Address Health Inequities Research Articles

Addressing Health Inequities in Gastroenterology: The Impact of a Digital Digestive Health Program with Virtual Dietitian and Health Coach Support for socially Vulnerable Populations

Addressing Health Inequities in Gastroenterology: The Impact of a Digital Digestive Health Program with Virtual Dietitian and Health Coach Support for socially Vulnerable Populations

Solidarity as a Political Determinant of Health: Insights from EU Competition Policy

Context: The connection between law and political determinants of health is not well understood, but nevertheless it is suggested that the two are inseparable, and this represents an upstream level with scope for influencing other determinants of health (particularly social determinants). Solidarity underpins European health care systems, and given its clear link with redistribution, it can be seen as a means for addressing health inequities. As such, solidarity may be seen as a political determinant of health in the specific context of European Union (EU) competition policy. Methods: A range of EU case law, treaty provisions, and European Commission publications relating to EU competition policy are analyzed. Findings: Solidarity is typically juxtaposed as antithetical to competition and thus as underpinning exceptions to the applicability of prohibitions on anticompetitive agreements, abuse of dominance, and state aid. Case law indicates an additional dynamic between definitions of solidarity at the EU and national levels. Conclusions: This analysis leads to two groups of considerations when framing solidarity as a political determinant of health in the EU competition policy context: first, the predominance of solidarity suggests it may shape competition reforms; second, the EU–member state dynamic indicates less EU-level reach into national competition reforms in health care than may be expected.

Reducing racial and ethnic disparities in cardiovascular outcomes among cancer survivors.

Analyze current evidence on racial/ethnic disparities in cardiovascular outcomes among cancer survivors, identifying factors and proposing measures to address health inequities. Existing literature indicates that the Black population experiences worse cardiovascular outcomes following the diagnosis of both initial primary cancer and second primary cancer, with a notably higher prevalence of cardio-toxic events, particularly among breast cancer survivors. Contributing socioeconomic factors to these disparities include unfavorable social determinants of health, inadequate insurance coverage, and structural racism within the healthcare system. Additionally, proinflammatory epigenetic modification is hypothesized to be a contributing genetic variation factor. Addressing these disparities requires a multiperspective approach, encompassing efforts to address racial disparities and social determinants of health within the healthcare system, refine healthcare policies and access, and integrate historically stigmatized racial groups into clinical research. Racial and ethnic disparities persist in cardiovascular outcomes among cancer survivors, driven by multifactorial causes, predominantly associated with social determinants of health. Addressing these healthcare inequities is imperative, and timely efforts must be implemented to narrow the existing gap effectively.

Improved Access to Genetics Care is Needed to Address Health Inequities in ATTRv Amyloidosis.

Improved Access to Genetics Care is Needed to Address Health Inequities in ATTRv Amyloidosis.

Relationships between social determinants of health and healthy body composition among Aboriginal and Torres Strait Islander youth in the Next Generation: Youth Well-being study.

Little is currently known about the relationships between body composition and the social determinants of health among Aboriginal and Torres Strait Islander youth in Australia, which could help inform policy responses to address health inequities. This study aimed to explore the relationship between various social factors and healthy body mass index (BMI) and waist/height ratio (WHtR) among Aboriginal and Torres Strait Islander youth aged 16-24 years. Baseline survey data from 531 participants of the 'Next Generation: Youth Well-being study' were used. Robust Poisson regression quantified associations between healthy body composition and self-reported individual social factors (education, employment and income, government income support, food insecurity, home environment, relationship status, racism), family factors (caregiver education and employment) and area-level factors (remoteness, socioeconomic status). Healthy body composition was less common among those living in a crowded home (healthy WHtR aPR 0.67 [0.47-0.96]) and those receiving government income support (healthy BMI aPR 0.74 [0.57-0.95]). It was more common among those with tertiary educated caregivers (healthy BMI aPR 1.84 [1.30-2.61]; healthy WHtR aPR 1.41 [1.05-1.91]) and those in a serious relationship (healthy BMI aPR 1.33 [1.02-1.75]). Social factors at the individual and family level are associated with healthy body composition among Aboriginal and Torres Strait Islander youth. SO WHAT?: The findings of this study highlight the potential for health benefits for youth from policies and programs that address social inequities experienced by Aboriginal and Torres Strait Islander people in Australia.

A Dedicated Graduate Certificate in Health Equity: A Novel Approach to Increase the Future Physician Capacity to Address Health Inequities.

