Determinants Of Population Health Research Articles

Advancing the Social Epidemiology Mission of the American Journal of Epidemiology.

Social epidemiology is concerned with how social forces influence population health. Rather than focusing on a single disease (as in cancer or cardiovascular epidemiology) or a single type of exposure (e.g., nutritional epidemiology), social epidemiology encompasses all the social and economic determinants of health, both historical and contemporary. These include features of social and physical environments, the network of relationships in a society, and the institutions, politics, policies, norms and cultures that shape all of these forces. This commentary presents the perspective of several editors at the Journal with expertise in social epidemiology. We articulate our thinking to encourage submissions to the Journal that: 1) expand knowledge of emerging and underresearched social determinants of population health; 2) advance new empirical evidence on the determinants of health inequities and solutions to advance health equity; 3) generate evidence to inform the translation of research on social determinants of health into public health impact; 4) contribute to innovation in methods to improve the rigor and relevance of social epidemiology; and 5) encourage critical self-reflection on the direction, challenges, successes, and failures of the field.

Disparities in cancer care delivery during the COVID-19 pandemic: An update of a prospective, cross-sectional study.

136 Background: Impact of COVID19 on cancer care delivery and outcomes remains unknown. Few trials have investigated patients’ perceived risks and benefits, and cancer care delivery (CCD) alterations related to COVID19. We sought to identify differences on behaviors and social determinants of health in Hispanics and other underrepresented populations (H/UP) compared to the general population (GP). Methods: An IRB-approved validated 27-item questionnaire was offered in English and Spanish to all pts receiving cancer care at participating cancer centers over a 6 month period. Examined variables included demographic information, social risk and behavioral factors, preferred sources of health information, and overall satisfaction with CCD during the pandemic. Results: A total of 245 pts were enrolled in the study. Compared to GP, H/UP’s perceived risk of COVID19 was higher with 92.4% vs 85.2% (p = 0.000) more likely to cancel or avoid social gatherings and 69.2% vs 32.1% more likely to change daily routine. H/UP appeared more concerned with personal and financial safety; if unable to find work/get paid for 2 weeks, 24.1% H/UP vs 13% GP would struggle to keep up with expenses. 33.7% H/UP vs 8.6% GP had concerns on ability to secure food and consider COVID19 a major threat to their health (63.9% vs 42.6%, p = 0.003) and financial situation (61.4% vs 35.8%, p = 0.001). H/UP’s perceived benefits of protective measures is higher with 97.4% vs 90.7% routinely practicing social distancing (SD) and 92.8% vs 64.2% in agreement with punitive actions for not following SD. Analysis demonstrated no significant difference by gender, level of education, marital status, however Hispanic ethnicity and Spanish as primary language were significant variables (p = 0.000) in perceived risks and satisfaction with CCD. No major differences were noted on sources of health information although more H/UP relied on social media (26.5% vs 24.7%). H/UP appeared more skeptical about availability and safety of targeted vaccines (28.2% vs 14.8%, p = 0.001). H/UP were less satisfied with CCD during the pandemic (72.1% vs 82.1%, p = 0.024) and also perceived CCD alterations (19.2% vs 7.4%). Conclusions: COVID19-related societal, financial, health and personal fears are increased in H/UP which likely negatively affects quality of life of these at-risk populations. H/UP’s trust in SD recommendations is heightened although linguistically and culturally appropriate information may be deficient. H/UP were more skeptical of the safety and availability of the vaccine, which is consistent with recent reports suggesting deeper fears of experimentation. Interventions aimed to decrease these differences could incorporate standard communications with special attention to social media.

