Indigenous Men With Disabilities at Work: Corpospatial Reconfigurations in/of a Changing Rural Mexico

From Invisible to Visible to Valued: Improving Population Health of People With Intellectual and Developmental Disabilities.

At the intersection of chronic disease, disability and health services research: A scoping literature review

Health in 2020 and beyond: what do the numbers tell us?

Traditionally, health protection and health promotion activities have operated independently of each other in the workplace. Health protection has usually been viewed as encompassing the activities that protect workers from occupational injury and illness ranging from basic safety training to the us

Purpose: This article provides a conceptual framework for understanding healthcare disparities experienced by individuals with disabilities. While health disparities are the result of factors deeply rooted in culture, life style, socioeconomic status, and accessibility of resources, healthcare disparities are a subset of health disparities that reflect differences in access to and quality of healthcare and can be viewed as the inability of the healthcare system to adequately address the needs of specific population groups. Methods: This article uses a narrative method to identify and critique the main conceptual frameworks that have been used in analyzing disparities in healthcare access and quality, and evaluating those frameworks in the context of healthcare for individuals with disabilities. Specific models that are examined include the Aday and Anderson Model, the Grossman Utility Model, the Institute of Medicine (IOM)’s models of Access to Healthcare Services and Healthcare Disparities, and the Cultural Competency model. Results: While existing frameworks advance understandings of disparities in healthcare access and quality, they fall short when applied to individuals with disabilities. Specific deficits include a lack of attention to cultural and contextual factors (Aday and Andersen framework), unrealistic assumptions regarding equal access to resources (Grossman’s utility model), lack of recognition or inclusion of concepts of structural accessibility (IOM model of Healthcare Disparities) and exclusive emphasis on supply side of the healthcare equation to improve healthcare disparities (Cultural Competency model). In response to identified gaps in the literature and short-comings of current conceptualizations, an integrated model of disability and healthcare disparities is put forth. Conclusion: We analyzed models of access to care and disparities in healthcare to be able to have an integrated and cohesive conceptual framework that could potentially address issues related to access to healthcare among individuals with disabilities. The Model of Healthcare Disparities and Disability (MHDD) provides a framework for conceptualizing how healthcare disparities impact disability and specifically, how a mismatch between personal and environmental factors may result in reduced healthcare access and quality, which in turn may lead to reduced functioning, activity and participation among individuals with impairments and chronic health conditions. Researchers, health providers, policy makers and community advocate groups who are engaged in devising interventions aimed at reducing healthcare disparities would benefit from the discussions.Implications for RehabilitationEvaluates the main models of healthcare disparity and disability to create an integrated framework.Provides a comprehensive conceptual model of healthcare disparity that specifically targets issues related to individuals with disabilities.Conceptualizes how personal and environmental factors interact to produce disparities in access to healthcare and healthcare quality.Recognizes and targets modifiable factors to reduce disparities between and within individuals with disabilities.

Rebuilding a Reproductive Future Informed by Disability and Reproductive Justice.

Definitions of disability have evolved over time. Consistent with the biopsychosocial model used by the World Health Organization, we conceptualize disability as an interaction between a person's functional impairments or chronic health conditions and the physical and social environment. Having a disability is not synonymous with poor health, and maintaining and improving health is equally important for both people with and people without disabilities. In this article we review estimates of disability prevalence in the US and present evidence of differences in prevalence by race, ethnicity, and sexual orientation; health disparities by disability status and type of disability; and health disparities for people whose disability intersects with other forms of marginalization. We suggest policy changes to advance equity, reduce disparities, and enhance the health and well-being of all Americans with disabilities.

