Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.065
Filtrar
1.
Acad Pediatr ; 21(8S): S140-S145, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34740421

RESUMEN

Despite our wealth, child poverty in the United States remains too high. The social safety net prevents and mitigates poverty for millions of children each year and evidence demonstrates long-term positive effects for recipients. But absent a commitment to universalism, our public investments in children produce uneven - and often inequitable - results. Our current system is heavily means-tested and work-conditioned. Though heavily targeted, it varies widely in adequacy and coverage by location and across population groups and it fails to serve all children in need. This article describes the evolution of the US social safety net for children over the last century. It traces the early 20th century origins of the contemporary system and the changes it saw through the mid-century's War on Poverty expansions and late 20th century's welfare reforms. Focusing specifically on federal cash and near-cash programs, it discusses key facets and principles of the current social safety net structure, its impact on children's health and economic well-being, remaining gaps, and promising advances for the future. Temporary improvements to the social safety net enacted as part of the pandemic response indicate important ways in which our public supports can reach more families, more consistently, moving forward. To reduce child poverty, one of the most promising approaches is to enact a national child allowance in the United States. Converting the existing Child Tax Credit into a universal child allowance, making it more generous, and delivering it to families on a regular basis throughout the year can accomplish this goal.


Asunto(s)
Pobreza , Bienestar Social , Niño , Salud del Niño , Familia , Humanos , Motivación , Estados Unidos
2.
Artículo en Inglés | MEDLINE | ID: mdl-34769949

RESUMEN

Community services have played a significant role in supporting the psychosocial health and well-being of vulnerable populations during the SARS-CoV-2 (COVID-19) pandemic. To meet increased community needs, organisations were required to rapidly modify service provision, often using remote delivery systems. This in-depth study, undertaken early in the pandemic, explored staff and clients' experiences of adapting to using telehealth to provide and access services in one regional social services agency. Semi-structured interviews from 15 staff and 11 clients from a regional not-for-profit agency in Western Australia were recorded and transcribed. Inductive coding, and thematic analysis identified eight subthemes, with experiences and perceptions of telehealth varying substantially among staff and client groups. Distinct benefits and challenges were associated with telehealth. Participants highlighted tensions and complexities and commented on the place of telehealth in the community service sector. Clients expressed the importance of relationships and communication. This study provides in-depth insights into the contextualised experiences of staff and clients during a time at which change was both enabled and necessary. The findings highlight the need for tailored service delivery; choice; client collaboration; ongoing staff training relating to telehealth; and guidelines specific to telehealth in the community service sector.


Asunto(s)
COVID-19 , Telemedicina , Australia , Humanos , SARS-CoV-2 , Bienestar Social
4.
Hawaii J Health Soc Welf ; 80(9 Suppl 1): 12-23, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34661124

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on the world. To address the impact of COVID-19 in the state of Hawai'i, the Hawai'i Emergency Management Agency (HI-EMA) Community Care Outreach Unit conducted an assessment survey to determine the impact of COVID-19 on the health and social welfare of individuals and their families across the state. This article presents key statewide findings from this assessment, including areas of need and community-based recommendations to help mitigate the impact of the pandemic, particularly for vulnerable groups. A total of 7927 participants responded to the assessment survey from across the state's counties. In all questions related to paying for essentials, the percentage of participants that expect to have problems in the future, as compared to now, almost doubled. Slightly higher than one-third reported that they would know how to care for a family member in the home with COVID-19, and half of the respondents reported a lack of space for isolation in their home. About half reported that if they got COVID-19, they would have someone available to care for them. Overall, Native Hawaiian, Pacific Islander, and Filipino groups reported greater burden in almost all areas surveyed. The results presented provide a baseline in understanding the impact, needs, and threats to the health and social welfare of individuals and their families across the state of Hawai'i. Local stakeholders can utilize this information when developing priorities, strategies, and programs to address current and future pandemics in the state.


