Causes Of Health Inequalities Research Articles

Communities for Wellness Equity: Implementing a Partnered Symposium to Identify Social Determinants of Health Priorities.

Social determinants of health (SDoH) affect under-resourced communities. Such communities are seldom involved in defining and prioritizing local SDoH for policy action. Apply community-partnered, participatory research (CPPR) to identify community stakeholder priorities for addressing SDoH in South Los Angeles. Over 10 months, CPPR was applied to develop a multi-sector partnership and working group to plan and host a symposium for community stakeholders. 148 individuals and 16 organizations participated and engaged in focus and symposium-wide discussions. Themes were identified through collaborative inductive content analysis.Results and Lessons Learned: Participants identified ten specific SDoH, such as housing, with structural racism and discrimination as the underlying cause. Using CPPR to gain community members' insight about local factors that drive individual and community health is feasible and viewed by the community as socially responsible, suggesting it holds promise to address root causes of health inequality in under-resourced communities.

The Temporal and Spatial Changes of Health Inequality in Rural China.

This article estimates the temporal and spatial changes of health inequality in rural China from 2010 to 2018. Based on a panel database of 29,616 rural residents, the Health Utility Index (HUI) and a spatial econometric model are used for analysis. The results show that, on the temporal dimension, the health inequality of rural China first expands and then deflates. On the spatial dimension, the health inequality gradually deflates from eastern to western China. Furthermore, from 2010 to 2018, the high and low-value areas constantly changed among different provinces. After decomposing the causes of health inequality, it is found that behind the health inequality is the difference of socioeconomic-related status. Moreover, narrowing the difference in socioeconomic-related status is the key to improving health inequality.

Addressing racism in the healthcare encounter: The role of clinical ethics consultants.

Justice is a core principle in bioethics, and a fair opportunity to achieve health is central to this principle. Racism and other forms of prejudice, discrimination, or bias directed against people on the basis of their membership in a particular racial or ethnic group are known contributors to health inequity, defined as unjust differences in health or access to care. Though hospital-based ethics committees and consultation services routinely address issues of justice that arise in the course of patient care, there is variability in whether and how racism and other causes of health inequities are addressed. In this paper, we describe a novel structure and process for addressing health equity within clinical ethics consultation. In addition, we discuss the barriers and challenges to its success, many of which are rooted in the identities, norms and assumptions that underlie traditional clinical ethics consultation. We offer pragmatic recommendations and conclude with unresolved questions that remain as we work to adapt the structure of a clinical ethics consultation service to improve attention to issues of health equity and promote anti-racism in patient care and institutional policy.

Health literacy Knowledge and understanding of registered nurses in tertiary care teaching hospital of eastern Nepal: two important dimensions for better health results

Background: Difference in health literacy skills among peoples is a cause of health inequality and has a profound effect on health care system. Correlation between health literacy and health outcome of patient subsequently demands identification of patient’s health literacy level by health professionals. Objective: The study aims to assess the health literacy knowledge and understanding of registered nurses working in tertiary care teaching hospital. Methods: A cross-sectional method was employed among 125 registered nurses. Health Literacy Knowledge and Experience Survey (HLKES-2) was used to gather knowledge related data. Descriptive statistical tools, t Mann-Whitney U test and Kruskal-Wallis H were used to analyze the data. A focus group discussion (N=10) was conducted to obtain nurses' understanding of health literacy. Results: Majority of nurses had not heard the term health literacy before. Finding suggest gap in health literacy knowledge among nurses. Knowledge scarcity was in almost all areas but noticeably in the area of evaluation of healthcare teaching. Half of the respondent scored less than 50% of the total score. Analysis demonstrated that Health literacy knowledge was independent of nurses' characteristics. Conclusion: limited knowledge of health literacy among nurses stresses for integration of health literacy education in nursing curriculum and continuing education.

INTRODUCTION: What is Health Justice?