Pervasive health inequities require new approaches to medical education to equip future physicians to address unjust disparities in health outcomes. Few curricula exist that focus on development of competencies and leadership skills in health equity, and little is known about the content that should be included. Vanderbilt University Medical Center and Vanderbilt University School of Medicine developed and implemented the Graduate Certificate in Health Equity (CHE) to address this educational gap. The CHE proposal was approved in summer 2019, enrollment began in October 2019, and the first course was offered in February 2020. The CHE includes 11 objectives, and programming spans medical school years 2 to 4. Students must complete 2 foundational courses, 2 health equity-focused electives, and a health equity immersion experience. Seventy-three students have enrolled since the CHE launched in academic year 2019 to 2020. In year 1, 14 third-year students enrolled in an inaugural condensed version and 16 second-year students enrolled in the full program. In subsequent years, 16 students (year 2), 15 students (year 3), and 12 students (year 4) enrolled. To date, 38 medical students have graduated. The CHE has engaged 16 community partners, including community health centers, immigrant and refugee services, rural health programs, and the LGBTQI+ community, as lecturers and hosts for immersion experiences. Future work will focus on updating objectives and developing a rigorous evaluation scheme. The CHE team members will follow up with graduates to determine how the CHE influenced their care for marginalized and minoritized patients, ability to identify and address systemic and structural barriers, and career development. The CHE is a potential model for other institutions to adapt and implement. Accruing a critical mass of institutions with health equity-focused programming for medical students is necessary to develop future leaders in health equity.

Role of mixed healthcare providers networks in strengthening primary care systems: a case study of a rural primary care site

IntroductionService delivery networks, also called healthcare providers networks (HCPNs) have been used to address health inequities and promote universal healthcare (UHC). This study described the effect of instituting a mixed...

Abstract C001: Global disparities in prostate cancer burden: An analysis of the GLOBOCAN 2020 database

Abstract Background: Prostate cancer (PCr) is one of the most common cancers among men globally, with considerable variations in incidence and death rates between racial/ethnic groups and geographical regions. With more than 1.4 million new cases reported in 2020, the global burden of PCr is predicted to double over the next two decades, to 2.9 million new cases and approximately 700,000 fatalities. Understanding the disparities in PCr is crucial for designing targeted treatments, and interventions and addressing health inequities. This study seeks to provide a comprehensive analysis of the recent global trends in PCr, focusing on incidence, mortality, and disparities in disease burden. Methods:This study analyzed age-standardized PCr incidence and mortality rates from the GLOBOCAN 2020 database for 174 countries, categorized by region and income level. Descriptive statistics and regression analyses were used to investigate the relationships between PCr rates and socioeconomic factors like the Human Development Index (HDI) and healthcare expenditure (HE). The study evaluated PCr distribution across age and geography, with statistical significance set at p < 0.05. Results:PCr incidence rates were highest in developed regions like Northern America (73.8/100,000), Western Europe (69.1/100,000), and Australia/New Zealand (88.2/100,000), and lowest in Eastern Asia (10.5/100,000) and Northern Africa (9.7/100,000). Mortality patterns were similar, with highest rates in the Caribbean (29.3/100,000) and Sub-Saharan Africa (26.6/100,000), and lowest in Eastern Asia (4.1/100,000) and Northern Africa (8.3/100,000). While incidence correlated positively with the HDI (p<0.001), mortality showed no significant association after adjusting for HE. Conclusion:This global analysis revealed major disparities in PCr incidence and mortality rates. Incidence was higher in developed regions, while mortality was elevated in economically disadvantaged areas. Further research is needed to understand the complex genetic, environmental, and socioeconomic factors driving these disparities. Key Takeaways: There is a continued need for targeted interventions to reduce the global burden of PCr and address disparities in disease burden. Citation Format: Olumide Arigbede, Sarah G. Buxbaum, Sara Falzarano, Suhn K. Rhie. Global disparities in prostate cancer burden: An analysis of the GLOBOCAN 2020 database [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C001

It's all about relationships: Developing nurse-led primary health care in rural communities.