Asunto(s)
COVID-19 , Pandemias , Hawaii/epidemiología , Humanos , SARS-CoV-2 , Bienestar Social
5.
Hawaii J Health Soc Welf ; 80(9 Suppl 1): 34-43, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34661126

RESUMEN

The Community Care Outreach Unit (CCO) of the Hawai'i Emergency Management Medical/Public Health Services Branch conducted a survey to gauge the impact of coronavirus disease 2019 (COVID-19) on the health and social welfare of individuals and families in the state of Hawai'i. A mixed-methods framework was utilized for survey distribution; 7927 respondents participated in the survey. This article presents key findings for the state's Hawai'i County (HC). It presents a descriptive analysis of the data to provide a basic overview of the impact of COVID-19 in HC, as assessed in August-September 2020. A total of 936 participants from HC responded to the survey. Approximately one-third reported that they or their family members experienced reduced work hours, and one-fifth lost their jobs because of COVID-19. Many reported difficulties paying for many types of living essentials and expected these difficulties to increase in the near future. Challenges for the fall school semester included lack of access to funds for school supplies and face-coverings. The majority perceived the severity of COVID-19 to be moderate/very high and most had at least a moderate level of knowledge about risks for developing severe COVID-19. Approximately half reported maintaining social distancing usually/all of the time, and about two-thirds reported wearing a face-covering usually/always when needed. Other barriers for COVID disease prevention and response included a lack of space for quarantine/isolation of family members, not having enough cleaning supplies, low knowledge of how to care for a household member with COVID disease and not having someone available to care for them if they contracted the virus. The results provide a baseline for understanding the impact, needs, and threats to the health and social welfare of individuals and their families as a result of COVID-19 in HC. Local stakeholders can utilize this information when developing priorities, strategies, and programs to address the pandemic where needed.


Asunto(s)
COVID-19 , Pandemias , Hawaii/epidemiología , Humanos , Pandemias/prevención & control , SARS-CoV-2 , Bienestar Social , Estados Unidos
6.
Hawaii J Health Soc Welf ; 80(9 Suppl 1): 44-52, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34661127

RESUMEN

The Hawai'i Emergency Management Agency Community Care Outreach Unit (CCO) conducted a survey to gauge the impact of coronavirus disease 2019 (COVID-19) on the health and social welfare of individuals and their families across the state of Hawai'i. A mixed-methods framework was utilized for survey distribution. This article presents a descriptive analysis of the data to provide a basic overview of the impact of COVID-19 in Kaua'i County (KC), as assessed in August/September 2020. A total of 420 participants in KC responded to the statewide survey. Approximately one-third reported that they or their family members experienced reduced work hours or lost their job because of COVID-19. Many reported difficulties paying for many types of living essentials and expected these difficulties to increase in the near future. Prevalent challenges for the fall school semester included access to funds for school supplies and face-coverings. About one-third reported feeling nervous more than half the time or nearly every day in the past 2 weeks, and one-fourth reported feeling worried more than half the time or nearly every day in the past 2 weeks. The majority perceived the severity of COVID-19 to be moderate/very high and most had at least a moderate level of knowledge about risks for contracting severe COVID-19. Less than half said they would know how to provide care for someone in their family with COVID-19. Half of the respondents in KC reported maintaining social distancing usually/all of the time, the majority reported wearing a face-covering usually/always when needed. The results provide a baseline for understanding the impact, needs, and threats to the health and social welfare of households and their families in KC as a result of COVID-19. Local stakeholders can utilize this information for developing priorities, strategies, and programs to address the pandemic where needed and also to assess progress in areas of need.


Asunto(s)
COVID-19 , Pandemias , Hawaii/epidemiología , Humanos , SARS-CoV-2 , Bienestar Social
7.
Hawaii J Health Soc Welf ; 80(9 Suppl 1): 53-61, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34661128