Health justice is both a community-led movement for power building and transformational change and a community-oriented framework for health law scholarship. Health justice is distinguished by a distinctively social ethic of care that reframes the relationship between health care, public health, and the social determinants of health, and names subordination as the root cause of health inequities.

Health Inequalities and Social Determinants of Indigenous Peoples’ Health in Australia, Canada, and the United States: Causes and Policies Options

The author of the paper investigates the issue of Indigenous health inequalities. The main purpose of the research is to assess the causes of health inequalities among Indigenous people and policy options to reduce the health gaps. Systematization of the literary sources shows that there are health disparities between Indigenous people and non-Indigenous people and approaches for solving the problem come in different forms. The methodological basis of this study is a comparative analysis that used secondary data to capture health inequalities among the Indigenous populations in Australia, Canada, and the United States. These countries have adopted different policy options to reduce these inequalities. The paper presents the results of a comparative analysis that contributes to knowledge by articulating what is not known about Indigenous health inequalities and social determinants of health and policy response. The study contributes to understanding by articulating what is not known about Indigenous health inequalities and social determinants of health and policy response. Aside from the study being useful to policymakers, politicians, development experts and the academic environments, the study provides the opportunity to assess some of the policy interventions. When necessary, it provides ample opportunity if there is a need to reform the social and health policies meant to reduce health inequalities among Indigenous populations. The author found that both grey and academic studies have examined policy options and governance meant to reduce health inequalities among Indigenous people in Australia, Canada, and the U.S. However, there is a lack of quality studies that have evaluated these policy options, limiting the strength to determine achievement associated with such policy options and governance. Further, there is limited information on whether these policy options are suitable for the Indigenous population to enhance their health status. With these limitations, future studies need to assess the effectiveness of these policy options and determine if the policy options are culturally suitable to reduce Indigenous people’s health inequalities.

Cooperative Ownership as a Health Justice Intervention: A Promising Strategy to Advance Health Equity Through the U.S. Childcare System.

In their article "The Civil Rights of Health," Harris and Pamukcu offer a framework connecting civil rights law to unjust health disparities with the aims of creating broader awareness of subordination as a root cause of health inequities and inviting policymakers to create new legal tools for dismantling it. They close with a call to action. Here, we take up their call and propose cooperative enterprises as a health justice intervention. To illustrate this conceptualization, we focus on childcare as a system with robust connections to social, economic, and health equity for children, workers, and families.

Un]Forgetting History: Preparing Public Health Professionals to Address Structural Racism.

Structural racism, a fundamental cause of health inequities, must be dismantled to fulfill society's interest in ensuring conditions in which all people have opportunities conducive to health. Correspondingly, the Ten Essential Public Health Services center equity, and Council on Education for Public Health (CEPH) accreditation criteria require public health students to learn about racism. However, little guidance is provided to help faculty empower future generations of public health professionals to challenge it. In response to the 2020 murders of George Floyd, Ahmaud Arbery, and Breonna Taylor, faculty at UNC Greensboro denounced racism and recommitted to anti-racist pedagogy and praxis. In this article, we discuss integrated ways a graduate-level public health assessment and planning course empowered students to name structural racism, understand how it operates, and collaborate for action. Specifically, we highlight (1) our use of the book The Color of Law as means to understand racism as a structural intervention; (2) the Harvard Case Teaching Method as an organizing framework to make the classroom a critically engaged democratic setting; (3) change experts from local health and nonprofit organizations engaged in policy making to address social determinants and disparities resulting from structural racism (eg, housing, health care access, food insecurity); and (4) engagement with a minority-owned nonprofit to allow for practice applying knowledge and skills to address local inequities. Our 4-pronged pedagogical approach provides an innovative, tangible example for other public health programs as they reflect upon academic institutions' unique power and role in addressing the public health crisis of structural racism.

Measuring Health Equity in Emergency Care Using Routinely Collected Data: A Systematic Review.