The role of nurses in leading the design and delivery of primary health care services to address health inequities is growing in prominence, specifically in rural Australia. However, limited evidence exists to inform nurse-led primary health care in this context. Based on a focus group with nursing executives and semi-structured interviews with registered nurses we describe nurse experiences of leading the design of a primary health care service in rural Australia and nurse transition to and practice in this service. Nurse experiences were analysed using reflexive thematic analysis. The study reveals the centrality of relational integration in service design and nurse acquisition of relational practice as it relates to nurse to care recipient and nurse to nurse relationships. Tensions between primary health care nurses and their peers, and resultant de-valuing of primary health care practice, are described. The acquisition of nurse professional agency draws attention to investments required to position nurses to lead and sustain care innovations external to hospital settings. The authors propose that relational approaches may provide nurses with the opportunity to reframe their leadership and service contributions towards community literate primary health care provision and provide a pathway to professional emancipation from constrained practice expectations.

Improving Identification of Patients Experiencing Homelessness in the Electronic Health Record: A Curated Registry Approach.

Identification of persons experiencing homelessness (PEH) within healthcare systems is critical to facilitate patient and population-level interventions to address health inequities. We created an enhanced electronic health record (EHR) registry to improve identification of PEH within a safety net healthcare system. We compared patients identified as experiencing homelessness in 2021, stratified by method of identification (i.e., through registration data sources versus through new EHR registry criteria). Sociodemographic and clinical characteristics, healthcare utilization, engagement with homeless service providers, and mortality. In total, 10,896 patients met the registry definition of a PEH; 30% more than identified through standard registration processes; 78% were identified through only one data source. Compared with those identified only through registration data, PEH identified through new registry criteria were more likely to be female (42% vs. 25%, p < 0.001), Hispanic/Latinx or Black/African American (30% versus 25% and 25% vs. 18%, p < 0.0001), and Medicaid or Medicare beneficiaries (74% vs. 67% and 16% vs.10%, respectively, p < 0.0001). New data sources also identified a higher proportion of patients: at extremes of age (16% < 18years and 9% ≥ 65years vs. 2% and 5%, respectively, p < 0.0001), with increased clinical risk (31% with CRG 6-9 vs. 18%, p < 0.0001), and with a mental health diagnosis (56% vs. 42%, p < 0.0001), and a lower proportion of patients with a substance use diagnosis (39% vs. 54%, p < 0.0001) or criminaljustice involvement (8% vs. 15%, p < 0.0001). Newly identified patients were more likely to be engaged in primary care (OR 2.03, 95% CI 1.83-2.26) but less likely to be engaged with homeless service providers (OR 0.70, 95% CI 0.63-0.77). Commonly utilized methods of identifying PEH within healthcare systems may underestimate the population and introduce reporting biases. Recognizing alternate identification methods may more comprehensively and inclusively identify PEH for intervention.

Mitigating Health Disparities among the Elderly in China: An Analysis of the Roles of Social Security and Family Support from a Perspective Based on Relative Deprivation

The joint involvement of family and society in elderly care is a crucial factor in improving the health status of older adults and narrowing health disparities, which are essential for achieving sustainable development goals. However, the interactions between these entities and their mechanisms of influence require further investigation. By utilizing data from the China Longitudinal Aging Social Survey (CLASS) spanning 2014 to 2016 and employing the Kakwani index of individual relative deprivation in conjunction with a two-way fixed-effects model for unbalanced panel data, in this study, we investigated the mechanisms through which social elderly care security and familial support influence health inequalities among the elderly. The findings reveal that only senior benefits (=−0.009, p &lt; 0.05) significantly mitigate relative health deprivation in this population. Enrollment in pension insurance amplifies the sense of relative health deprivation among the elderly, but this effect becomes insignificant after controlling for temporal effects. Both economic support (=−0.002, p &lt; 0.05) and emotional support (=−0.004, p &lt; 0.01) from offspring significantly reduce the level of relative health deprivation among the elderly. Mechanism testing results indicate that individual attitudes towards aging serve as a mediator in the relationship between relative health deprivation and preferential treatment, economic support, and emotional support. The results of further heterogeneity tests suggest that the impact of various elderly support models on relative health deprivation differs by age, gender, and residential area.These findings confirm that support from both society and family plays a crucial role in achieving sustainable health outcomes for the elderly. Consequently, it is recommended to enhance the social elderly care security system, bolster familial support functions, cultivate positive individual attitudes towards aging, and address health inequalities among the elderly in accordance with their distinct characteristics, thereby improving their quality of life and sense of fulfillment, and contributing to the broader goals of sustainable development.

