitative study, developed between January and April of 2011. Study participants were ten HIV-infected mothers with infants exposed to the virus, living in Fortaleza, Ceará. The data collection instruments included: a disposable digital camera and forms to obtain information on health associated with the home environment. Results were contextualized according to the theory and organized into the following categories: vulnerabilities associated with the physical structure of the house; contaminated intra and peridomestic air; unclean water used for drinking; sanitation and sewerage system; lighting and ventilation of the house. In conclusion, the home environment offers unfavorable environmental conditions for the child. Targeted interventions in the home environment are necessary so as to promote the health of children born exposed to HIV.