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1.
Int J Health Serv ; 52(1): 5-8, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34463182

RESUMO

The recent events in Palestine-Israel once again have brought anger and frustration to people inside and outside the medical community. Especially for the pediatric community, the recent wars' toll of at least 67 children in the Gaza Strip and two children in Israel killed warrants attention. Armed conflicts have both direct effects on children's physical health and indirect harms through toxic stress and deprivation. During these troubling times, when civilians, including children, are dying and being mutilated because of conflict, it is crucial to understand the role of structural violence in perpetuating immediate violence. This article will shed light on the historical context of the recurrent wars and military aggressions in Palestine-Israel and contextualize them from a broader public health perspective.


Assuntos
Árabes , Guerra , Conflitos Armados , Criança , Humanos , Oriente Médio/epidemiologia , Violência
2.
Biomedica ; 41(4): 660-675, 2021 12 15.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34936252

RESUMO

Introduction: Armed conflicts affect territories rich in resources and biodiversity. As a result of the environmental damage caused by violent actions, the health of populations can be affected. Objectives: To assess the risks to human health due to environmental degradation associated with three violent actions in the context of the Colombian armed conflict: Pipeline bombing, informal mining with mercury, and spraying of illicit crops with glyphosate. Materials and methods: We conducted a quantitative evaluation of the risks to individual health associated with armed conflict activities using methodologies focused on the routes of pollutants dispersion, their concentrations in the environment, the exposure of the individuals, and the risks of carcinogenic and non-carcinogenic effects. Results: The risk assessment of the armed conflict-related actions under study evidenced intolerable carcinogenic risk and unacceptable non-carcinogenic risk due to the consumption of water and fish contaminated by polycyclic aromatic hydrocarbons (PAH), mercury, and glyphosate. Conclusions: The study reiterates the inextricable connections existing among the environment, society, and health, as well as the implications of environmental violence for the public health of vulnerable population groups and, in general, for the well-being of all living beings affected by the armed conflict.


Introducción. Los conflictos armados afectan los territorios ricos en recursos y biodiversidad; el daño ambiental causado por las acciones violentas puede afectar la salud de las poblaciones. Objetivos. Evaluar los riesgos para la salud humana debidos a la degradación ambiental asociada con tres acciones violentas en el marco del conflicto armado colombiano: la voladura de oleoductos, la minería informal con mercurio y la aspersión de cultivos ilícitos con glifosato. Materiales y métodos. Se hizo una evaluación cuantitativa de los riesgos para la salud individual asociados con actividades del conflicto armado, usando metodologías que tienen en cuenta la ruta de dispersión de los contaminantes, su concentración en el ambiente, la exposición de los individuos y los riesgos de efectos cancerígenos y no cancerígenos. Resultados. La evaluación de los riesgos asociados con las acciones en el marco del conflicto armado analizadas, evidenció un riesgo cancerígeno intolerable y uno no cancerígeno inaceptable debidos al consumo de agua y peces contaminados por hidrocarburos aromáticos policíclicos, mercurio y glifosato. Conclusiones. El estudio reafirmó las conexiones inextricables que existen entre ambiente, sociedad y salud, y las implicaciones de la violencia ambiental para la salud pública de los grupos poblacionales vulnerables y, en general, para el bienestar de todos los seres vivos afectados por el conflicto armado.


Assuntos
Exposição Ambiental , Mercúrio , Animais , Conflitos Armados , Colômbia/epidemiologia , Exposição Ambiental/efeitos adversos , Humanos , Mineração , Medição de Risco
3.
PLoS One ; 16(12): e0261787, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34972142

