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1.
Thorac Surg Clin ; 32(1): 13-21, 2022 Feb.
Article in English | MEDLINE | ID: mdl-34801191

ABSTRACT

Racial disparities in health care systems exist in all phases of health care delivery. The Affordable Care Act has been unable to completely mitigate disparities in health care as the root cause (ie, socioeconomic inequality) remains unaddressed. Uninsured status, lack of transportation, high costs, health literacy, provider unavailability, lack of trust in the health system, and implicit bias block minority populations from obtaining deserved quality care. With the COVID-19 crisis, increased sensitivity and development of innovative approaches to provide accessibly and quality health care are necessary.


Subject(s)
COVID-19 , Patient Protection and Affordable Care Act , Delivery of Health Care , Humans , Quality of Health Care , SARS-CoV-2 , United States
2.
Surg Oncol Clin N Am ; 31(1): xi-xii, 2022 Jan.
Article in English | MEDLINE | ID: mdl-34776069
3.
Eval Program Plann ; 90: 101981, 2022 Feb.
Article in English | MEDLINE | ID: mdl-34392968

ABSTRACT

African American/Black and Hispanic/Latino sexual and gender minority populations are disproportionately affected by HIV in the United States and continue to experience HIV-related disparities. CDC funded project PrIDE to support 12 health departments (HD) with implementing pre-exposure prophylaxis (PrEP) strategies for men who have sex with men (MSM) and transgender persons, with a health-equity focus established by HDs. Each HD conducted mixed-methods evaluation of at least one local strategy. CDC employed a cluster evaluation approach to maximize cross validation. As a result, this cluster evaluation focused on three HDs that evaluated health equity-focused PrEP implementation strategies. Findings suggest that integrating health equity strategies such as storytelling and healthcare worker (HCW) trainings can help reduce HIV-related disparities. Storytelling improved HCW's understanding of clients' experiences of stigma due to racial, gender, and sexual identities. Provider training increased competencies on culturally appropriate care and the use of clinic services by Black and Hispanic MSM and transgender persons. Good practices included community engagement, seeking leadership buy-in, and integration of programmatic staff in health equity and evaluation activities. Evaluating strategies and training policies addressing social determinants of health that adversely affect HIV outcomes may help mitigate barriers Black and Hispanic MSM and transgender populations encounter in their HIV prevention seeking efforts.

4.
J. Health NPEPS ; 6(2): 1-15, dez. 2021.
Article in English | LILACS, BDENF - Nursing, Coleciona SUS | ID: biblio-1337842

ABSTRACT

ABSTRACT Objective:to analyze the epidemiological data of Severe Acute Respiratory Syndrome (SARS), and the access to health of black people in Brazil during the pandemic, comparing them with previous years. Method:epidemiological, descriptive, and quantitative study of SARS cases in black patients, reported in the information system on epidemiological surveillance of influenzaof the Ministry of Health, between 2017 and 2020. Results:it was observed that, in 2020, there was an increase in the prevalence of SARS cases in blacks, in addition to a significant increase in lethality when compared to the general population. Furthermore, it was found that mortality was significantly higher in individuals with SARS who required ventilatory support. Conclusion:skin color is a determinant of several social and health vulnerabilities in Brazil and worldwide, having a direct impact on theincreased morbidity and mortality of the black population during the pandemic.


RESUMEN Objetivo:analizar los datos epidemiológicos del Síndrome Respiratorio Agudo Severo (SRAS) y el acceso a la salud de los negros en Brasil durante la pandemia, comparándolos con años anteriores. Método:estudio epidemiológico, descriptivo y cuantitativo de casos de SRAS en pacientes de raza negra, reportados en el sistema de información de vigilancia epidemiológica de Influenza del Ministerio de Salud, entre 2017 y 2020. Resultados:se observó que, en En 2020, hubo un aumento en la prevalencia de casos de SARS en negros, además de un aumento significativo en la letalidad en comparación con la población general. Además, se encontró que la mortalidad fue significativamente mayor en las personas con SARS que requirieron soporte ventilatorio. Conclusión:color de la piel es un determinante de varias vulnerabilidades sociales y de salud en Brasil y en todo el mundo, teniendo un impacto directo en el aumento de la morbilidad y mortalidad de la población negra durante la pandemia.