Artificial Intelligence in the NHS: Climate and Emissions✰,✰✰

Healthcare provision has a significant climate impact and, conversely, the climate is a determinant of population health. Research is underway to quantify the emissions from healthcare systems, which helps with reducing and offsetting them. Artificial intelligence (AI) is a rapidly developing field contributing to the English National Health Service (NHS) goals of more efficient care and reduced climate impact. There are concerns about the detrimental carbon emissions from training and deploying AI models. Conversely, AI could potentially reduce emissions through process optimisation and changing models of care.In this narrative scoping review using the NHS as a case study we consider: AI in healthcare, methodologies for quantifying AI associated emissions, and opportunities for using AI to support NHS emission reduction efforts. We present the metrics and approaches commonly used to quantify climate impact in the field of AI and interpret them alongside healthcare AI.While the NHS, and other health systems, are investing in the potential of AI technologies to improve health services, more should be done to quantify the climate impact of AI tools. Standardised measures are lacking, thereby limiting the ability to reduce and offset the climate impact of AI. We provide recommendations for policymakers, climate researchers, and AI developers to consider as part of achieving a net zero NHS by 2040.

The social determinants of health and health seeking behaviour in populations affected by armed conflict: a qualitative systematic review

ABSTRACT This systematic review explored the relationship between the social determinants of health and health seeking behaviour of individuals affected by armed conflicts. A systematic search of all available evidence was conducted through well-known academic databases. Seven studies met the inclusion criteria and were quality assessed. The synthesis revealed that the social determinants of health in times of conflict also determine the level of health seeking in these individuals. The social determinants were grouped in three main themes a) individual and economic b) sociocultural c) political and health systems. The three themes show that armed conflicts affect health seeking behaviour of individuals in a multi-layered manner with strong connections across the social determinants. This review shows that individuals are forced to choose between fulfilling their basic needs and attending health services. This is further compounded by the lack of health provision in conflict settings. Future research must address the social determinants of health when examining health seeking behaviour of conflict affected populations.

Community health worker roles and their evolving interprofessional relationships in the United States

ABSTRACT In the United States, growing attention to the cost of care, the social determinants of health, prevention, and population health, signals a refocusing of efforts on value-based care. Just as Accountable Care Organizations and alternative payment models exemplify this shift in attention, so does the increasing integration of Community Health Workers (CHWs) into the US health care system. CHWs are often referred to as “bridge figures,” helping clients to navigate what are oftentimes complicated pathways to access a variety of needed services. The integration of CHWs into interprofessional care teams is a process that takes time, and can lead to conflict as traditional care models are disrupted. Through focus groups with CHWs in rural and urban areas of four states, this work identifies and describes three early stages in the evolving interprofessional relationships between CHWs and other care providers. These stages are characterized by: (1) a lack of knowledge and understanding of CHW roles, (2) conflict and competition, and (3) engagement and integration of CHWs into patient care teams. A better understanding of the evolving process of CHW integration is critical to facilitate education and training that will more quickly encourage the development and efficacy of modern models of interprofessional care that include CHWs.

Work Redesign for the 21st Century: Promising Strategies for Enhancing Worker Well-Being.

Work is a key social determinant of population health and well-being. Yet, efforts to improve worker well-being in the United States are often focused on changing individual health behaviors via employer wellness programs. The COVID-19 health crisis has brought into sharp relief some of the limitations of current approaches, revealing structural conditions that heighten the vulnerability of workers and their families to physical and psychosocial stressors. To address these gaps, we build on existing frameworks and work redesign research to propose a model of work redesign updated for the 21st century that identifies strategies to reshape work conditions that are a root cause of stress-related health problems. These strategies include increasing worker schedule control and voice, moderating job demands, and providing training and employer support aimed at enhancing social relations at work. We conclude that work redesign offers new and viable directions for improving worker well-being and that guidance from federal and state governments could encourage the adoption and effective implementation of such initiatives. (Am J Public Health. 2021;111(10):1787-1795. https://doi.org/10.2105/AJPH.2021.306283).