RESUMEN

The Community Care Outreach Unit of the Hawai'i Emergency Management Agency (HI-EMA) Medical/Public Heath Branch conducted a survey to gauge the impact, needs, and threats to the health and social welfare of individuals and their families pertaining to coronavirus disease 2019 (COVID-19). This article presents key findings for the County of Maui (MC) in the state. A mixed-methods framework was utilized for survey distribution and recruitment of participants from across the state. Recruitment strategies included snowball sampling via website and social media, and paper surveys. Descriptive analysis of the data is presented to give a basic overview of the impact of COVID-19 in MC. A total of 883 participants in MC responded to the survey. Approximately one-third reported that they or family members experienced reduced work hours or lost their job because of COVID-19. In all questions related to paying for essential living needs, the percentage of participants who expected to have future problems was higher than the percentage who reported having current problems. Of those preparing for the fall 2020 school semester, expected challenges included lack of funds to purchase school supplies, lack of face coverings, and language barriers. Most participants in MC perceived the severity of COVID-19 to be moderate to very high, and there was a moderate level of knowledge about which groups are more at risk for contracting severe COVID-19. Less than half would know how to provide care for someone in their family with COVID-19. Several resource barriers for caring for a family member with COVID-19 were identified. The COVID-19 pandemic has had a more severe impact on Native Hawaiian and Pacific Islander groups compared to others in the county. The results may provide a baseline for understanding the impact, needs, and threats to the health and social welfare of individuals and their families in MC. Local stakeholders can utilize this information to develop priorities, strategies, and programs to address the COVID-19 pandemic response in MC.


Asunto(s)
COVID-19 , Pandemias , Hawaii/epidemiología , Humanos , SARS-CoV-2 , Bienestar Social
8.
Hawaii J Health Soc Welf ; 80(9 Suppl 1): 62-70, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34661129

RESUMEN

Native Hawaiians (NHs) are among the most vulnerable groups at greater risk for coronavirus disease 2019 (COVID-19). To understand the impact of COVID-19 on the state's population, a 35-question cross-sectional survey was administered across the state of Hawai'i. NH data from the larger report are provided here. The findings indicate that the impact of COVID-19 is disproportionately affecting NH households in areas of income and housing stability, chronic disease prevalence, emotional wellness, and COVID-19 prevention. Short-, medium-, and long-term recommendations are presented as next steps to addressing the health inequities among NHs.


Asunto(s)
COVID-19 , Grupo de Ascendencia Oceánica , Estudios Transversales , Hawaii/epidemiología , Humanos , Pandemias/prevención & control , SARS-CoV-2 , Bienestar Social
9.
Hawaii J Health Soc Welf ; 80(9 Suppl 1): 71-77, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34661130

RESUMEN

Hawai'i's Filipino community has been deeply impacted by coronavirus disease 2019 (COVID-19). This article reports the findings for the Filipino population from the Hawai'i Emergency Management Agency (HI-EMA) Community Care Outreach Unit (CCO) Unit evaluation assessment of the impact of COVID-19 on the health and social welfare of individuals across the state. The survey was conducted from August-September 2020. We propose recommendations to mitigate the impact of the pandemic on this community, including the following actions: (1) developing linguistically and culturally appropriate support for all COVID-19 related services, especially for the high number of older Filipinos with limited English proficiency, (2) providing support and resource information in locations that are accessible to Filipino communities, and (3) supporting those already doing work to address the deep and diverse needs in the Filipino community with funding. Building partnerships between existing Filipino organizations, health and social service providers, and state agencies will contribute to sustainability over time.


Asunto(s)
COVID-19 , Pandemias , Hawaii/epidemiología , Humanos , SARS-CoV-2 , Bienestar Social
10.
Hawaii J Health Soc Welf ; 80(9 Suppl 1): 78-87, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34661131

RESUMEN

Hawai'i's Pacific Islander (PI) population has suffered a higher burden of coronavirus disease 2019 (COVID-19) infections, hospitalizations, and deaths compared to other groups in the state. The Hawai'i Emergency Management Agency Community Care Outreach Unit conducted an assessment across the state to gain an understanding of the impact of the COVID-19 pandemic on the health and social welfare of households. Survey data was collected from individuals across the state during a period of 3 weeks (August 12-September 5, 2020). The following are resulting recommendations from the Pacific Island community to mitigate the impact and disparities of the pandemic as immediate and medium-term structural requests: (1) ensure that Pacific Island communities are proactively represented in state and county committees that develop health interventions to ensure that relevant language and culturally tailored communications and strategies are included, (2) provide consistent funding and community centered support to ensure consistent COVID-19 impact services for the Pacific Island families, (3) enhance the capacity of PI health care navigators and interpreters through increased funding and program support, and (4) engage state policy makers immediately to understand and address the systemic structural barriers to health care and social services for Pacific Islanders in Hawai'i. These recommendations were developed to address the generational inequities and disparities that exist for Pacific islanders in Hawai'i which were exacerbated by the COVID-19 pandemic.