RESUMO

BACKGROUND: The Spanish Civil War (1936-1939) is an example of a historic event involving nurses, with the participation of professional and volunteer nurses from Spain and other countries. In this context, nurses were trained over short periods of time and recruited to work at hospitals serving the two warring camps. OBJECTIVES: To identify the characteristics of the training received by volunteer nurses on both sides in the Spanish Civil War and compare it with previous experiences in the history. DESIGN: Historical research. METHODS: Heuristic and hermeneutical analysis of nurse training manuals and news articles from 1936 to 1939. Spanish primary sources were consulted at the Red Cross Documentation Centre Archive in Madrid, the General Military Archive in Ávila, the Municipal Newspaper Archive in Madrid, and the archives of Spanish daily newspapers ABC and La Vanguardia. The following variables were analysed: duration, entry requirements, and theoretical content of the training courses. Consolidated Criteria for Reporting Qualitative Research (COREQ) has been used. FINDINGS: Both sides in the conflict offered a varied training programme, which was supported by official institutions and private initiatives. The courses lasted between one week and two months. Entry requirements were influenced by education level, age, moral conduct, health status, and social and political background. Training content focused on the techniques needed in conflict settings and covered specific moral values. CONCLUSIONS: Despite the different social and political characteristics of the two warring factions, the variety of training programmes on offer, the entry requirements, and the theoretical content of volunteer nurse training were similar on both sides. At the end of the Spanish Civil War, volunteer nurses on the Republican side suffered reprisals or had to go into exile. We now know that some countries involved in World War II provided training courses for volunteer nurses. It would therefore be interesting to ascertain whether Spanish volunteer nurses contributed their experience to these courses.


Assuntos
Conflitos Armados , Voluntários , Espanha , II Guerra Mundial
4.
Int J Public Health ; 66: 595311, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34744562

RESUMO

Objectives: Colombia's civil conflict and persistent socio-economic disparities have contributed to mental health inequalities in conflict-affected territories. We explore the magnitude of mental health inequalities, contributing socio-economic factors, and sociodemographic characteristics that explain these differences. Methods: The study draws on data collected in 2018, using the household survey Conflicto, Paz y Salud (CONPAS) applied to 1,309 households in Meta, Colombia. Logistic regression and decomposition analysis were used to analyze the risk of mental health disorders, measured with the Self-Reporting Questionnaire -20 (SRQ-20). Results: Individuals with lower socio-economic status are at a higher risk for mental health disorders. Forced displacement accounts for 31% of the measured mental health inequalities. Disparities in employment, education level, disability and conflict incidence between municipalities are other contributing factors. Women and people with disabilities are respectively 2.3 and 1.2 times more prone to present a mental health disorder. Conclusion: It is necessary to tackle the identified risk factors and sociodemographic circumstances that contribute to mental health inequalities in conflict-affected territories, as these hinder adequate/equitable access to mental health services.


Assuntos
Conflitos Armados , Disparidades nos Níveis de Saúde , Transtornos Mentais , Colômbia/epidemiologia , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Transtornos Mentais/epidemiologia , Fatores Socioeconômicos
5.
Front Public Health ; 9: 765261, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34778192

RESUMO

Objective: To examine the possibility of estimating the number of civilian casualties in modern armed conflicts. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Scopus, and Web of Science search engines. The outcome was analyzed using a qualitative inductive thematic analysis. The scientific evidence of selected article was assessed, using the Health Evidence Quality Assessment Tool. Findings: The review of 66 included articles in this study indicates that with an increasing number of public health emergencies and the lack of vital elements of life such as water and food, emerging armed conflicts seem to be inevitable. In contrast to military-led cross-border traditional wars, modern armed conflicts affect internally on local communities and take civilian lives. Consequently, the measures and tools used in traditional military-led cross-border wars to adequately tally wounded and dead for many decades under the mandates of the International Humanitarian Law, is insufficient for modern warfare. While casualty counting during modern conflicts is deficient due to organizational, political or strategic reasons, the international organizations responsible for collecting such data (the International Federation of Red Cross and Red Crescent and International Institute of Humanitarian Law) face difficulties to access the conflict scene, resulting in under-reported, unreliable or no-reported data. Conclusion: There are challenges in estimating and counting the number of civilian casualties in modern warfare. Although the global need for such data is evident, the risks and barriers to obtaining such data should be recognized, and the need for new international involvement in future armed conflicts should be emphasized.


Assuntos
Conflitos Armados , Militares , Emergências , Humanos , Direito Internacional , Guerra
7.
J Emerg Manag ; 19(5): 493-503, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34812484

RESUMO

This study aims to assess the potential of urban agriculture (UA) to secure daily needs during the armed conflicts, in addition to assess the contribution of UA in alleviating poverty levels and unemployment rates for its practitioners. A combination of both quantitative and qualitative research methods were employed in this study. In the quantitative design, 129 randomly selected urban farmers from the area of the survey completed the self-administered close-ended questionnaires, whereas the statistical analysis presents the socio-demographic, economic, and other aspects of the households. The qualitative data collection included interviews with six governmental and nongovernmental officials. The results show that 89.2 percent of the UA practitioners are feeling food security. However, a small percentage of the households who practice UA are still experiencing difficulties with food security. In the meantime, the armed conflict forced most of the urban farmers to evacuate their homes or lands; thus, only 34.9 percent of urban farmers managed to gain food during the 2014 armed conflict. In a nutshell, UA significantly and positively contributes to alleviating household food insecurity in the study area. However, its role was very limited during the 2014 armed conflict.