Evaluation of a school-based participatory intervention to improve school environments using the Consolidated Framework for Implementation Research

BackgroundParticipatory research offers a promising approach to addressing health inequities and improving the social determinants of health for diverse populations of adolescents. However, little research has systematically explored factors influencing the implementation of participatory health interventions targeting health disparities.ObjectiveThis study examined the utility of the Consolidated Framework for Implementation Research (CFIR) in identifying and comparing barriers and facilitators influencing implementation of participatory research trials by employing an adaptation of the CFIR to assess the implementation of a multi-component, urban public school-based participatory health intervention.MethodsWe collected qualitative data over a one-year period through weekly team meeting observational field notes and regular semi-structured interviews with five community-based participatory researchers, one school-based partner, and four school principals involved in implementing a participatory intervention in five schools. Adapted CFIR constructs guided our largely deductive approach to thematic data analysis. We ranked each of the three intervention components as high or low implementation to create an overall implementation effectiveness score for all five schools. Cross-case comparison of constructs across high and low implementation schools identified constructs that most strongly influenced implementation.ResultsTen of 30 assessed constructs consistently distinguished between high and low implementation schools in this participatory intervention, with five strongly distinguishing. Three additional constructs played influential, though non-distinguishing, roles within this participatory intervention implementation. Influential constructs spanned all five domains and fit within three broad themes: 1) leadership engagement, 2) alignment between the intervention and institutional goals, priorities, demographics, and existing systems, and 3) tensions between adaptability and complexity within participatory interventions. However, the dynamic and collaborative nature of participatory intervention implementation underscores the artificial distinction between inner and outer settings in participatory research and the individual behavior change focus does not consider how relationships between stakeholders at multiple levels of participatory interventions shape the implementation process.ConclusionsThe CFIR is a useful framework for the assessment of participatory research trial implementation. Our findings underscore how the framework can be readily adapted to further strengthen its fit as a tool to examine project implementation in this context.

88The Role of Visceral Adiposity in the Metabolic Phenotype of multi-ethnic South-East Asian population

Abstract Background Ethnic Asians are known to exhibit worse metabolic phenotypes as compared to Caucasians despite lower body mass index1, 2. Ethnic South-Asians and Malays were also found to display greater insulin resistance than Chinese3. One potential biological mechanism for this phenomenon is the inter-ethnic differences in the visceral adiposity deposition4. Here we hypothesised that visceral adiposity contributes to ethnic differences in metabolic phenotype more than subcutaneous adiposity. Methods We quantified total, subcutaneous and visceral adipose deposition (BMI, waist circumferences, Dual-energy X-ray absorptiometry [DEXA]) and metabolic phenotypes (blood pressure, fasting glucose and lipid profile, HbA1c) in 3403 participants. Analyses were adjusted for age, and sex. Results Participants were 40.6% male, mean age 49.7±11.4 years, Chinese: Malays: South-Asians in 72:9:19 ratio. Ethnic Malays and South-Asians had raised blood pressure, fasting glucose, triglycerides, HbA1c, reduced HDL, and higher total and visceral fat than Chinese (P < 0.001), independent of covariates. Increased adiposity was strongly associated with poorer metabolic phenotype (all P < 0.0001), with strongest associations found amongst visceral Fat Mass Index (□□95%CI]=0.48[0.20;0.23]) and android/gynoid ratio (□[95%CI]=0.55[1.31;1.63]) with triglycerides levels. Visceral adiposity contributed 17-40% (all P < 0.0001) to the variance in the associations of ethnic Malays and South-Asians with metabolic phenotypes, 3-7% higher than subcutaneous adiposity. Conclusions Visceral adiposity contributes to poorer metabolic phenotype in ethnic Malays and South Asians as compared to Chinese. Key messages Visceral adiposity expansion is an important determinant of metabolic health in Asian populations.