RESUMO Objetivo: analisar os dados epidemiológicos da síndrome respiratória aguda grave (SRAG) e o acesso à saúde de pessoas negras no Brasil durante a pandemia, comparando-os com os anos anteriores.Método: estudo epidemiológico, descritivo e quantitativo de casos de SRAG em pacientes negros, notificados no sistema de informação em vigilância epidemiológica da influenza do Ministério da Saúde, entre 2017 e 2020. Resultados: observou-se que, em 2020, houve um aumento da prevalência dos casos de SRAG em negros, além de um aumento significativo da letalidade quando comparada à população em geral. Além disso, verificou-se que a mortalidade foi significativamente maior em indivíduos com SRAG que necessitaram de suporte ventilatório. Conclusão: a cor da pele é um determinante de diversas vulnerabilidades sociais e de saúde no Brasil e no mundo, tendo impacto direto no aumento da morbimortalidade da população negra durante a pandemia.


Subject(s)
Coronavirus Infections , Severe Acute Respiratory Syndrome , Social Determinants of Health , Healthcare Disparities , Racism
5.
Multimedia | Multimedia Resources | ID: multimedia-9323

ABSTRACT

The COVID-19 pandemic brought to light the shortcomings of health systems worldwide and the need to address the factors underpinning these flaws. In this webinar, we discuss the role of private sector and commercial determinants of health (#CDoH) in this global health crisis. Through their different perspectives, the panelists explore the role of private sector in the pandemic, the relationship between CDoH and COVID-19 on national and global levels and discuss the implications for global health. TIMESTAMPS: 00:00 | Welcome and Objective 02:35 | Opening Remarks 07:00 | COVID-19 as Commercial Determinant of Health 19:58 | Unhealthy Commodity Industries' Response to COVID-19 38:00 | Moderated Discussion and Q&A


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/economics , Public Health Systems , Health Policy , Global Health Strategies , Capitalism , Marketing of Health Services , Racism , Health Equity , Physical Distancing , Quarantine , Risk Groups , COVID-19 Testing , Personal Protective Equipment , Health Promotion , Private Sector/economics , Tobacco Industry
6.
Internet resource in English | LIS -Health Information Locator | ID: lis-48490

ABSTRACT

In 2020, the Southgate Institute was designated as a World Health Organization Collaborating Centre to support international research and knowledge translation on social, political, and commercial determinants of health equity. Prof Fran Baum is designated as the Director of the Centre.


Subject(s)
Social Determinants of Health , Health Equity/standards , World Health Organization/organization & administration
7.
J Clin Med ; 10(22)2021 Nov 15.
Article in English | MEDLINE | ID: mdl-34830579

ABSTRACT

The identification of general population groups particularly vulnerable to the impact of COVID-19 lockdown measures on mental health and the development of healthcare policies are priority challenges in the current and future pandemics. This study aimed to identify the personal and social determinants of the impact of COVID-19 lockdown measures on mental health in a large sample of the Colombian population. In this cross-sectional study, an anonymous online survey was answered by 18,061 participants from the general population residing in Colombia during the first wave of the COVID-19 outbreak (from 20 May to 20 June 2020). The risk of depression, anxiety, and somatization disorders were measured using the Patient Health Questionnaire (PHQ-2), Generalized Anxiety Disorder Scale (GAD-2), and Somatic Symptom Questionnaire (SSQ-5), respectively. Overall, 35% of participants showed risk of depression, 29% of anxiety, and 31% of somatization. According to the analysis of social determinants of health, the most affected groups were people with low incomes, students, and young adults (18-29 years). Specifically, low-income young females were the most at-risk population group. These findings show how the lockdown measures affected the general population's mental health in Colombia and highlight some social risk factors in health.

8.
Article in English | MEDLINE | ID: mdl-34831556

ABSTRACT

BACKGROUND: Lesbian, gay, bisexual, and transgender (LGBT) people present poorer mental and physical health results compared to the heterosexual and cisgender population. There are barriers in the healthcare system that increase these health inequities. OBJECTIVE: To synthesise the available evidence on how nurses can intervene in reducing health inequities in LGBT people, identifying their specific health needs and describing their experiences and perceptions of the barriers they face in the healthcare system. METHODS: Systematic review. Between March and April 2021, a bibliographic search was carried out in the Cuiden, LILACS, PubMed, Dialnet, SciELO, Trip Database, and Web of Science databases and metasearch engines. INCLUSION CRITERIA: Articles published in the last 5 years that address the specific health needs of LGBT people, their experiences and perceptions, or interventions in this group in which nurses may engage. RESULTS: A total of 16 articles were selected. Health disparities were detected in the LGBT community, which exhibited higher rates of mental health problems, substance abuse, risky sexual behaviours, self-harm, and suicide. These inequalities were related to minority stress, and each of them differently impacted individual populations within the broader LGBT community depending on their sexual orientations and gender identities. The impact of these factors was, in turn, modified by the intersections of race/ethnicity, geographic region, and socioeconomic factors. LGBT people described discriminatory experiences by health professionals, as well as their distrust and fear in this setting. Nurses can carry out interventions such as inclusive education about sex and sexual and gender diversity and bullying and suicide prevention programmes, and can provide gender-affirming and family-centred care. CONCLUSIONS: LGBT people experience health inequities and discrimination in the healthcare system. Nurses can implement diverse interventions to reduce these problems and, moreover, these health professionals are obliged to acquire cultural competence regarding LGBT health.