Assuntos
Segurança Alimentar , Abastecimento de Alimentos , Agricultura , Conflitos Armados , Humanos , População Urbana
8.
BMJ Glob Health ; 6(10)2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34620613

RESUMO

For over 60 years, Colombia has endured violent civil conflict forcibly displacing more than 8 million people. Recent efforts have begun to explore mental health consequences of these contexts, with an emphasis on national surveys. To date few Colombian studies explore mental health and well-being from a lived experience perspective. Those that do, overlook processes that enable survival. In response to this gap, we conducted a life history study of seven internally displaced Colombian women in the Cundinamarca department, analysing 18 interview sessions and 36 hours of transcripts. A thematic network analysis, informed by Latin-American perspectives on gender and critical resilience frameworks, explored women's coping strategies in response to conflict-driven hardships related to mental well-being. Analysis illuminated that: (1) the gendered impacts of the armed conflict on women's emotional well-being work through exacerbating historical gendered violence and inequality, intensifying existing emotional health challenges, and (2) coping strategies reflect women's ability to mobilise cognitive, bodied, social, material and symbolic power and resources. Our findings highlight that the sociopolitical contexts of women's lives are inseparable from their efforts to achieve mental well-being, and the value of deep narrative and historical work to capturing the complexity of women's experiences within conflict settings. We suggest the importance of social interventions to support the mental health of women in conflict settings, in order to centre the social and political contexts faced by such marginalised groups within efforts to improve mental health.


Assuntos
Saúde Mental , Violência , Conflitos Armados , Colômbia/epidemiologia , Feminino , Humanos , Pesquisa
9.
Curr Psychiatry Rep ; 23(11): 76, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34613521

RESUMO

PURPOSE OF REVIEW: The aim of this review was to unravel recent evidence for children's reactions to war and armed conflict focusing on resilience factors mitigating adverse psychological and psychiatric consequences. RECENT FINDINGS: Three categories of mitigating resilience factors emerged from the literature - personal, family, and community factors. In addition, a unifying model of moderating resilience factors emerged, proposing a higher-tier environmental dimension conceptualized here as social climate of support. Wars and armed conflict affect children both by direct exposure to threats, and by disruption of the social fabric supporting development. The notion of producing a climate of social support can direct policy toward service provision and resilience-based programs that both build individual capacities and encompass development of the resources of families, schools, community, and societal structures supportive of children's adjustment and wellbeing. Future research should shift toward systems thinking within a socio-ecological nesting of individual, familial, community, and societal systems.


Assuntos
Conflitos Armados , Resiliência Psicológica , Criança , Humanos , Fatores de Proteção , Meio Social , Apoio Social
10.
BMC Emerg Med ; 21(1): 109, 2021 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-34600474

RESUMO

INTRODUCTION: Penetrating craniocerebral injuries (PCCI) are types of open head injuries caused by sharp objects or missiles, resulting in communication between the cranial cavity and the external environment. This condition is deemed to be more prevalent in armed conflict regions where both civilians and military are frequently assaulted on the head, but paradoxically their hospital outcomes are under-reported. We aimed to identify factors associated with poor hospital outcomes of patients with PCCI. METHODS: This was a retrospective series of patients admitted at the Regional Hospital of Bukavu, DRC, from 2010 to 2020. We retrieved medical records of patients with PCCI operated in the surgical departments. A multivariate logistic regression model was performed to find associations between patients' admission clinico-radiological parameters and hospital outcomes. Poor outcome was defined as a Glasgow Outcomes Score below 4. RESULTS: The prevalence of PCCI was 9.1% (91/858 cases) among admitted TBI patients. More than one-third (36.2%) of patients were admitted with GCS < 13, and 40.6% of them were unstable hemodynamic. Hemiplegia was found in 23.1% on admission. Eight patients had an intracerebral hemorrhage. Among the 69 operated patients, complications, mainly infectious, occurred in half (50.7%) of patients. Poor hospital outcomes were observed in 30.4% and associated with an admission GCS < 13, hemodynamic instability, intracerebral hemorrhage, and hemiplegia (p < 0.05). CONCLUSION: The hospital poor outcomes are observed when patients present with hemodynamic instability, an admission GCS < 13, intracerebral hemorrhage, and hemiplegia. There is a need for optimizing the initial care of patients with PCCI in armed conflict regions.


