Economic Determinants Of Health Research Articles

A meta-analysis on global change drivers and the risk of infectious disease.

Anthropogenic change is contributing to the rise in emerging infectious diseases, which are significantly correlated with socioeconomic, environmental and ecological factors1. Studies have shown that infectious disease risk is modified by changes to biodiversity2-6, climate change7-11, chemical pollution12-14, landscape transformations15-20 and species introductions21. However, it remains unclear which global change drivers most increase disease and under what contexts. Here we amassed a dataset from the literature that contains 2,938 observations of infectious disease responses to global change drivers across 1,497 host-parasite combinations, including plant, animal and human hosts. We found that biodiversity loss, chemical pollution, climate change and introduced species are associated with increases in disease-related end points or harm, whereas urbanization is associated with decreases in disease end points. Natural biodiversity gradients, deforestation and forest fragmentation are comparatively unimportant or idiosyncratic as drivers of disease. Overall, these results are consistent across human and non-human diseases. Nevertheless, context-dependent effects of the global change drivers on disease were found to be common. The findings uncovered by this meta-analysis should help target disease management and surveillance efforts towards global change drivers that increase disease. Specifically, reducing greenhouse gas emissions, managing ecosystem health, and preventing biological invasions and biodiversity loss could help to reduce the burden of plant, animal and human diseases, especially when coupled with improvements to social and economic determinants of health.

Impact of sociodemographic and economic determinants of health on COVID-19 infection: incidence variation between reference periods

ObjectivesThe COVID-19 pandemic hit Portugal in March 2020, causing widespread disruption to various aspects of society. While extensive research has been conducted on the significance of socio-economic disparities in infection risk, this study aims to enhance our understanding of their evolving relationship over time by analysing four distinct periods in 2020. Study design and methodsThis retrospective observational ecological study included individuals residing in the Primary Healthcare Cluster areas of Almada-Seixal and Western Lisbon and Oeiras, who tested positive for SARS-CoV-2 through a polymerase chain reaction (PCR) test between the 2nd of March and the 8th of November of 2020. Using incidence rates for each specific neighbourhood (n = 29) and period, we explored the relationship between neighbourhood-level socio-economic variables and the risk of infection using negative-binomial regression models. ResultsIn the analysed period, a total of 8562 confirmed COVID-19 cases were identified. Overall incidence rates for each period were sequentially 2.74, 5.03, 3.99 and 14.29 COVID-19 cases per 100,000 person-days. Housing overcrowding, illiteracy rate and place of birth were associated with increased risk of infection, while age, congregate living, and employment in the secondary sector exhibited the opposite association. No association was consistent across all time periods. ConclusionsOur findings support the idea that the influence of socio-economic determinants of health is not immutable throughout time. In a pandemic context where information, knowledge, beliefs, and behaviours are ever-changing and evolving, a dynamic, inclusive, and adaptable approach to disease control can lead to a more equitable distribution of improved outcomes, benefiting all strata of society.

Relationship between perceived and measured body size among Pacific 14-year-olds in Aotearoa|New Zealand: Findings from the Pacific Islands Families Study.

Pacific people carry a disproportionate burden of socio-cultural and economic determinants of health in Aotearoa | New Zealand (NZ), and 61.7% of Pacific children aged 0-14 years are overweight or obese. Yet Pacific children's self-perception of their body size is unknown. This population-based study aimed to investigate the concordance between measured and perceived body size in a cohort of Pacific 14-year-olds in NZ, and to assess how this relationship is influenced by their cultural orientation, socio-economic deprivation and degree of recreational internet use. The Pacific Islands Families Study tracks a cohort of Pacific infants born in the year 2000 at Middlemore Hospital, South Auckland. This study is a nested cross-section of participants at the 14-year postpartum measurement wave. Following strict measurement protocols, body mass index was measured and categorised according to the World Health Organization classifications. Agreement and logistic regression analysis methods were employed. Of 834 participants with valid measures, 3 (0.4%) were measured as being underweight, 183 (21.9%) as normal, 235 (28.2%) as overweight and 413 (49.5%) as obese. Overall, 499 (59.8%) perceived their body size to have a lower classification than that when measured. Neither cultural orientation nor deprivation was significantly related to weight misconception but recreational internet use was, with higher use associated with increased misconception. Improving body size awareness together with the risk of higher recreational internet use is likely to be an important component in any population-based healthy weight intervention formulation for Pacific adolescents.

The Perils of Medicalization for Population Health and Health Equity.