A realist impact evaluation of a tool to strengthen equity in local government policy-making

BackgroundLocal governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts.MethodsWe conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs.ResultsAlmost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA’s related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support.ConclusionOur study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health.

Diabetes Disparities: Addressing Health Inequities and Improving Outcomes in Underserved Populations

Diabetes mellitus, characterized by high blood sugar levels due to insulin deficiency or resistance, is a global public health crisis with significant disparities in prevalence, management, and outcomes, particularly among underserved populations such as racial and ethnic minorities, low-income groups, and rural residents. These populations faced higher rates of diabetes and complications due to social determinants of health, including economic instability, inadequate education, and limited access to healthcare. Barriers such as lack of insurance, transportation challenges, and cultural and linguistic differences further hindered effective diabetes management. Lifestyle and behavioral factors, including diet, physical activity, medication adherence, and mental health, play critical roles in diabetes outcomes. Policy and system-level interventions, such as expanding healthcare coverage, improving access to care, and addressing social determinants of health, are essential to reducing disparities. Technological innovations like telehealth, mobile health applications, wearable devices, and data analytics offered significant potential to enhance diabetes management in underserved populations. This review was conducted using a comprehensive analysis of current literature and existing studies to provide insights into the multifaceted nature of diabetes disparities and to highlight successful interventions and necessary policy changes to improve health outcomes for underserved populations. Addressing these inequities required a multifaceted approach, including community-based interventions, policy reforms, and technological advancements to ensure equitable diabetes care for all. Keywords: Diabetes disparities, Underserved populations, social determinants of health, Healthcare access, Technological innovations.

Gender differences in cost-related unmet healthcare needs: a national study in Turkiye

BackgroundUnmet healthcare needs are a complex and multifaceted issue, influenced by individual, socioeconomic, and healthcare system factors. This study aimed to investigate the determinants influencing cost-related unmet healthcare needs within the Turkish population, emphasizing a comprehensive analysis of gender disparities in accessing healthcare services.MethodsThis secondary analysis scrutinizes the 2019 Turkiye Health Survey data of 16,976 individuals aged 15 and older. The dependent variables included cost-related unmet medical, dental, and prescribed medication, and mental services. The independent variables were considered under a three-domain approach for the determination of health service utilization, developed by Andersen. Logistic regression models with predisposing, enabling, and need factors were run for any self-perceived cost-related unmet need for each sex and overall population. Another six regression models for both sexes were run for each subgroup of indivuals with unmet healthcare needs.ResultsThe study revealed that 15.4% of individuals cannot access healthcare due to financial constraints, with 16.8% for women and 13.5% for men. The highest level of unmet needs is associated with accessing dental care services for both sexes. According to multivariate analyses, the unmet need for both sexes decreases with older age and higher education level, and it is greater for those who have difficulties communicating in Turkish. By adding enabling and needs factors, the odds ratios of education decreased for men, while education became nonsignificant for women. Having chronic disease impacts unmet needs for both sexes. However, the inability to perform daily activities due to health problems was not a significant factor for men. Poorer household income increases overall unmet needs. Education is a determinant of both medical and mental care needs.ConclusionsThis pioneering study illuminates the multifaceted gender disparities in cost-related unmet healthcare needs across Turkiye, reflecting the intertwined issues of access influenced by a complex interplay of factors. Our findings underscore the significance of adopting an intersectional approach to address health inequalities.

Healthcare Technology Management: Electronic Health Records and Informatics

The application of health informatics enables the creation of customised health interventions based on each person's requirements, preferences, and risk factors. Public health organisations can identify people who are at high risk for specific illnesses and provide tailored interventions to reduce risk factors and enhance outcomes by using data analytics and predictive modelling. Furthermore, via the use of social media platforms, digital health technologies, and personalised health interventions, health informatics enables public health organisations to interact with communities, encourage healthy lifestyles, and address health inequities. The importance of promoting teamwork, standardising data exchange procedures, and investing in workforce development is emphasised in this work. Public health management can meet these obstacles and fully utilise the advantages of health informatics to enhance population health outcomes.