9.
Article in English | MEDLINE | ID: mdl-34837163

ABSTRACT

Health disparities are well-documented among different racial and ethnic minority groups in the United States. Filipino Americans (FAs) are the third-largest Asian-American group in the USA and are commonly grouped under the Asian categorization. FAs have a higher prevalence of cardiometabolic disorders than non-Hispanic Whites and other Asian subgroups with rates comparable to African Americans. Although no major epidemiological studies have ascertained the prevalence of cardiometabolic diseases in FAs, limited reports suggest that FAs have a higher prevalence of dyslipidemia, hypertension, diabetes, metabolic syndrome, hyperuricemia, and gout than non-FAs. A recent genetic study has shown that FAs could have the highest prevalence of a genetic polymorphism strongly associated with the development of gout and gout-related comorbidities. While developing cardiometabolic disorders is a heterogeneous and multifaceted process, the overall prevalence of certain cardiometabolic disorders parallel the prevalence of population-level risk factors, including genetics, dietary lifestyles, health beliefs, and social determinants of health. Therefore, assessment of the Filipino cuisine, health behaviors among Filipinos, socio-cultural factors, and acculturation to living in the USA are equally critical. Ascertaining the contribution of the biological causes to disease onset and the different psychosocial factors that could modulate disease risk or disease management are needed. Ultimately, a multilevel research approach is critical to assess the role of biological and non-biological risk factors of cardiometabolic disorders in FAs to inform culturally appropriate health promotion, disease prevention strategies, and a personalized approach to health.

10.
Int J Public Health ; 66: 609179, 2021.
Article in English | MEDLINE | ID: mdl-34744575

ABSTRACT

Objective: To describe the inequalities in the double burden of malnutrition (DBM) in the adult population. Methods: Study carried out with data from the VIGITEL study, conducted in 2019 in all Brazilian capitals. Underweight and excess weight were evaluated on the basis of years of schooling and age. Multi-level analysis was performed including Human Development Index of each capital and individual-level variables. The inequality slope index was used to assess the magnitude of the inequalities found. All analyses considered the svy command owing to the complexity of the sampling process. Results: 47.119 individuals were studied. Men with no education had 6 percentage points more underweight compared to those with higher education. Higher prevalence of excess weight was found among men with higher education and women with no education. In women, the difference was 18 percentage points between extreme categories. Elderly people with no education had 10 percentage points more excess weight than those with higher education. Conclusions: The findings suggest the need for intersectoral actions that can cope with the social inequalities and help confronting with the DBM in Brazil.


Subject(s)
Health Status Disparities , Malnutrition , Adult , Brazil/epidemiology , Female , Humans , Male , Malnutrition/epidemiology , Socioeconomic Factors
11.
Salud Colect ; 17: e3461, 2021 Jul 13.
Article in Spanish | MEDLINE | ID: mdl-34752021

ABSTRACT

Equity is an unresolved issue on the Spanish healthcare agenda. This paper explores the importance that health professionals give to social determinants of health and the means they possess to address them. It also analyzes the relationship between food insecurity and increases in certain diseases. One of its objectives is to ascertain how increasing uncertainty is being addressed in primary healthcare services. We present a qualitative study carried out in six primary care centers in the cities of Reus and Tarragona between 2018 and 2019, involving 19 practitioners active in the areas of nursing, family practice, and social work. Results indicate that the lack of resources in primary care centers makes it difficult to integrate a social determinants of health approach, and thus to mitigate inequalities. Furthermore, a lack of structural actions diminishes the ability to respond to citizens' healthcare needs.


Subject(s)
Delivery of Health Care , Primary Health Care , Humans , Qualitative Research , Socioeconomic Factors , Spain
12.
Pediatr Clin North Am ; 68(6): 1147-1155, 2021 12.
Article in English | MEDLINE | ID: mdl-34736581

ABSTRACT

Social determinants of health (SDH) as outlined by Healthy People 2020 encompasses 5 key domains: economic, education, social and community context, health and health care, and neighborhood and built environment. This article emphasizes pediatric populations and some of the existing SDH and health care disparities seen in pediatric gastroenterology. We specifically review inflammatory bowel disease, endoscopy, bariatric surgery, and liver transplantation. We also examine the burgeoning role of telehealth that has become commonplace since the coronavirus disease 2019 era.