Policy Points Medicalization is a historical process by which personal, behavioral, and social issues are increasingly viewed through a biomedical lens and "diagnosed and treated" as individual pathologies and problems by medical authorities. Medicalization in the United States has led to a conflation of "health" and "health care" and a confusion between individual social needs versus the social, political, and economic determinants of health. The essential and important work of population health science, public health practice, and health policy writ large is being thwarted by a medicalized view of health and an overemphasis on personal health services and the health care delivery system as the major focal point for addressing societal health issues and health inequality. Increased recognition of the negative consequences of a medicalized view of health is essential, with a focus on education and training of clinicians and health care managers, journalists, and policymakers.

The rising burden of non-communicable diseases in the Americas and the impact of population aging: a secondary analysis of available data

Public health progress in the Americas has reduced the burden of many infectious diseases, helping more people live longer lives. At the same time, the burden of non-communicable diseases (NCDs) is increasing. NCD prevention rightly focuses on lifestyle risk factors, social, and economic determinants of health. There is less published information on the importance of population growth and aging to the regional NCD burden. For 33 countries in the Americas, we used United Nations population data to describe rates of population growth and aging over two generations (1980-2060). We used World Health Organization estimates of mortality and disability (disability-adjusted life years, DALYs) to describe changes in the NCD burden between 2000 and 2019. After combining these data resources, we decomposed the change in the number of deaths and DALYs to estimate the percentage change due to population growth, due to population aging, and due to epidemiological advances, measured by changing mortality and DALY rates. In a supplement, we provide a summary briefing for each country. In 1980, the proportion of the regional population aged 70 and older was 4.6%. It rose to 7.8% by 2020 and is predicted to rise to 17.4% by 2060. Across the Americas, DALY rate reductions would have decreased the number of DALYs by 18% between 2000 and 2019 but was offset by a 28% increase due to population aging and a 22% increase due to population growth. Although the region enjoyed widespread reductions in rates of disability, these improvements have not been sufficiently large to offset the pressures of population growth and population aging. The region of the Americas is aging and the pace of this aging is predicted to increase. The demographic realities of population growth and population aging should be factored into healthcare planning, to understand their implications for the future NCD burden, the health system needs, and the readiness of governments and communities to respond to those needs. This work was funded in part by the Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health.

Соціально-економічні детермінанти стоматологічного здоров’я у дітей

The purpose of the work was to study the world literature on the socio-economic determinants of dental health among children. Materials and methods. An online information search was performed in the databases “PubMed”, “SciELO”, “Medcape” and “Science of Ukraine: access to knowledge” using the keywords “children caries”, “dental (oral) health”, “children and adolescents”, “social and economic determinants of health” with appropriate translations in foreign languages. Results and discussion. At the global level, dental diseases lead to serious medical and economic consequences which manifest themselves in the form of a significant decrease in the quality of life. The foundations of the dental health level are laid in childhood and are strengthened in adolescence, so these age groups of the population are the main “target audience” for disease prevention measures, valeological research, sanitary and educational work and the formation of appropriate habits. Socio-economic determinants of dental health in children, adolescents and adults on a global scale have been studied unevenly. Mostly, the results of research performed in the developed countries of the world are available. Such a situation creates a need for rethinking approaches and methods for assessing the problem of health care systems in separate countries and changing the methods for developing measures to influence the dental health of children and adolescents with high individualization and adaptation of socially oriented program products in health care. Giving a priority in the development of preventive programs in the field of health care to only individual and collective training measures and communal prevention does not allow to neutralize the negative impact of socio-economic conditions, and even more – it deepens inequality in dental health in the population, which is recognized as a problem by the World Health Organization. With regard to Ukraine, the presence of martial law and the continuation of fighting in certain countries have caused a number of demographic and socio-economic processes, which will be measured and evaluated after some time. But, unequivocally, the existing economic crisis, a decrease in the level of income of the population, negative demographic processes, complications of work in the health care system and other factors that can be defined as determinants of children's dental health continue to operate. Therefore, it is expected that we should be prepared for the deterioration of dental health indicators at the national level and the negative consequences of this. Conclusion. The main socio-economic determinants of children's dental health are recognized as: the level of economic development of the country, access to medical and dental care, the level of family wealth, the age and level of education of parents, their employment, the number of children in the family, the migration status of the family and separately – parents, local peculiarities of the culture of oral cavity care and nutrition, availability and level of coverage of educational and sanitary-educational measures, local levels of development of the system of health care institutions, effectiveness of interaction between health care institutions, education and social protection management bodies

Health inequities and social determinants of health in refugee and immigrant communities.