Introduction: Achieving equity in health care remains a challenge for health care systems worldwide and marked inequities in access and quality of care persist. Identifying health care equity indicators is an important first step in integrating the concept of equity into assessments of health care system performance, particularly in emergency care.Methods: We conducted a systematic review of administrative data-derived health care equity indicators and their association with socioeconomic determinants of health (SEDH) in emergency care settings. Following PRISMA-Equity reporting guidelines, Ovid MEDLINE, EMBASE, PubMed, and Web of Science were searched for relevant studies. The outcomes of interest were indicators of health care equity and the associated SEDH they examine.Results: Among 29 studies identified, 14 equity indicators were identified and grouped into four categories that reflect the patient emergency care pathway. Total emergency department (ED) visits and ambulatory care-sensitive condition-related ED visits were the two most frequently used equity indicators. The studies analyzed equity based on seven SEDH: social deprivation, income, education level, social class, insurance coverage, health literacy, and financial and nonfinancial barriers. Despite some conflicting results, all identified SEDH are associated with inequalities in access to and use of emergency care.Conclusion: The use of administrative data-derived indicators in combination with identified SEDH could improve the measurement of health care equity in emergency care settings across health care systems worldwide. Using a combination of indicators is likely to lead to a more comprehensive, well-rounded measurement of health care equity than using any one indicator in isolation. Although studies analyzed focused on emergency care settings, it seems possible to extrapolate these indicators to measure equity in other areas of the health care system. Further studies elucidating root causes of health inequities in and outside the health care system are needed.

Doctoral Students as Agents for Change: Shaping Our Public Health Training Environment

This reflective article describes how we, a trio of doctoral students, applied critical pedagogical approaches to identify gaps in our public health training, reflect on the value of our lived experiences and ancestral histories, and take action toward advancing change within our School of Public Health. Additionally, we argue that our future effectiveness in leading systemic change toward health justice requires our public health training institutions to deliver course content that addresses racism and other systemic forms of oppression, largely responsible for reproducing health inequities. We also reflect upon how our efforts to find spaces in which to critically engage with content related to social and structural determinants of health transformed into a collaborative learning opportunity that has served to strengthen our skills as public health researchers, advocates, and future educators. We conclude by calling upon our schools of public health to take the lead in preparing the public health workforce of tomorrow for the challenges of addressing systemic causes of health inequities. Our goal is to share our experiences so that graduate students across public health training institutions may look to this piece as a concrete example of how we can shape our schools of public health to meet our needs.

Instability in Housing and Medical Care Access: The Inequitable Impacts of the COVID-19 Pandemic on U.S. Transgender Populations.

To assess whether the COVID-19 pandemic has inequitably impacted key social determinants of health (SDoH), specifically employment, housing, and health care, for U.S. transgender populations. Between April 13, 2020 and August 3, 2020, we conducted a national, cross-sectional online survey of sexual and gender minority individuals (N=870). We used logistic regression to calculate both unadjusted and adjusted odds of unemployment, homelessness/housing instability, and interruptions in medical care owing to the pandemic by gender and gender modality. Adjusted models controlled for age, race/ethnicity, and region. In adjusted models, transgender and gender diverse people had 2.12 times the odds of reporting homelessness/housing instability and 2.88 times the odds of reporting medical care interruptions compared with cisgender peers. Transgender men, women, and nonbinary people had 4.12, 3.29, and 3.48 times the adjusted odds of interruptions in medical care compared with cisgender men, respectively. We did not observe significant differences in employment. Findings add empirical support to the hypothesis that socioeconomic consequences of COVID-19 are inequitably impacting transgender people. To contextualize our results and support future research in this area, we present a conceptual model of the short- and long-term impacts of COVID-19 on transgender populations using a framework of stigma as a fundamental cause of health inequities. Our findings emphasize that public health professionals must urgently consider-and intervene to address-the pandemic's SDoH-related impacts on transgender populations.

Policy Considerations to Promote Equitable Cervical Cancer Screening and Treatment in Peru.