There are currently 1.5 million indigenous people in Bangladesh, constituting 1.8% of the total population and representing one of the country's most deprived communities. This study explores the health status and quality of life along with their determinants among indigenous older people in Bangladesh in order to fill the knowledge and evidence gap on this topic. A mixed-methods approach was deployed in October 2019 in the Sylhet division of Bangladesh which involved a cross-sectional survey among 400 indigenous older adults (200 males, 200 females) from 8 tea gardens using a pre-tested semi-structured questionnaire. Ten in-depth interviews were also conducted with providers of the tea garden health facilities. Descriptive analysis, multiple logistic and multi-nominal linear regression were performed to explore associated factors around health and quality of life. Of the total respondents, the majority (79.5%) had chronic diseases, with visual difficulty being predominant (74%) among the conditions. Almost all (94%) of the respondents experienced delays in receiving treatment and poverty was identified by most (85%) as the primary cause of those delays. Extreme age, being male, living alone and low family income were significantly associated with suffering from chronic conditions. Furthermore, having a chronic condition and extreme age were found to be significantly associated with a low quality of life. Health service providers identified lack of logistical support in the health facilities, the economic crisis and lack of awareness as the major causes of poor health status and poor health seeking behaviour of the indigenous older adults. Indigenous older men in extreme old age are more vulnerable to adverse health conditions and poor quality of life. Health literacy and health seeking behaviour is poor among indigenous older adults generally and there is a huge gap in the health services and social supports available to them.

The first European observers in the archipelago we now call Vanuatu characterised Indigenous men as martial warriors. Such observations occluded the diversity of Indigenous masculinities and the violence inherent in colonial processes of exploration, and later dispossession, ‘pacification’ and the imposition of colonial law. Indigenous relations between men were grounded in ascribed hierarchies of seniority and either achieved or ascribed hierarchies of divine power. Ideally more senior and higher ‘men of peace’ were seen to eclipse younger, lower ‘men of war’, but creative and destructive aspects of masculine power were often co-present in Janus-face formations. In surveying the longue durée of changing masculinities in Vanuatu we can witness complex reconfigurations associated with Christian conversion, the ‘labour trade’, commodity economy and state politics. The American military presence during the Second World War was a pivotal moment in such historical reconfigurations. As against the colonial masculine hierarchy of white mastas and black boes, it generated idioms of racial equality and fraternity between black men and white men and fuelled movements for independence. This is in stark contrast with the historical experience of another Pacific archipelago, Hawai‘i, a state of the United States and a major base for the US military securing what some Kānaka Maoli see as an occupation of their homelands. A comparison of these two Pacific archipelagos highlights how Indigenous masculinities are historically formed and transformed in the context of the race relations of different colonialisms.

Comprehensive reproductive health care for people with chronic health conditions is reproductive justice in action. As the authors in this special series have underscored, lack of quality, coordinated, and respectful reproductive care for this population leads to infertility, mental distress, untreated and misunderstood health problems, and altered life courses that can result in maternal mortality and morbidity, poor outcomes for infants, and exacerbation of conditions that have lasting impacts on people with chronic conditions and their families. Improving reproductive wellness requires the engagement of many system actors, identified by Hassmiller Lich et al., as health care institutions, medical leaders, medical providers, patient advocates and foundations, patients and families, payers, policymakers, and research funders. Their research identified 40 pain points and 46 corresponding action items for change. Their systems approach to problem solving underscored that there is not a single lever or action that can affect broad reform; rather, this is a time that calls for complex thinking and work happening simultaneously across sectors and systems.1 Their call for collaboration across all sectors was answered in part by the research of Goodsmith et al., who explored the acceptability of integrating reproductive goal assessment into mental health service provision. While the timing and approach need to be carefully considered and based on a foundation of trust, patients and providers alike expressed an interest in and the value of opening space for conversations about having or not having children.2 Thematic across the papers in this special series is the urgent call for health care providers and professionals to invest time in understanding and addressing their own biases—overt and covert—on the reproductive care they provide to patients with chronic conditions as well as building their knowledge on the most current treatment options available. Opening opportunities for conversations about reproductive goals is especially important for people with chronic conditions, for whom the stakes are high for their own health as well as that of their family and future children, if desired. These conversations must be based on a foundation of trust and, if done well, can be a bridge to comprehensive care and well-being. There are resources available for people as consumers of information at ShowYourLoveToday.com and for people in their role as professionals at BeforeandBeyond.org. In response to the work elevating lived experiences, a patient research advisory group is being developed to provide feedback to researchers. There is a group of change agents that meets quarterly to advance this work. Reach out to the author if you are interested in engaging further. The research and expertise shared across the 12 articles in this series offer a wealth of ideas and strategies for advancing care for this population, including the opening commentary that offers a clear model for change. The next steps are up to readers. The answers are there; now we must find the moral courage and collective response to make it happen. W.K. Kellogg Foundation, Grant/Award Number: P-P30391-47-2020.