Influence of social determinant on values formation in healthcare

The high level of economic and demographic development of the country does not guarantee the equality of its citizens with regard to health. Differentiation at the health level is not only related to ge- netic, behavioral or infrastructural factors; despite their importance, it also reflects the socio-economic differentiation of society. Thus, a social determinant of health appears – an idea of the living conditions of people from birth to old age. The World Health Organization defines health not only as the absence of disease and physical defects, but also as a state of complete physical, mental and social well-being. However, this definition does not allow us to single out a set of objective indicators by which it is possible to observe and assess health. Currently, there is no single comparative scale that determines the level of health, the develop- ment of which requires high-quality interdisciplinary research. The purpose of the article is to study the concept of the socio-economic determinant of population health and the definition of the classification. Using the examples of modern foreign studies linking spe- cific indicators of health or life expectancy with a number of social determinants, the nature of the influ- ence of socio-economic factors on the health of the population is revealed. Due to the lack of knowledge of the concept of the socio-economic factor of population health in Kazakhstan, this article is of interest to the Kazakhstan audience due to a broad review of theoretical and empirical works on this topic. Key words: social policy, the relationship between health and the socio-economic situation, in- equality in the health sector. &nbsp

The effect of education level on intensity of using medical care by women of reproductive age

The education is often considered as one of the basic social determinants of population health, but its impact on the need for medical care is to be studied. The purpose of the study is to analyze effect of education as health social determinant on intensity of medical care consumption by women of reproductive age. The sampling consisted of 566 non-pregnant women aged 18-49 years residing in Samara and being monitored in municipal antenatal clinics. The level of territorial accessibility of medical care for all women participating in the study did not differ reliably. The data was obtained using anonymous survey with adapted questionnaire "Research of social determinants of health". The first comparison group included 306 women with higher or incomplete higher education (high educational status). The second comparison group included 260 women with secondary or specialized secondary education (lower educational status). Each of the groups was divided into four subgroups based on age characteristic (18-25, 26-34, 35-42, 43-49 years). In the group of women with a high educational status, volume of consumption of out-patient medical care were higher and decreasing of health self-rating was accompanied by decreased rate of visits to ambulatory physicians (r = -0.67). Whereas in women with low educational status, decreasing of health self-rating is accompanied by decreased rates of visits to ambulatory physicians (r=0.5). With age increased, volume of out-patient medical care consumption in group of women with high educational status increases, while in group of women with low educational status this volume decreases. The lower rate of out-patient medical care consumption results in increasing of volume of in-patient medical care consumption in the group of women with low educational status. Despite the same increasing dynamics of volume of consumption of in-patient medical care in women with different educational statuses, gain rate of demand is significantly higher in group of women with low educational status (1.42% versus 2.54% of annual gain in consumption). More significant increase in consumption of emergency medical care was observed in group of women with low educational status (annual increase 3% versus 0.22%).

Initiatives addressing precarious employment and its effects on workers\u2019 health and well-being: a protocol for a systematic review

BackgroundPrecarious employment is a significant determinant of population health and health inequities and has complex public health consequences both for a given nation and internationally. Precarious employment is conceptualized as a multi-dimensional construct including but not limited to employment insecurity, income inadequacy, and lack of rights and protection in the employment relation, which could affect both informal and formal workers. The purpose of this review is to identify, appraise, and synthesize existing research on the effectiveness of initiatives aiming to or having the potential to eliminate, reduce, or mitigate workers’ exposure to precarious employment conditions and its effects on the health and well-being of workers and their families.MethodsThe electronic databases searched (from January 2000 onwards) are Scopus, Web of Science Core Collection, and PubMed, along with three institutional databases as sources of grey literature. We will include any study (e.g. quantitative, qualitative, or mixed-methods design) evaluating the effects of initiatives that aim to or have the potential to address workers’ exposure to precarious employment or its effects on the health and well-being of workers and their families, whether or not such initiatives were designed specifically to address precarious employment. The primary outcomes will be changes in (i) the prevalence of precarious employment and workers’ exposure to precarious employment and (ii) the health and well-being of precariously employed workers and their families. No secondary outcomes will be included. Given the large body of evidence screened, the initial screening of each study will be done by one reviewer, after implementing several strategies to ensure decision-making consistency across reviewers. The screening of full-text articles, data extraction, and critical appraisal will be done independently by two reviewers. Potential conflicts will be resolved through discussion. Established checklists will be used to assess a study’s methodological quality or bias. A narrative synthesis will be employed to describe and summarize the included studies’ characteristics and findings and to explore relationships both within and between the included studies.DiscussionWe expect that this review’s findings will provide stakeholders interested in tackling precarious employment and its harmful health effects with evidence on effectiveness of solutions that have been implemented to inform considerations for adaptation of these to their unique contexts. In addition, the review will increase our understanding of existing research gaps and enable us to make recommendations to address them. Our work aligns with the sustainable development agenda to protect workers, promote decent work and economic growth, eliminate poverty, and reduce inequalities.Systematic review registrationPROSPERO CRD42020187544.