Assuntos
Conflitos Armados , Traumatismos Craniocerebrais , Adolescente , Adulto , Idoso , Traumatismos Craniocerebrais/epidemiologia , República Democrática do Congo/epidemiologia , Feminino , Escala de Coma de Glasgow , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
PLoS One ; 16(10): e0258161, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34669706

RESUMO

What have been the causes and consequences of technological evolution in world history? In particular, what propels innovation and diffusion of military technologies, details of which are comparatively well preserved and which are often seen as drivers of broad socio-cultural processes? Here we analyze the evolution of key military technologies in a sample of pre-industrial societies world-wide covering almost 10,000 years of history using Seshat: Global History Databank. We empirically test previously speculative theories that proposed world population size, connectivity between geographical areas of innovation and adoption, and critical enabling technological advances, such as iron metallurgy and horse riding, as central drivers of military technological evolution. We find that all of these factors are strong predictors of change in military technology, whereas state-level factors such as polity population, territorial size, or governance sophistication play no major role. We discuss how our approach can be extended to explore technological change more generally, and how our results carry important ramifications for understanding major drivers of evolution of social complexity.


Assuntos
Conflitos Armados , Indústrias , Militares , Tecnologia , Animais , Geografia , Cavalos , Ferro , Metalurgia , Análise de Regressão , Fatores de Tempo
12.
Int J Equity Health ; 20(1): 232, 2021 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-34670575

RESUMO

BACKGROUND: Adolescent pregnancy in rural areas is a persistent health problem that has still not properly been understood. Studies with qualitative perspectives that address this phenomenon as a complex social process, which involves the recognition of the voices of the actors involved and the analysis of the specific context in which it takes place, are limited. OBJECTIVE: This research explored the perceptions of young people and other social actors (municipalities of Palmira and El Cerrito in Colombia) of the social forces and dimensions of the social determination of adolescent pregnancy in the Amaime river basin. These geographic areas have been scenes of armed violence with various groups in combat within the context of a long-standing political conflict in Colombia. After the 2016 Havana agreements were signed, peacebuilding has been underway in its territories. METHODS: A qualitative study that implemented focus groups and semi-structured interviews was conducted. The theoretical approach of social determination of health proposed by Breilh was used to study the social process entailed in adolescent pregnancy. Perceptions about social conditions, specific ways of life, and lifestyles were addressed. Galtung and Fischer's theoretical approach on violence and peacebuilding was also incorporated to enrich the understanding of the Colombian context. The analysis was conducted with approaches from phenomenology. RESULTS: Living conditions with strong social stigma and demand for social, political, and cultural opportunities were found. Regarding ways of life, little communication and information about sex education was perceived. As for lifestyles, there are youthful behaviors infused by sociocultural traditions that affect life projects and sexual behavior. Gender relations are precarious, and there are various types of violence that limit effective peacebuilding. CONCLUSIONS: This study contributes to a priority issue in sexual and reproductive health, with an approach that generates analytical elements to comprehensively expand the social and health interventions required.


Assuntos
Gravidez na Adolescência , Saúde Sexual , Adolescente , Conflitos Armados , Colômbia , Feminino , Humanos , Percepção , Gravidez , Pesquisa Qualitativa
13.
BMC Health Serv Res ; 21(Suppl 1): 195, 2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34511092