In the United States, approximately 20 million children under age 18 have a chronic physical illness or disability (CID) (Newacheck & Taylor, 1992). As a result of the advances in medical technology, most of these children will attain adulthood, an outcome heretofore not readily achieved (Ell & Reardon, 1990; Gortmaker & Sappenfield, 1984). Many of these children will be well physically and psychologically (Noll, Ris, Davies, Bukowski, & Koontz, 1992; Perrin, Ramsey, & Sandler, 1987; Wertleib, Hauser, & Jacobson, 1986). The ongoing strain of living with a chronic physical condition, puts other children at increased risk of social and emotional problems (Gortmaker, Walker, Weitzman, & Sobol, 1990; Pless, Power, & Peckman, 1993; Roberts, Turney, & Knowles, 1998). There are two schools of thought regarding the etiology of social morbidities experienced by children who have chronic conditions. One perspective is that the health status (the actual manifestation and management of a CID or the inherent characteristics of CID) of a child is the primary source of psychosocial problems such as diminished self-worth, depression, and lower sense of competence than that of peers without chronic conditions (Lavigne & Faier-Routman, 1992; Pless & Nolan, 1991; Pless & Pinkerton, 1975; Pless et al.). The second perspective identifies social isolation and other sequelae of living with a chronic condition as the cause of psychosocial problems (Blum, 1992; Patterson, 1991; Redd, 1994; Zeltzer, 1993). SELF-PERCEPTION: A PROTECTIVE FACTOR? Social isolation is reported to be particularly potent when coupled with invisible physical chronic conditions such as asthma, diabetes, and congenital heart disease (Sinnema, 1991). Earlier research suggests that children with these conditions face especially complex challenges in developing a sense of self-worth (Starfield, 1992; Stein & Jessop, 1984). Children with invisible conditions may not exhibit overt physical limitations but are often hampered by complex clinical care requirements or their inability to perform tasks and participate in certain age-appropriate activities. Because their chronic conditions are not obvious, children with invisible conditions may avoid needed health maintenance in an effort to be normal, thereby placing themselves at increased risk of exacerbating their physical conditions. Research suggests that children who demonstrate the most psychological distress have the least overt signs of disability (Kellerman, Zeltzer, Ellenberg, Dash, & Rigler, 1980; Tavormina, Kastner, Slater, & Watt, 1976; Zeltzer, 1993). Those research findings concluded that the perceptions of illness far more than the physiological manifestations affect the children's functioning. According to Patterson (1991), the dissonance between sociobehavioral norms and physiological restrictions can result in poor self-esteem and withdrawal. The latter are risk factors of depression, suicide, and other psychological problems (Masten, 1988). It may not be the severity of limitation but rather the child's perceptions of herself or himself as a worthwhile person that influences emotional distress and cognitive and sociobehavioral outcomes. In school-age children, feedback from peers is central to the development of self-esteem (Rosenberg, 1979). Harter (1990a) reported that there is a hierarchy of feedback informants in the peer group. The respect of classmates who are not close friends is most revered among childhood peers and has the greater effect on self-esteem (Harter, 1990a). Essentially, children and youths see themselves through the eyes of others (Cooley, 1902); their perceptions of self-worth are rooted in interpersonal relationships (Harter, 1990a; Leahy & Shirk, 1985; Rosenberg, 1979; Selman, 1980). According to James (1892), if the number of successes experienced is greater than the unrealized attempts, then the individual feels a sense of competence. …

The stories in this book illustrate a broad spectrum of effects, and that rights have played a vital role for some of them while having little significance for others. The sense of self that emerges over a long span of time, from early childhood to adulthood, may be affected in different ways by a disability, and the intersection of disability and identity can make rights appear more or less relevant, useful, or attainable. An important aspect of the recursive relationship between rights and identity is that it extends over many years. It is important to explore the recursive effects of identity and rights in research that has considerable temporal depth. The recursive relationship between rights and identity should be understood in terms of the effects of rights on social institutions, such as the workplace, the family, and schools. ADA rights become active through cultural and discursive shifts even when rights do not directly transform an individual's self-perceptions. A recursive theory of rights and identity might suggest a continual evolution toward greater rights consciousness and an ever-increasing role for rights.