Asunto(s)
COVID-19 , Pandemias , Hawaii/epidemiología , Humanos , SARS-CoV-2 , Bienestar Social
11.
Artículo en Inglés | MEDLINE | ID: mdl-34682705

RESUMEN

To promote low-carbon production, the government simultaneously provides some subsidies under carbon tax regulations. Two government subsidies are widely adopted: one is based on emissions reduction quantity and the other is based on emissions reduction investment cost. Additionally, consumer low-carbon awareness has also been enhanced. Considering the aforementioned circumstances, this paper investigates the effects of different government subsidies on production and emissions reduction decisions under a carbon tax regulation by formulating three decision-making optimization models. The results show that (1) although the carbon tax regulation cannot guarantee further improvement of emissions reduction levels, government subsidies could make the corresponding conditions of improving emissions reduction investments wider; (2) a heavy carbon tax or stronger consumer low-carbon awareness would make the positive effect of government subsidies more apparent; and (3) subsidy policies may also be selected by the government from different perspectives, such as manufacturer development, consumer surplus, environmental damage and social welfare. Especially, from the perspective of maximizing social welfare, investment cost (IC) subsidy is not always advantageous, while emissions reduction (ER) subsidy can always bring higher social welfare compared with the case under no government subsidy.


Asunto(s)
Carbono , Financiación Gubernamental , Políticas , Bienestar Social
12.
Pediatrics ; 148(5)2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34706903

RESUMEN

OBJECTIVES: During infancy, the American Academy of Pediatrics Bright Futures fourth edition health supervision guidelines recommend frequent well-child visits (WCVs) in which providers are expected to screen for and address maternal depression, intimate partner violence (IPV), and health-related social needs (HRSN). We spread an evidence-based approach that implements these recommendations (Developmental Understanding and Legal Collaboration for Everyone; DULCE) with 3 aims for 6-month-old infants and their families: 75% receive all WCVs on time, 95% are screened for 7 HRSNs, and 90% of families with concrete supports needs and 75% of families with maternal depression or IPV receive support. METHODS: Between January 2017 and July 2018, five DULCE teams (including a community health worker, early childhood system representative, legal partner, clinic administrator, pediatric and behavioral health clinicians) from 3 communities in 2 states participated in a learning collaborative. Teams adapted DULCE using Plan-Do-Study-Act cycles, reported data, and shared learning monthly. Run charts were used to study measures. The main outcome was the percent of infants that received all WCVs on time. RESULTS: The percentage of families who completed all WCVs on time increased from 46% to 65%. More than 95% of families were screened for HRSNs, 70% had ≥1 positive screen, and 86% and 71% of those received resource information for concrete supports and maternal depression and IPV, respectively. CONCLUSIONS: Quality improvement-supported DULCE expansion increased by 50% the proportion of infants receiving all WCVs on time and reliably identified and addressed families' HRSNs, via integration of existing resources.


Asunto(s)
Práctica Clínica Basada en la Evidencia , Salud del Lactante , Salud Materna , Evaluación de Necesidades , Pediatría , Adolescente , Adulto , Cuidadores/estadística & datos numéricos , Depresión/diagnóstico , Salud de la Familia , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Lactante , Violencia de Pareja , Masculino , Persona de Mediana Edad , Pobreza , Mejoramiento de la Calidad , Determinantes Sociales de la Salud , Bienestar Social , Adulto Joven
13.
Washington, D.C.; PAHO; 2021-10-14.
en Inglés | PAHO-IRIS | ID: phr-54991

RESUMEN

The Economic Commission for Latin America and the Caribbean (ECLAC) and the Pan American Health Organization (PAHO) have produced this second joint report to update the situation on the evolution of the COVID-19 pandemic and its implications for health, society and the economy. This report defines potential scenarios for control of the pandemic in the short term as well as long-term action recommended to strengthen the response capacity of countries with regard to the health needs of their populations and determinants in the context of a transformative recovery.