RESUMO

BACKGROUND: In conflict-affected settings, data on reproductive, maternal, newborn and child health (RMNCH) are often lacking for priority setting and timely decision-making. We aimed to describe the levels and trends in RMNCH indicators within Kivu provinces between 2015 and 2018, by linking conflict data with health facility (HF) data from the District Health Information System 2 (DHIS2). METHODS: We used data from the DHIS2 for the period 2015-2018, the 2014 Demographic and Health Survey, the 2018 Multiple Indicators Cluster Survey and the Uppsala Conflict Data Program. Health zones were categorised in low, moderate and high conflict intensity level, based on an annual conflict death rate. We additionally defined a monthly conflict death rate and a conflict event-days rate as measures of conflict intensity and insecurity. Outcomes were completion of four antenatal care visits, health facility deliveries, caesarean sections and pentavalent vaccine coverage. We assessed data quality and analyzed coverage and trends in RMNCH indicators graphically, by conflict categories and using HF data aggregated annually. We used a series of fixed-effect regression models to examine the potential dose-response effect of varying conflict intensity and insecurity on RMNCH. RESULTS: The overall HF reporting was good, ranging between 83.3 and 93.2% and tending to be lower in health zones with high conflict intensity in 2016 and 2017 before converging in 2018. Despite the increasing number of conflict-affected health zones over time, more in North-Kivu than in South-Kivu, we could not identify any clear pattern of variation in RMNCH coverage both by conflict intensity and insecurity. North-Kivu province had consistently reported better RMNCH indicators than South-Kivu, despite being more affected by conflict. The Kivu as a whole recorded higher coverage than the national level. Coverage of RMNCH services calculated from HF data was consistent with population-based surveys, despite year-to-year fluctuation among health zones and across conflict-intensity categories. CONCLUSIONS: Although good in general, the HF reporting rate in the Kivu was negatively impacted by conflict intensity especially at the beginning of the DHIS2's rolling-up. Routine HF data appeared useful for assessing and monitoring trends in RMNCH service coverage, including in areas with high-intensity conflict.


Assuntos
Saúde da Criança , Serviços de Saúde Reprodutiva , Conflitos Armados , Criança , República Democrática do Congo , Feminino , Instalações de Saúde , Humanos , Recém-Nascido , Saúde Materna , Gravidez
17.
PLoS One ; 16(9): e0257080, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34492080

RESUMO

INTRODUCTION: Armed conflicts result in greater vulnerability and socioeconomic inequality of populations besides risking their health and well-being. Conflict intensifies the health needs and risks the life and well-being of individuals at large through displacement. Therefore, our study aims to apprise the interventions to which children under-five living in Jordan are especially at risk for acute respiratory infections, diarrhea, and fever in the conflict circumstances. MATERIALS AND METHODS: Secondary data analysis is used in the present study. We used a weighted sample of around 9650 children from Jordan Population and Family Health Survey (JPFHS), 2017-18. Bivariate analysis including prevalence rates were used to examine the distribution of socio-demographic characteristics of children. The study has also used multinomial logistic regression model, in order to evaluate the variations in the probability of nationality of under-five children living in Jordan. RESULTS: "Syrian nationalist" children have a higher relative risk of ARI (RRR = 1.19, [1.08, 1.32]), and "Other-nationalist" children have two times greater risk of ARI compared to "Jordanian children." The relative risk of diarrhea is lower among "Syrian nationalist" and "Other-nationalist" children compared to "Jordanian children." Children belong "Other-nationalist" are found to be less relative risk of fever (RRR = 0.9, [0.80, 1.01]) than "Jordanian children." CONCLUSIONS: Our study concludes that conflict-driven displacement has an immediate effect on child health through access, availability, and affordability of health care services, resulting in more significant health care risks. However, sufficient investment is required to address such adversities that affect the health care system due to uneven demand as experienced by the Jordanian health care system. Thus, collaborative efforts through global partners can play a significant role in the countries facing the challenges of managing these health care emergencies.


Assuntos
Conflitos Armados , Saúde da Criança , Inquéritos Epidemiológicos , Mães , Adolescente , Adulto , Criança , Pré-Escolar , Diarreia/epidemiologia , Feminino , Febre/epidemiologia , Humanos , Lactente , Recém-Nascido , Jordânia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Refugiados , Análise de Regressão , Infecções Respiratórias/epidemiologia , Tamanho da Amostra , Fatores Socioeconômicos , Síria , Adulto Jovem
18.
Hist Cienc Saude Manguinhos ; 28(3): 685-708, 2021.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-34495112

RESUMO

An analysis of the relationship between health and war in the context of the Caste War in Yucatan, Mexico, during the second half of the nineteenth century. Using qualitative and quantitative sources, this article reconstructs the main critical health events and argues that the health/disease process at the time can necessarily only be explained in relation to variables connected to the conflict, such as arms trafficking, displacements, diasporas and migrations, food shortages, violence and administrative chaos.