Comparison of patient-reported impact of COVID19 on cancer care delivery: A prospective, cross-sectional study.

6551 Background: Impact of COVID19 on cancer care delivery and outcomes remains unknown. Few trials have investigated patients’ perceived risks and benefits, and cancer care delivery (CCD) alterations related to COVID19. We sought to identify differences on behaviors and social determinants of health in Hispanics and other underrepresented populations (H/UP) compared to the general population (GP). Methods: An IRB-approved validated 27-item questionnaire was offered in English and Spanish to all pts. receiving cancer care at participating cancer centers over a 4 month period. Examined variables included demographic information, social risk and behavioral factors, preferred sources of health information, and overall satisfaction with CCD during the pandemic. Results: A total of 180 pts were enrolled in the study. Compared to GP, H/UP’s perceived risk of COVID19 was higher with 93% vs 87% more likely to cancel or avoid social gatherings and 54% vs 46% more likely to change daily routine. H/UP appeared more concerned with personal and financial safety; if unable to find work/get paid for 2 weeks, 26% H/UP vs 10% GP would struggle to keep up with expenses. 40% H/UP vs 10% GP have concerns on perceived ability to secure food on short term and consider COVID19 a major threat to their health (70% vs 46%) and financial situation (63% vs 35%). H/UP’s perceived benefits of protective measures is higher with 81% vs 60% routinely practicing social distancing (SD) and 79% vs 66% in agreement with punitive actions for not following SD. Analysis demonstrated no significant difference by age, gender, level of education, marital status, however Hispanic ethnicity and Spanish as primary language was a statistically significant variable (p = 0.025) in perceived risks and satisfaction with CCD. No major differences were noted on sources of health information although more H/UP relied on social media (33% vs 24%). H/UP appeared to be more skeptical about availability and safety of targeted vaccines (40% vs 15%). Satisfaction regarding CCD was comparable (84% vs 86%), although more H/UP perceived CCD alterations (15% vs 10%). Going forward, H/UP would prefer to incorporate virtual visits (VV) when possible (36% vs 25%). Conclusions: COVID19-related societal, financial, health and personal fears are increased in H/UP which likely negatively affects quality of life of these at-risk populations. H/UP’s trust in SD recommendations is heightened although linguistically and culturally appropriate information may be deficient. H/UP’s belief in vaccine availability and safety is comparable to GP, although recent reports suggest deeper fear and emphasize their fear of experimentation. Interventions aimed to decrease these differences could incorporate standard communications with special attention to social media. H/UP would prefer to incorporate VV into their care, although most do not possess appropriate technology to do so.

The Roots of Structural Racism in the United States and their Manifestations During the COVID-19 Pandemic

During the COVID-19 pandemic, the disproportionate morbidity and mortality borne by racial minorities, patients of lower socioeconomic status, and patients lacking health insurance reflect pre-existing structural inequities. Structural racism is racial discrimination rooted in history, perpetuated through policies, and manifested in disparities in healthcare, housing, education, employment, and wealth. Although these disparities exert greater impacts on health outcomes than do genetics or behavior, scientists, and policy makers are only beginning to name structural racism as a key determinant of population health and take the necessary steps to dismantle it. In radiology, structural racism impacts how imaging services are utilized. Here we review the history and policies that contribute to structural racism and predispose minority and disadvantaged communities to inferior outcomes during the COVID-19 pandemic in order to identify policy changes that could promote more equitable access to radiologic services.