Background: Adults with chronic medical conditions complicated by food insecurity or physical limitations may have higher barriers to accessing telehealth implemented during the COVID-19 pandemic. Objective: To examine the relationships of self-reported food insecurity and physical limitations with changes in health care utilization and medication adherence comparing the year before (March 2019-February 2020) and the first year of the COVID-19 pandemic (April 2020-March 2021) among patients with chronic conditions insured by Medicaid or Medicare Advantage. Methods: A prospective cohort study of 10,452 Kaiser Permanente Northern California members insured by Medicaid and 52,890 Kaiser Permanente Colorado members insured by Medicare Advantage was conducted. Difference-in-differences (DID) between the pre-COVID and COVID years in telehealth versus in-person health care utilization and adherence to chronic disease medicines by food insecurity and by physical limitation status were measured. Results: Food insecurity and physical limitations were each associated with small but significantly greater shifts from in-person to telehealth. Medicare Advantage members with physical limitations also had significantly greater decline in adherence to chronic medications from year to year compared with those without physical limitations (DID from pre-COVID year to COVID year ranged from 0.7% to 3.6% greater decline by medication class, p < 0.01). Conclusions: Food insecurity and physical limitations did not present significant barriers to the transition to telehealth during the COVID pandemic. The greater decrease in medication adherence among older patients with physical limitations suggests that care systems must further address the needs of this high-risk population.

To examine recent trends and differences in all-cause and cause-specific hospitalization rates by race, ethnicity, and gender among persons with HIV (PWH) in the United States and Canada. HIV clinical cohort consortium. We followed PWH at least 18 years old in care 2005-2015 in six clinical cohorts. We used modified Clinical Classifications Software to categorize hospital discharge diagnoses. Incidence rate ratios (IRR) were estimated using Poisson regression with robust variances to compare racial and ethnic groups, stratified by gender, adjusted for cohort, calendar year, injection drug use history, and annually updated age, CD4+, and HIV viral load. Among 27 085 patients (122 566 person-years), 80% were cisgender men, 1% transgender, 43% White, 33% Black, 17% Hispanic of any race, and 1% Indigenous. Unadjusted all-cause hospitalization rates were higher for Black [IRR 1.46, 95% confidence interval (CI) 1.32-1.61] and Indigenous (1.99, 1.44-2.74) versus White cisgender men, and for Indigenous versus White cisgender women (2.55, 1.68-3.89). Unadjusted AIDS-related hospitalization rates were also higher for Black, Hispanic, and Indigenous versus White cisgender men (all P < 0.05). Transgender patients had 1.50 times (1.05-2.14) and cisgender women 1.37 times (1.26-1.48) the unadjusted hospitalization rate of cisgender men. In adjusted analyses, among both cisgender men and women, Black patients had higher rates of cardiovascular and renal/genitourinary hospitalizations compared to Whites (all P < 0.05). Black, Hispanic, Indigenous, women, and transgender PWH in the United States and Canada experienced substantially higher hospitalization rates than White patients and cisgender men, respectively. Disparities likely have several causes, including differences in virologic suppression and chronic conditions such as diabetes and renal disease.

IntroductionWith population ageing the prevalence of multi-morbidity (the co-occurrence of two or more chronic medical conditions) is increasing.&#x0D; Objectives and ApproachOur goal was to use data linkage to obtain clinically validated data on the incidence of a range of common chronic conditions developed by participants in the Australian Longitudinal Study on Women’s Health (57,000 women) and hence to track the cumulative incidence of multi-morbidity over time.&#x0D; ResultsThe major data sources differed for different conditions, e.g. the Pharmaceutical Benefits Scheme was important for identifying musculoskeletal conditions, whereas hospital admission data was crucial for identifying stroke. The most common combinations of conditions differed for women at different ages, e.g., mental health, musculoskeletal and respiratory conditions were most common for women born in 1989-95, whereas heart disease was a prominent part of multi-morbidity for women born in 1921-26. Among these older women about 50% had 3 or more chronic conditions in 2002 (when they were aged 76-81) and this increased to over 80% by 2015 (when they were 89-93). For comparison, among women born in 1973-78 fewer than 5% had 2 or more chronic conditions in 2002 (when they were aged 24-29) and this increased to about 15% in 2016 (when they were 38-43).&#x0D; Conclusion / ImplicationsRecord linkage from multiple data sources, repeated over a long time span, is a powerful method for studying the development of multi-morbidity patterns in cohorts.