Asunto(s)
COVID-19 , Coronavirus , Infecciones por Coronavirus , Pandemias , Salud Pública , Economía , Economía y Organizaciones para la Atención de la Salud , Problemas Sociales , Bienestar Social , Capital Social
14.
Washington, D.C.; OPS; 2021-10-14.
en Español | PAHO-IRIS | ID: phr-54990

RESUMEN

Más de un año después del inicio de la pandemia de COVID-19, América Latina y el Caribe acumula un número desproporcionado de casos y muertes respecto de otras regiones del mundo y sufre la mayor contracción económica de los últimos 120 años. En este segundo informe conjunto de la Comisión Económica para América Latina y el Caribe y la Organización Panamericana de la Salud se actualizan la situación de la evolución de la pandemia y sus implicaciones sociales, económicas y para la salud. Para ello se abordan los principales impactos económicos y sociales de la pandemia en la región, junto con el papel central de la protección social y el Estado, y la necesidad de incrementar la inversión pública en salud y fortalecer la institucionalidad del sector de la salud. Por último, se analizan los posibles escenarios de supresión de la pandemia en el corto plazo y un conjunto de condiciones contextuales que inciden de forma directa en este objetivo. El informe se cierra con un apartado de recomendaciones que enfatizan la importancia de adoptar un abordaje integral para poner fin a la crisis de salud en el corto plazo, avanzar hacia una recuperación económica sostenible y con igualdad, y promover la salud universal mediante sistemas de salud resilientes.


Asunto(s)
COVID-19 , Coronavirus , Infecciones por Coronavirus , Pandemias , Sistemas de Salud , Salud Pública , Economía , Economía y Organizaciones para la Atención de la Salud , Problemas Sociales , Bienestar Social , Capital Social
15.
Soc Sci Med ; 289: 114455, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34626882

RESUMEN

The Nordic Paradox of inequality describes how the Nordic countries have puzzlingly high levels of relative health inequalities compared to other nations, despite extensive universal welfare systems and progressive tax regimes that redistribute income. However, the veracity and origins of this paradox have been contested across decades of literature, as many scholars argue it relates to measurement issues or historical coincidences. Disentangling between potential explanations is crucial to determine if widespread adoption of the Nordic model could represent a sufficient panacea for lowering health inequalities, or if new approaches must be pioneered. As newfound challenges to welfare systems continue to emerge, evidence describing the benefits of welfare systems is becoming ever more important. Preliminary evidence indicates that the COVID-19 pandemic is drastically exacerbating social inequalities in health across the world, via direct and indirect effects. We argue that the COVID-19 pandemic therefore represents a unique opportunity to measure the value of welfare systems in insulating their populations from rising social inequalities in health. However, COVID-19 has also created new measurement challenges and interrupted data collection mechanisms. Robust academic studies will therefore be needed-drawing on novel data collection methods-to measure increasing social inequalities in health in a timely fashion. In order to assure that policies implemented to reduce inequalities can be guided by accurate and updated information, policymakers, academics, and the international community must work together to ensure streamlined data collection, reporting, analysis, and evidence-based decision-making. In this way, the pandemic may offer the opportunity to finally clarify some of the mechanisms underpinning the Nordic Paradox, and potentially more firmly establish the merits of the Nordic model as a global example for reducing social inequalities in health.