Background:Cervical cancer is one of the leading causes of death among Peruvian women. Women seeking screening or treatment services experience delays in receiving screening results provided at community clinics or district hospitals, and lack sufficient resources to pay out-of-pocket to travel to the capital city of Lima for specialized treatment. Continued disparities in health outcomes and systemic barriers to accessing services suggest there are gaps between policy measures and implementation.Objectives:We aim to understand why national policies and clinical pathways that are aligned to global standards have been insufficient in improving cervical cancer screening and treatment in Peru, particularly among women who experience systemic exclusion from health services.Methods:We conducted a policy analysis based on a literature review (2005–2020), in Spanish and English, on PubMed, Global Health, Scopus, EconLit, Lilacs, and Scielo using a value-based care framework.Findings:The main barriers included unequal distribution of health infrastructure and health care workforce, and differences in access to health insurance. Additional barriers, including limited political will and support, limit efforts to prioritize the implementation of cervical cancer policies. We propose policy considersations in redesigning payment models, expanding healthcare workforce, generating costing and policy evidence, and reviewing policies for point-of-care technologies.Conclusions and Recommendations:The barriers identified in this literature review are applicable not only to cervical cancer care, but to primary health care in Peru. Systematic policy changes that address root causes of health inequities and are implemented at scale are needed to advance health reform efforts.

Reflections on Neurofeminism and Intersectionality Using Insights From Psychology.

Intersectionality contends that sex/gender is constituted of and with other social categories, and that the social structures giving rise to inequality should be addressed in research. This is a powerful and important perspective from which to investigate the processes and consequences of social group memberships, one which has been overlooked by most neuroscientific research. In particular, neurofeminism, a field of critical neuroscience that challenges neuroscientific assumptions, methods and interpretations of data that reinforce sexism, has ignored intersectionality to date. In contrast, research in the field of psychology has been engaging with intersectionality for more than a decade. In reflecting on how intersectionality has advanced feminist research in psychology, this paper provides a critical analysis of potential novel research avenues for neurofeminism. We identify three main research themes guided by intersectionality. The first theme involves research centered on understanding the socio-structural causes of health inequalities experienced by individuals with intersecting marginalized social identities; the second concerns research addressing the psychological processing of social group memberships that underlies the enactment of systemic discriminatory practices; and the third theme comprises intersectionality research that aims to challenge psychological epistemology. Drawing parallels between the fields of psychology and neuroscience, we explore the potential benefits and risks of advancing an intersectionality-informed neurofeminism.

Poverty and health inequalities: Perceptions of social work students and nursing students.

This study describes student perceptions on health inequalities and causes of poverty. As frontline providers, social workers and nurses are expected to engage with patients from socioeconomically diverse backgrounds. In this cross-sectional study, a socio-demographic questionnaire, a questionnaire on health inequalities and the Perceived Causes of Poverty Scale were administered using a convenience sample of 155 students in social work and 266 students in nursing undergraduate programmes at a state university in Turkey. Mann-Whitney U test and Spearman correlation coefficient were used in the analysis of the data. Social work students were more likely to attribute the cause of poverty to social injustice and a lack of opportunities, whereas nursing students had more fatalistic explanations or beliefs, maintaining that outcomes are pre-determined and therefore cannot be changed. In both groups, those who agreed that there were problems and deficiencies in health service provision and that there was ill-health among poor groups were more likely to associate poverty with social injustice and lack of opportunities. Those without a systemic understanding of poverty and health inequalities showed a tendency to hold more individualistic/fate-related perspectives. The nursing students, as compared to the social work students, tended to explain poverty more on the basis of individual responsibility and fatalism and were less likely to link poverty with health inequalities and to advocate for policies to end health inequalities. The students' perceptions on the causes of poverty affected their views on health inequalities. These findings suggest the need to develop curricula that equip nursing students with an understanding of poverty as a systemic cause of health inequality. Health inequality and poverty need to be positioned at the centre of training curricula by professional accreditation bodies. Interdisciplinary collaboration is recommended to foster advocacy skills in students. Furthermore, transformative changes are needed in nursing and social work education to prepare students to adequately address the Social Determinants of Health. Curricula should incorporate leadership and political activism within courses to facilitate structural change.