Food Insecurity Is Prevalent in Iowa’s Medicaid Expansion Population

BackgroundFood insecurity has been identified as an important social determinant of health and is associated with many health issues prevalent in Medicaid members. Despite this, little research has been done around food insecurity within Medicaid populations. ObjectiveOur objective was to estimate the prevalence of household food insecurity and identify factors associated with experiencing food insecurity in Iowa’s Medicaid expansion population. DesignWe conducted a cross-sectional telephone survey between March and May of 2019. ParticipantsOur sample was drawn from Medicaid members enrolled in Iowa’s expansion program at least 14 months, stratified by Federal Poverty Level (FPL) category. Members who did not have valid contact information were excluded. We selected one individual per household to reduce the interrelatedness of responses. We sampled 6,000 individuals and had 1,349 respondents in the analytic sample. Main outcome measureOur main outcome was whether a respondent’s household experienced food insecurity in the previous year, using the Hunger Vital Sign screening tool. Statistical analyses performedWe weighted responses to account for the sampling design and differential nonresponse between strata. We estimated the prevalence of food insecurity and used logistic regression to model food insecurity as a function of demographic (age, FPL category, gender, employment, education, race, rurality, and Supplemental Nutrition Assistance Program [SNAP] participation) and health-related (self-rated health, self-rated oral health, health literacy) factors. ResultsThe estimated prevalence of experiencing food insecurity was 51.3%. Race, gender, education, employment, health literacy, and self-rated health were all significantly associated with food insecurity. ConclusionsOur findings show that food insecurity is prevalent in Iowa’s Medicaid expansion population. Food insecurity should be more widely measured as a critical social determinant of health in Medicaid populations. Policymakers and clinicians should consider interventions that connect households experiencing food insecurity to food resources (eg, produce prescriptions and food pantry referrals) and policies that increase food access. AbbreviationsIowa Wellness Plan (IWP); Federal Poverty Level (FPL); Healthy Behavior Program (HBP); Supplemental Nutrition Assistance Program (SNAP)

How Public Libraries Help Immigrants Adjust to Life in a New Country: A Review of the Literature.

Public library programs and services offer opportunities to help immigrants navigate daily life in unfamiliar surroundings and a new language. For example, language classes address the social determinants of health as they encourage social participation and community ties and help develop friendships. The purpose of this research was to conduct a narrative literature review to understand how immigrants use public libraries and how public library services influence the social determinants of health for immigrant populations. Keyword searches were conducted on five databases to identify research papers that met the inclusion criteria: empirical studies published in English between 2000 and 2020 related to immigrants' use of public libraries. Thirty-one articles were included in the analysis. Thematic coding identified cross-cutting themes within the sample using the framework of the social-ecological model. Immigrants commonly use public libraries for programs (e.g., language learning), collections (e.g., borrowing books), and services (e.g., asking librarians questions). Immigrant patrons often reported satisfaction with library programs, services, and collections in the language of the host country. A frequent criticism was the relevance and accessibility of collections in their heritage language. In addition, library staff demographics often did not reflect those of immigrant patrons. Health-enhancing benefits associated with library use included increased confidence and self-esteem, cultural integration and preservation, trust and relationships (e.g., making friends), community awareness and engagement, and political integration. Future research and practice areas include collaboration between public health and library professionals to develop library programming that maximizes health and well-being among immigrants.

Refugee and Migrant Health Literacy Interventions in High-Income Countries: A Systematic Review.