Asunto(s)
COVID-19 , Pandemias , Disparidades en el Estado de Salud , Humanos , Pandemias/prevención & control , SARS-CoV-2 , Bienestar Social , Factores Socioeconómicos
16.
Artículo en Inglés | MEDLINE | ID: mdl-34639383

RESUMEN

Senior population health often is underrepresented in curricula for medical and allied health students. Furthermore, entrenched and dense curricular schedules preclude interprofessional teams from clinical experiences related to senior population health. Community service learning potentially offers the opportunity to engage interprofessional students with a panel of older adults to assess health promotion metrics over time. To test this educational concept, we created Health Ambassador Teams for Seniors, also known as HATS. Utilizing a telehealth platform, interprofessional student teams were tasked with older adult wellness promotion. The annual Medicare wellness exam served as a template for patient encounters which was enhanced with key elements of geriatric assessment such as gait and balance, cognition, and functional evaluations. The objective was to have dyads of interprofessional students conduct telehealth visits and gather healthcare data to be used for serial patient encounters and track functional trajectories over time. As a proof of concept, pilot telehealth encounters with medical, physical therapy, nursing and occupational therapy students revealed that data on older adult functional performances such as gait speed, Timed Up and Go test (TUG), and Mini-Cog test could be acquired through telehealth. Equally importantly, trainees received diverse feedback from faculty, peers and volunteer patients. A Research Electronic Data Capture (REDCap) data repository allows trainees to track patient trends relative to their health promotion recommendations as well as handoff their patient panel to the next set of trainees. The HATS program promises to strengthen the Geriatric Workforce, especially with senior population health.


Asunto(s)
Equilibrio Postural , Telemedicina , Anciano , Actitud , Humanos , Relaciones Interprofesionales , Medicare , Bienestar Social , Estudios de Tiempo y Movimiento , Estados Unidos
17.
Multimedia | Recursos Multimedia | ID: multimedia-9238

RESUMEN

En el marco de la Semana de la Salud internacional, organizada por la Diplomatura en Salud Internacional de la Escuela de Gobierno en Salud Floreal Ferrara de la Provincia de Buenos Aires y la Universidad Nacional de José C. Paz, se brinda homenaje a Juan César García. La introducción de Mario Rovere, Director de la Escuela, da paso a las palabras de María Isabel Rodríguez, médica y ex ministra de salud de El Salvador. A través de textos de Galeano, Duarte Nunes y María Isabel Rodríguez, y de fotos cedidas por la familia, se relevan momentos y pensamientos significativos de Juan César García, fundador del pensamiento social en salud en América Latina. Se suman los aportes de les doctores María Laura Passarelli y Carlos Gallego


Asunto(s)
Medicina Social , Bienestar Social , América Latina
18.
PLoS One ; 16(9): e0257469, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34543292

RESUMEN

The COVID-19 pandemic is likely to have adverse effects on the economy through damage to migration and remittances. We use a unique monthly household panel dataset that covers the period both before and after the outbreak to examine the impacts of COVID-19 on a variety of household welfare outcomes in Tajikistan, where remittance inflows in recent years have exceeded a quarter of annual GDP. We provide several findings. First, after April 2020, the adverse effects of the pandemic on household welfare were significantly observed and were particularly pronounced in the second quarter of 2020. Second, in contrast to expectation, the pandemic had a sharp but only transitory effect on the stock of migrants working abroad in the spring. Some expected migrants were forced to remain in their home country during the border closures, while some incumbent migrants expecting to return were unable to do so and remained employed in their destination countries. Both departures and returns started to increase again from summer. Employment and remittances of the migrants quickly recovered to levels seen in previous years after a sharp decline in April and May. Third, regression analyses reveal that both migration and remittances have helped to mitigate the adverse economic outcomes at home during the "with-COVID-19" period, suggesting that they served as a form of insurance. Overall, the unfavorable effects of the COVID-19 pandemic were severe and temporary right after the outbreak, but households with migrants were more resilient against the pandemic.