Subject(s)
Child Welfare/statistics & numerical data , Gastroenterology/organization & administration , Health Equity/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Social Determinants of Health , Child , Health Services Accessibility/organization & administration , Health Status Disparities , Humans , Socioeconomic Factors , United States
13.
Pediatr Clin North Am ; 68(6): 1157-1169, 2021 12.
Article in English | MEDLINE | ID: mdl-34736582

ABSTRACT

Pediatric gastroenterologists took on a variety of challenges during the coronavirus disease 2019 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically decreased numbers of in-person visits, adopting telehealth technologies, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the impact of the pandemic on trainee education, clinical experience, research, and job searches.


Subject(s)
COVID-19/epidemiology , Child Welfare/statistics & numerical data , Gastroenterology/organization & administration , Health Equity/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Social Determinants of Health , Child , Health Services Accessibility/organization & administration , Health Status Disparities , Humans , Socioeconomic Factors , United States
14.
J Public Health Dent ; 2021 Nov 25.
Article in English | MEDLINE | ID: mdl-34821390

ABSTRACT

OBJECTIVES: To assess the magnitude of, and changes in, absolute and relative oral health inequality in Canada and the United States, from the 1970s till the first decade of the new millennium. METHODS: Data were obtained from four national surveys; two Canadian (NCNS 1970-1972 and CHMS 2007-2009) and two American (HANES 1971-1974 and NHANES 2007-2008). The slope and relative index of inequality were used to measure absolute and relative inequality, respectively. Percentage change in inequality was also calculated. RESULTS: Relative inequality for untreated decay increased by 91% in Canada and 189% in the United States, while for filled teeth it declined by 63% in Canada and 16% in the United States. Relative inequality in edentulism rose by 200% and 78% in Canada and United States, respectively. Absolute inequality declined in both countries. CONCLUSIONS: There was persistent absolute and relative inequality in Canada and the United States. An increase in relative inequality for adverse outcomes suggests that improvements in oral health were occurring primarily among the rich, while reductions in relative inequality for filled teeth indicate higher utilization of restorative services among the poor. These results point to the necessity of tackling the sociopolitical determinants of health to mitigate oral health inequality in Canada and the United States.

15.
Article in English | MEDLINE | ID: mdl-34814664

ABSTRACT

India has established health and wellness centres (HWCs) and appointed mid-level healthcare providers (community health officers, CHOs) to provide free and comprehensive primary healthcare (PHC), through screening, prevention, control, management and treatment for non-communicable diseases (NCDs), in addition to existing services for communicable diseases, and reproductive and child health. The range of services being provided and the number of people accessing ambulatory care in these government centres have increased, leading to more equitable healthcare access and financial protection. In policy debates, contestations exist prioritising between PHC or hospital services, and between publicly-provided healthcare or privatised and "purchased" services. Nationally and globally the influence of industries and corporations in health governance has weakened the response against NCDs. PHC initiatives for NCDs must be publicly funded and provided, located within communities, and necessitate action on the determinants of health. The experiences from Australia (a high-income country) and India (a low-and middle-income country) amply illustrate this.

16.
Nurs Clin North Am ; 56(4): 619-634, 2021 12.
Article in English | MEDLINE | ID: mdl-34749900

ABSTRACT

Obesity is a multifactorial disease that disproportionally affects diverse racial and ethnic groups. Structural racism influences racial inequities in obesity prevalence through environmental factors, such as racism and discrimination, socioeconomic status, increased levels of stress, and bias in the health care delivery system. Researchers, clinicians, and policy makers must work to address the environmental and systematic barriers that contribute to health inequities in the United States. Specifically, clinicians should quantitatively and qualitatively assess environmental and social factors and proactively engage in patient-centered care to tailor available treatments based on identified needs and experiences.