Health literacy is a key determinant of health in refugee and migrant populations living in in high-income countries (HICs). We conducted a systematic review of randomized-controlled trials (RCTs) to characterize the scope, methodology, and outcomes of research on interventions aimed at improving health literacy among these vulnerable populations. We searched EMBASE, MEDLINE, PsycINFO, CINAHL, and Web of Science databases to identify RCTs of health literacy intervenions in our target population published between 1997 and 2018. The search yielded 23 RCTs (n = 5625 participants). Study demographics, health literacy topics, interventions, and outcome measures were heterogeneous but demonstrated overall positive results. Only two studies used a common health literacy measure. Few RCTs have been conducted to investigate interventions for improving the health literacy of refugees and migrants in HICs. The heterogeniety of health literacy outcome measures used impeded a robust comparison of intervention efficacy.

Oral health literacy among third-level university students in cork city; Ireland

Health literacy is considered a social determinant of population health, but also relates to making informed health decisions. Little information is available on the oral health literacy (OHL) among young adults, and this is crucial to inform targeted interventions on oral health and care. This study (i) estimates the prevalence of OHL among the third-level university students in Cork City and (ii) identifies determinants of OHL by exploring potential correlates. All students in University College Cork (~ 21000) were sent out a previously validated questionnaire through the online Lime Survey in April 2018 (n = 1487). Both descriptive and inferential statistics (chi-squared/correlation) were undertaken. OHL score was calculated as adequate (2.1-3.0), marginal (1.1-2.0) or inadequate (0.0-1.0) in regard to the scores attained by the individuals. Adequate OHL prevalence was 23%. OHL was significantly correlated with age (r = 0.10), major discipline (r = - 0.13) and frequency of dental visits (r = - 0.08). Male gender, younger age group and those in non-medical schools had significantly higher inadequate OHL. Approximately, one-in-four third-level university students in Cork City have adequate OHL which is lower compared to the general Irish population but still significantly high in specific groups.

Cross-regional variations of Covid-19 mortality in Italy: an ecological study.

BackgroundDisparities in cross-regional coronavirus disease 2019 (Covid-19) mortality remain poorly understood. The association between pre-epidemic health and epidemic mortality can inform a policy response to future outbreaks.MethodWe conducted an ecological study of the association between the cumulative deaths attributed to Covid-19 epidemic in the 20 Italian regions and nine determinants of population health derived from a systematic review of the literature. We used a multiple least square regression to predict the cross-regional variation in mortality observed from the onset of the epidemic to 23 September 2020.ResultsFour independent variables best explained the cross-regional differences in the number of deaths attributed to Covid-19: the force of infection, population density, number of elderly living in assisted facilities and the standard rate of diabetes. The semi-partial correlation coefficients suggest that the force of infection and the number of elderly residents in nursing homes were the dominant predictors of the number of deaths attributed to Covid-19. Statistical controls and validation confirmed the generalizability of the predictive model.ConclusionsOur findings indicate that a significant reduction of social contacts in main metropolitan areas and the timely isolation of elderly and diabetic residents could significantly reduce the death toll of the next wave of Covid-19 infection in Italy.

Income Inequality and Population Health in Sub-Saharan Africa: A Test of Income Inequality-Health Hypothesis

Existing studies have shown that income inequality remains a core determinant of population health. These findings are in line with the Income Inequality-Health Hypothesis (IIHH). However, this assertion remains unclear for Sub-Saharan Africa (SSA), despite the rising trend of income disparity in the region and the vastness of the studies that tested the validity of the IIHH. This inferential study, therefore, examines the effect of income inequality on health for 31 Sub-Saharan African countries from 1995 to 2015 using life expectancy at birth, infant mortality rate, and under-five mortality rate as indicators of population health, as well as the Gini index as a measurement of income inequality. The study employed the Generalized Method of Moments (GMM). We infer that income inequality contributes significantly to poor population health in Sub-Saharan Africa, thereby affirming the validity of the Income Inequality-Health Hypothesis for the region.

Effective Health Services Planning and Delivery: A Qualitative Case Study Exploring Health Services Users’ Perspectives

Introduction: Healthcare service is an essential determinant of population health. This qualitative case study aims to explore health service users’ perspectives of effective health services delivery and the current challenges affecting the management and delivery of health services at a primary healthcare facility in Madang Province, Papua New Guinea (PNG).