Asunto(s)
COVID-19/epidemiología , COVID-19/psicología , Composición Familiar , Migración Humana , Pandemias , Resiliencia Psicológica , Bienestar Social/psicología , COVID-19/virología , Empleo , Humanos , Análisis de Regresión , SARS-CoV-2/fisiología , Tayikistán/epidemiología
19.
BMC Health Serv Res ; 21(1): 918, 2021 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-34488740

RESUMEN

BACKGROUND: Welfare technology has been launched as a concept to accelerate digital transformation in care services, but the deployment of these technologies is still hindered by organisational resistance, lack of infrastructure, and juridical and ethical issues. This paper investigates decision-making among municipal actors in the application and deployment of welfare technology from a procurement process perspective. The study explores the perceptions and negotiations involved in purchasing welfare technology at each stage of the procurement model, revealing the impact of technical, economic, juridical and ethical competence on the mapping, planning, procurement, implementation and management of welfare technology. METHODS: The study presents empirical findings from qualitative interviews conducted among municipal actors in Sweden. Semi-structured interviews were gathered in 2020 among procurement managers, IT managers, and managers in social administration in three different municipalities (n = 8). Content analysis and systematic categorisation were applied resulting in the division of procurement practices into sub-categories, generic categories and main categories. RESULTS: Challenges in the application and deployment of welfare technology occur at all stages of the procurement model. In mapping and planning, barriers are identified in the need analysis, requirement specification and market analysis. In the procurement stage, economic resources, standardisation and interoperability hinder the procurement process. Implementation and management are complicated by supplier assessment, legislation, cross-organisational collaboration and political strategy. Building on these findings, this study defines 'procurement competence' as consisting of technical, economic, juridical and ethical expertise in order to assess and evaluate welfare technology. Technical and ethical competence is needed in early stages of procurement, whereas juridical and economic competence relates to later stages of the model. CONCLUSIONS: Procurement competence is associated with the application and deployment of welfare technology in (1) assessment of the end-user's needs, (2) estimation of the costs and benefits of welfare technology and (3) management of juridical and legislative issues in data management. Economic and juridical decisions to purchase welfare technology are not value-neutral, but rather associated with socially shared understandings of technological possibilities in care provision. Optimisation of procurement processes requires a combination of capabilities to introduce, apply and deploy welfare technology that meets the demands and needs of end-users.


Asunto(s)
Bienestar Social , Tecnología , Ciudades , Investigación Cualitativa , Suecia
20.
Int J Equity Health ; 20(1): 211, 2021 09 24.
Artículo en Inglés | MEDLINE | ID: mdl-34560888

RESUMEN

BACKGROUND: While organized and opportunistic cervical cancer screening (CCS) programs implemented across the European Union have increased participation rates, barriers to socioeconomically deprived women remain substantial, implying high levels of inequality in CCS uptake. AIM: This study assesses how the screening strategy (as a score based on the availability of organized population-based CCS programs), accessibility of the healthcare system (as an index of out-of-pocket expenditure as a proportion of total healthcare costs, public health expenditure as a percentage of total GDP, and general practitioner (GP) density per 10'000 inhabitants) and social protection (as a decommodification index), impact education- and income-based inequalities in CCS uptake. METHODS: A two-level design with 25-64-year-old women (N = 96'883), eligible for Pap smear screening, nested in 28 European countries, was used to analyze data from the European Health Interview Survey's second wave, using multilevel logistic regression modelling. RESULTS: Clear educational and income gradients in CCS uptake were found, which were smaller in countries with organized CCS programs, higher accessibility of the healthcare system and a higher level of decommodification. Furthermore, three-way interaction terms revealed that these gradients were smaller when organized CCS programs were implemented in countries with better accessibility of the healthcare system or a high level of decommodification. CONCLUSION: This study indicates that the combination of organized screening and high accessibility of the healthcare system or social protection is essential for having lower levels of inequality in CCS uptake. In such countries, the structural threshold for poorer and lower educated women to engage in CCS is lower. This may be explained by them having a better interaction with their GP, who may convince them of the screening test, lower out-of-pocket payments, and financial support to buffer against a disadvantageous position on the labor market.


Asunto(s)
Detección Precoz del Cáncer , Disparidades en Atención de Salud , Neoplasias del Cuello Uterino , Adulto , Detección Precoz del Cáncer/estadística & datos numéricos , Europa (Continente) , Femenino , Política de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Bienestar Social , Factores Socioeconómicos , Neoplasias del Cuello Uterino/diagnóstico
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...