Epidemiologists’ ambivalence towards the epigenetics of social adversity

This article studies how social epidemiologists get involved in research carried out on rodent models to explore the biological pathways underpinning exposure to social adversity in early life. We analyze their interdisciplinary exchanges with biologists in a social epigenetics project—i.e., in the experimental study of molecular alterations following social exposures. We argue that social epidemiologists are ambivalent regarding the use of non-human animal models on two levels: first, in terms of whether such models provide scientific evidence useful to social epidemiology, and second, regarding whether such models help promote their conception of public health. While they maintain expectations towards rodent experiments by elevating their functional value over their representational potential, they fear that their research will contribute to a public health approach that focuses on individual responsibility rather than the social causes of health inequalities. This interdisciplinary project demonstrates the difficulties encountered when research in social epigenetics engages with the complexities of laboratory experiments and social environments, as well as the conflicting sociopolitical projects stemming from such research.

Use patterns of cigarettes and alternative tobacco products and socioeconomic correlates in Hong Kong secondary school students

Smoking is a major cause of health inequities. However, sociodemographic differences in adolescent tobacco use are unclear. In a territory-wide school-based anonymous survey in 2018/19, we investigated tobacco use and sociodemographic correlates in 33,991 students (mean age 14.8 ± 1.9 years) in Hong Kong. Tobacco use prevalence and current-ever use ratios by sociodemographic factors were calculated. Generalised linear mixed models were used in association analyses. Current use was highest for cigarettes (3.2%), closely followed by alternative tobacco products (3.0%). Current-ever use ratios were highest for heated tobacco products (HTPs, 0.60), followed by nicotine e-cigarettes (0.52), waterpipe (0.51), and cigarettes (0.35). Use prevalence and current-ever use ratios of all products showed curvilinear relations with perceived family affluence (P values < 0.01), being highest in the richest families. Tobacco use was also associated with more senior grades, the lowest parental education, and boys, but current-ever use ratios of HTPs and waterpipe were higher in girls (P values < 0.05). The results suggested that adolescent ever users of nicotine-containing alternative tobacco products were more likely to keep using them than cigarettes, and the richest adolescents were at the highest risks of tobacco use. Diverse tobacco control measures are needed to improve health equity, especially on alternative tobacco products.

Encountering the social determinants of health on a COVID-19 ICU: Frontline providers’ perspectives on inequality in a time of pandemic

Efforts to improve health equity may be advanced by understanding health care providers' perceptions of the causes of health inequalities. Drawing on data from in-depth interviews with nurses and registered respiratory therapists (RRTs) who served on intensive care units (ICUs) during the first surge of the pandemic, this paper examines how frontline providers perceive and attribute the unequal impacts of COVID-19. It shows that nurses and RRTs quickly perceived the pandemic's disproportionate burden on Black and Latinx individuals and families. Providers attribute these inequalities to the social determinants of health, and also raise questions about how barriers to healthcare access may have made some patients more vulnerable to the worst consequences of COVID-19. Providers' perceptions of inequality and its consequences on COVID-19 ICUs were emotionally impactful and distressing, suggesting that this is a critical moment for offering clinicians practical strategies for understanding and addressing the persistent structural inequities that cause racial inequalities in health.

A Critical Analysis of Representations of Inequalities in Childhood Obesity in Australian Health Policy Documents.