Assuntos
Violência , Guerra , Conflitos Armados , México , Classe Social
19.
PLoS One ; 16(9): e0256829, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34473786

RESUMO

Tobacco smoking might be impacted by various influences, including psychological, socio-cultural, and economic factors. A community-based cross-sectional survey was conducted in Syrian Arab Republic from March to April 2019 using a web-based questionnaire. The survey aimed at assessing tobacco use (shisha and cigarettes) as well as examining the association between current tobacco use and various sociodemographic and war-related factors. The sample comprised 978 participants (251 males: 727 females) and had a mean age of 24.7 years (SD: 7.60). Most participants were single (n = 825, 84.4%), reside in Damascus and Rif-Dimashq (n = 579, 59.2%), and had a college/university education (n = 911, 93.1%). Concerning smoking, a total of 371 participants (37.9%) were identified to be current tobacco smokers, of whom 211, 84, 76 were exclusive shisha smokers, exclusive cigarette smokers, and dual smokers, respectively. The prevalence of cigarette smoking (exclusive and dual) among males and females was found to be 34.7%, and 10.0%, respectively. On the other hand, the prevalence of shisha smoking (exclusive and dual) among males and females was around 34.3% and 27.6%, respectively. Additionally, various factors have predicted a higher likelihood of cigarette smoking including male gender (AOR = 4.152; 95% CI: 2.842-6.064; p<0.001), and losing someone due to the war (AOR = 1.487; 95% CI: 1.028-2.151; p = 0.035), while unemployed individuals were found to have lower odds of being cigarette smokers (AOR = 0.634; 95% CI: 0.429-0.937; p = 0.022). Concerning shisha smoking, married (AOR = 0.622; 95% CI: 0.402-0.963; p = 0.033), and unemployed individuals (AOR = 0.679; 95% CI: 0.503-0.916; p = 0.011) were found to have lower odds of shisha smoking. Amid the tobacco epidemic in the region, rates of tobacco use in Syria are still worrying. The Syrian armed conflicts may possess a double-edged effect on smoking, and tobacco users who adopt smoking to cope with various stressors should be targeted with well-structured health education, along with appropriate psychological services.


Assuntos
Conflitos Armados/psicologia , Fumar Cigarros/epidemiologia , Fumar Cigarros/psicologia , Fumantes/psicologia , Cachimbos de Água , Estresse Psicológico , Tabaco para Cachimbos de Água , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Fatores Sexuais , Inquéritos e Questionários , Síria/epidemiologia , Adulto Jovem
20.
Int J Equity Health ; 20(1): 217, 2021 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-34587942

RESUMO

BACKGROUND: The present study analyzes inequalities in catastrophic health expenditures in conflict-affected regions of Meta, Colombia and socioeconomic factors contributing to the existence and changes in catastrophic expenditures before and after the sign of Colombian Peace Agreement with FARC-EP guerilla group in 2016. METHODS: The study uses the results of the survey Conflicto, Paz y Salud (CONPAS) conducted in 1309 households of Meta, Colombia, a territory historically impacted by armed conflict, for the years 2014 and 2018. We define catastrophic expenditures as health expenditures above 20% of the capacity to pay of a household. We disaggregate the changes in inequalities in catastrophic expenditures through the Oaxaca-Blinder change decomposition method. RESULTS: The incidence of catastrophic expenditures slightly increased between 2014 to 2018, from 29.3 to 30.7%. Inequalities in catastrophic expenditures, measured through concentration indexes (CI), also increased from 2014 (CI: -0.152) to 2018 (CI: -0.232). Results show that differences in catastrophic expenditures between socioeconomic groups are mostly attributed to an increased influence of specific sociodemographic variables such as living in rural zones, being a middle-aged person, living in conflict-affected territories, or presenting any type of mental and physical disability. CONCLUSIONS: Conflict-deescalation and the peace agreement may have facilitated lower-income groups to have access to health services, especially in territories highly impacted by conflict. This, consequently, may have led to higher levels of out-of-pocket expenditures and, therefore, to higher chances of experiencing catastrophic expenditures for lower-income groups in comparison to higher-income groups. Therefore, results indicate the importance of designing policies that guarantee access to health services for people in conflict -affected regions but also, that minimize health care inequalities in out-of-pocket payments that may arouse between people at different socioeconomic groups.


Assuntos
Conflitos Armados , Doença Catastrófica , Gastos em Saúde , Conflitos Armados/prevenção & controle , Conflitos Armados/estatística & dados numéricos , Doença Catastrófica/economia , Colômbia , Gastos em Saúde/estatística & dados numéricos , Humanos
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