Subject(s)
Continental Population Groups , Environment , Ethnic Groups , Health Status Disparities , Obesity/epidemiology , Social Determinants of Health , Bias , Delivery of Health Care , Health Services Accessibility , Humans , Socioeconomic Factors , United States
17.
Article in English | MEDLINE | ID: mdl-34762746

ABSTRACT

BACKGROUND: During a pandemic, the occurrence of infections and case fatality rates are expected to vary from one country to another due to several variables such as poverty, existing comorbidities, population density, access to health care, availability and quality of health system resources, and environmental factors. OBJECTIVES: Our aim is to investigate the relationship between various demographic and socioeconomic factors and reported COVID-19 morbidity and mortality indicators in different countries. Also, to determine the position of the countries relative to each other in terms of three indicators including COVID-19 cases, deaths and tests. METHODS: Canonical correlation analysis is used to investigate the intercorrelations between independent variables and the COVID-19 cases and deaths for 92 countries. Countries' performances are measured by MULTIMOORA. RESULTS: Human Development Index, smoking habits, percentage of elderly population and test frequency are the most significant variables associated with COVID-19 morbidity and mortality according to our study findings. Singapore, New Zealand and Australia are the best performed countries. CONCLUSIONS: Several significant and unexpected associations exist between socioeconomic factors and the COVID-19 cases and deaths. Singapore, New Zealand and Australia are surrounded by water, have been more successful in the pandemic process compared to other countries.

18.
Article in English | MEDLINE | ID: mdl-34769535

ABSTRACT

BACKGROUND: Health equity features prominently in the 2030 Agenda for Sustainable Development, yet there are wide disparities in health between and within countries. In settings of natural resource extraction (e.g., industrial mines), the health of surrounding communities is affected through myriad changes in the physical, social, and economic environment. How changes triggered by such projects translate into health inequities is poorly understood. METHODS: This qualitative study explores potential layers of inequities by systematically coding perceived inequities of affected communities. Drawing on the framework method, we thematically analyzed data from 83 focus group discussions, which enrolled 791 participants from 10 study sites in Burkina Faso, Mozambique, and Tanzania. RESULTS: Participants perceived inequities related to their individual characteristics, intermediate factors acting on the community level, and structural conditions. Due to environmental pollution and land loss, participants were concerned about unsecured livelihoods. Positive impacts, such as job opportunities at the mine, remained scarce for local communities and were claimed not to be equally distributed among community members. CONCLUSION: Extractive industries bear considerable risks to widen existing health gaps. In order to create equal opportunities among affected populations, the wider determinants of health must be considered more explicitly in the licensing process of resource extraction projects.


Subject(s)
Health Equity , Mining , Burkina Faso , Humans , Mozambique , Tanzania
19.
Article in English | MEDLINE | ID: mdl-34769536

ABSTRACT

This paper provides a longitudinal examination of local inequalities in health behaviours during a period of austerity, exploring the role of 'place' in explaining these inequalities. Data from the Stockton-on-Tees prospective cohort study of 836 individuals were analysed and followed over 18 months (37% follow-up). Generalised estimating equation models estimated the deprivation gap in health behaviours (smoking status, alcohol use, fruit and vegetable consumption and physical activity practices) between the 20% most- and least-deprived neighborhoods (LSOAs), explored any temporal changes during austerity, and examined the underpinning role of compositional and contextual determinants. All health behaviours, except for frequent physical activity, varied significantly by deprivation (p ≤ 0.001). Smoking was lower in the least-deprived areas (OR 0.21, CI 0.14 to 0.30), while alcohol use (OR 2.75, CI 1.98 to 3.82) and fruit and vegetable consumption (OR 2.55, CI 1.80 to 3.62) were higher in the least-deprived areas. The inequalities were relatively stable throughout the study period. Material factors (such as employment, education and housing tenure) were the most-important and environmental factors the least-important explanatory factors. This study suggests that material factors are the most important 'place' determinants of health behaviours. Health promotion activities should better reflect these drivers.


Subject(s)
Alcohol Drinking , Exercise , Alcohol Drinking/epidemiology , Cohort Studies , Humans , Prospective Studies , Socioeconomic Factors
20.
J Acquir Immune Defic Syndr ; 88(S1): S1-S5, 2021 Dec 15.
Article in English | MEDLINE | ID: mdl-34757986

ABSTRACT

ABSTRACT: Racial and ethnic minority, sexual and gender minority, and low-income people have historically experienced poorer health outcomes and poorer social conditions that lead to poorer health outcomes (social determinants of health) than nonminority people in the United States. To eliminate these health disparities, intentional and targeted interventions that address the needs and preferences of diverse populations are needed. To address disparities, the California HIV/AIDS Research Program focused their funding resources tightly on communities facing elevated HIV incidence or prevalence. This special issue describes interventions that aimed to increase linkage to and engagement in HIV-specific prevention or medical care, each uniquely tailored to the needs of an identified California population with disparate HIV-related health outcomes and each for implementation at a specific stage of the HIV prevention and care continuum.

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