In Australia, childhood obesity follows a socioeconomic gradient whereby children with lower socioeconomic position are disproportionately burdened. To reduce these inequalities in childhood obesity requires a multi-component policy-driven response. Action to address health issues is underpinned by the ways in which they are represented as 'problems' in public policy. This study critically examines representations of inequalities in childhood obesity within Australian health policy documents published between 2000-2019. Australia's federal, state and territory government health department websites were searched for health policy documents including healthy weight, obesity, healthy eating, food and nutrition strategies; child and youth health strategies; and broader health and wellbeing, prevention and health promotion policies that proposed objectives or strategies for childhood obesity prevention. Thematic analysis of eligible documents was guided by a theoretical framework informed by problematization theory, ecological systems theory, and theoretical principles for equity in health policy. Eighteen policy documents were eligible for inclusion. The dominant representation of inequalities in childhood obesity was one of individual responsibility. The social determinants of inequalities in childhood obesity were acknowledged, yet policy actions predominantly focused on individual determinants. Equity was positioned as a principle of policy documents but was seldom mentioned in policy actions. Current representations of inequalities in childhood obesity in Australian health policy documents do not adequately address the underlying causes of health inequities. In order to reduce inequalities in childhood obesity future policies will need greater focus on health equity and the social determinants of health (SDoH).

Building structural competency through community engagement.

The importance of addressing the social determinants of health (SDOH) in medical education has been ubiquitously recognised. However, current pedagogical approaches are often limited by inadequate or ahistorical exploration of the fundamental causes of health inequity. Community-engaged pedagogy and structural competency frameworks advocate for progressing from passive SDOH education to directly discussing systemic aetiologies of health inequity through reciprocal partnership with marginalised communities. Herein, we describe the development and exploratory evaluation of a community-engaged structural competency curriculum implemented in 2019 at the University of Nebraska Medical Center. Our curriculum explored the downstream impacts of sociopolitical structures on local health inequities. We engaged university, health system and community stakeholders throughout curriculum development, implementation and evaluation. Curricular components included didactic lectures, reflective writing assignments and a community-based, stakeholder-led experience in North Omaha. We used inductive thematic analysis to explore free-text responses to a post-curriculum survey. Eighteen community stakeholders, eleven multidisciplinary UNMC facilitators, and all 132 first-year medical students were involved in the curriculum pilot, with 93% and 55.1% of students and faculty/community facilitators, respectively, responding to the post-session evaluation. Analysis revealed themes including widespread desire for community-engaged teaching, appreciation for the hyperlocal focus of curricular content and recognition of the importance of creating space for lived experiences of community members. Co-created by a university-community coalition, our pilot findings highlight the crucial role of community-engaged pedagogy in promoting critical understanding of historic structural inequities and present-day health disparities. Our communities can and should be reciprocal partners in training the physicians of tomorrow.

Seeing the Window, Finding the Spider: Applying Critical Race Theory to Medical Education to Make Up Where Biomedical Models and Social Determinants of Health Curricula Fall Short.

A professional and moral medical education should equip trainees with the knowledge and skills necessary to effectively advance health equity. In this Perspective, we argue that critical theoretical frameworks should be taught to physicians so they can interrogate structural sources of racial inequities and achieve this goal. We begin by elucidating the shortcomings in the pedagogic approaches contemporary Biomedical and Social Determinants of Health (SDOH) curricula use in their discussion of health disparities. In particular, current medical pedagogy lacks self-reflexivity; encodes social identities like race and gender as essential risk factors; neglects to examine root causes of health inequity; and fails to teach learners how to challenge injustice. In contrast, we argue that Critical Race Theory (CRT) is a theoretical framework uniquely adept at addressing these concerns. It offers needed interdisciplinary perspectives that teach learners how to abolish biological racism; leverage historical contexts of oppression to inform interventions; center the scholarship of the marginalized; and understand the institutional mechanisms and ubiquity of racism. In sum, CRT does what biomedical and SDOH curricula cannot: rigorously teach physician trainees how to combat health inequity. In this essay, we demonstrate how the theoretical paradigms operationalized in discussions of health injustice affect the ability of learners to confront health inequity. We expound on CRT tenets, discuss their application to medical pedagogy, and provide an in-depth case study to ground our major argument that theory matters. We introduce MedCRT: a CRT-based framework for medical education, and advocate for its implementation into physician training.