Adaptive Strategies for Mitigating Climate-Related Health Risks in Urban Environments

The potential for selecting and implementing climate response solutions across several sectors to realize synergies and prevent conflicts with other elements of sustainable development is becoming more clear. Mental and physical wellbeing are both impacted by climate change. Health may be affected in other ways by climate change adaptation and mitigation strategies, some of which may not be intended. The health impacts of climate mitigation and adaptation policies are outlined in this scoping review. We searched PubMed, Scopus, and Web of Science for relevant articles without time constraints. All studies that reported measurable health consequences associated with certain adaptation and mitigation approaches for climate change were included. Only a select few factors and outcomes related to health were taken into account among the 89 studies examined. Air temperature and air pollution were the primary foci of publications exploring adaptation and mitigation strategies, respectively. Mental health, diet and nutrition difficulties, and communicable illnesses were not investigated nearly as often as non-communicable diseases despite their importance. Inadequate attention of health equity components is shown by the paucity of research examining social health factors and offering stratified health effects among disadvantaged population groups in evaluations. There seems to be a need for greater work to be done to both measure health consequences and uncover underlying susceptibility characteristics among various demographic groups. Better evidence for addressing health inequities, reducing negative health consequences, and maximizing health co-benefits of climate change adaptation and mitigation might be provided by this data.

The Impact of Public Health on Health Planning

This study investigates the complex relationship between public health and health planning, specifically how public health influences the design of health systems and services. It looks into the use of public health data and frameworks in health planning to address health inequities, socioeconomic factors, and community-level health issues. Case studies demonstrate effective models in which public health initiatives influence health planning, stressing stakeholder involvement, interdisciplinary methods, and policy frameworks. The study continues by discussing the obstacles and potential for better integrating public health into comprehensive health planning. Keywords: Public health, health planning, socio-economic determinants, health disparities, community health, policy integration.

Use of Intersectionality as a tool in the development of interventions, protocols and advanced health analyzes associated with people living with HIV. A Scoping Review

Introduction: Intersectionality has been used as a tool to understand and address health inequalities, especially in the context of health care for people with HIV. However, its application in the development of intervention strategies and care protocols is scarce.Methods: a systematic scoping bibliographic review was carried out to identify studies that use intersectionality in the field of health, as a tool for the development of advanced information analysis, development of instruments and protocols associated with people with HIV. Databases such as Scopus, PubMed and Clarivate Analytics Wos of Science were used.Results: Intersectionality has been used as a tool for the development of basic frameworks for the development of protocols and measurement instruments, its use in the development of intervention programs is scarce.Conclusions: Intersectionality is a valuable tool to understand health inequalities, but its application in the development of intervention strategies and care protocols is limited. It is necessary to develop research that uses intersectionality to create health intervention and professional training programs that address health inequalities and reduce the stigma associated with HIV.

How can health systems approach reducing health inequalities? An in-depth qualitative case study in the UK

BackgroundAddressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system’s level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions.MethodsIn-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach.ResultsInterviews (n = 14) with wide representation from local authority (n = 8), NHS (n = 5) and voluntary, community and social enterprise (VCSE) sector (n = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system’s approach to reducing health inequalities was evident as was collective action and involving people, with links to a “strong third sector”. Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system.ConclusionWe provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system’s working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.

Integrated care systems in England: the significance of collaborative community assets in promoting and sustaining health and wellbeing.

Until recently the healthcare system in England was based on a commissioning/provider model. However, this has been replaced with an Integrated Care Systems (ICSs) approach, aimed at improving health and wellbeing and reducing inequalities through local collaborative partnerships with public sector organizations, community groups, social enterprise organizations and other local agencies. Part of this new approach is an emphasis on the role of community assets (i.e., local resources), that are considered integral to promoting positive health and wellbeing outcomes. This paper presents research from a series of three research studies on "community assets" conducted in the East of England within a newly established ICS. Based on analysis of qualitative data highlighting the lived experience of community asset members, this paper shows the positive wellbeing impact on vulnerable community members that assets provide. Further insight on the local impact and the collaborative nature of the research is provided suggesting that new asset-based approaches recognize the social determinants of health. This presents a shift away from positivistic linear approaches to population health and wellbeing to a new non-linear collaborative approach to addressing health inequalities and promoting wellbeing. The authors suggest that exploring this through a complexity theory lens could illuminate this further. Finally, the authors warn that while community assets have an important role to play in empowering citizens and providing much needed support to vulnerable and disadvantaged communities, they are not a substitute for functioning funded public sector services that are currently being undermined by ongoing local governments funding cuts. As such, while community assets can help ameliorate some of the negative effects people experience due to economic, structural and health disadvantages, only a more fair and more equal distribution of resources can address growing health inequalities.