This article evaluates and elucidates the intersections across social and economic determinants of health and social structures that maintain current inequities and structural violence with a focus on the impact on imMigrants (immigrants and migrants), refugees, and those who remain invisible (e.g., people without immigration status who reside in the United States) from Black, Indigenous, and People of Color communities. Psychology has a history of treating individuals and families without adequately considering how trauma is cyclically and generationally maintained by structural violence, inequitable resources, and access to services. The field has not fully developed collaboration within an interdisciplinary framework or learning from best practices through international/global partnerships. Psychology has also been inattentive to the impact of structural violence prominent in impoverished communities. This structural harm has taken the form of the criminalization of imMigrants and refugees through detention, incarceration, and asylum citizenship processes. Most recently, the simultaneous occurrence of multiple catastrophic events, such as COVID-19, political polarization and unrest, police violence, and acceleration of climate change, has created a hypercomplex emergency for marginalized and vulnerable groups. We advance a framework that psychologists can use to inform, guide, and integrate their work. The foundation of this framework is select United Nations Sustainable Development Goals to address health inequities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

WHO RHN Network

Abstract The WHO European Office for Investment for Health and Development (Venice Office) works in the thematic areas of health equity, social and economic determinants of health, and investment for health in the context of the 2030 Agenda for Sustainable Development and the European Programme of Work. Within the WHO Venice Office, the the Regions for Health Network (RHN) works to place health and well-being high on the key political agendas, and advocates the needs of local and subnational authorities at the regional and international levels. RHN has been launched in 1993 to help regions to accelerate the delivery of improved population health, and currently has 34 members. It has developed over the decades into a forum that creates synergies between regions and stakeholders in the field of health (mutual learning); strengthens cooperation/collaboration between regional and local actors and international health institutions; increases understanding of the functioning of regional and local health systems; promotes the exchange of experience, and mutual learning. RHN positions itself at the forefront of innovative approaches and aims at becoming a cutting-edge network ready to capture and disseminate effective approaches, policies and strategies that improve population health at the regional level of governance. In past years, RHN has spearheaded collaborative efforts amongst cross-border regions, on different topics, and with technical guidance from WHO. These efforts have led to joint initiatives, publications, study trips, project collaboration and periodic and structured exchanges of experiences.

Food insecurity and its determinants in a vulnerable area of Santiago, Chile

This study aims to identify the determinants associated to food insecurity in a group of households composed of schoolchildren and their mothers/caregivers, who lived in a low-to-medium community development index area of the city of Santiago, Chile with a high presence of migrant population. The non-probabilistic and convenience sample was made up of 646 people, who answered a series of surveys with the aim of characterizing this group in sociodemographic terms (sex, age, number of inhabitants in the household, place of food purchase, conditional or non-conditional state transfer program beneficiary status, persons in charge of purchasing food for the household, mothers/caregivers education level and basic knowledge of food and nutrition). To assess moderate-to-severe food insecurity and severe food insecurity, the Food Insecurity Experience Scale-FIES was applied between September and October 2021. Logistic regression analysis were used to carry out multivariate analyses, with the use of stepwise back-and-forward strategies for the selected variables and defining p < 0.05. These models were adjusted per number of inhabitants in the household. The results indicate that 25.4% of households presented moderate-to-severe food insecurity, and 6.4% severe food insecurity experience. The variables that presented significant odds of risk to food insecurity were being a migrant, low maternal education level, low performance on basic knowledge in nutrition and when the father was responsible for food purchases. Several public policies have been implemented in Chile during the most recent decades aimed at increasing access to healthier foods and the implementation of healthier food environments. Despite this, there are still social and economic health determinants that contribute to the risk of odds insecurity for the most vulnerable groups in the country, thus putting at risk the fulfillment of the human right to adequate food at risk.

Structural barriers to refugee, asylum seeker and undocumented migrant healthcare access. Perceptions of Doctors of the World caseworkers in the UK

This article contributes new insights into how refugees, asylum seekers and undocumented migrants experience access to healthcare in the UK from both the perspective of caseworker volunteers and the assessment of policy regulations that influence such experiences. Drawing on material taken from qualitative interviews conducted with Doctors of the World caseworkers and Freedom of Information documents from NHS trusts, we reveal the various complexities faced by refugees, asylum seekers and undocumented migrants when trying to access vital health care. These issues include, charging regulations, the refusal to register patients at GP practices without proof of ID, language barriers and complications navigating the healthcare system. We found that such deterrents lead to risky help and health seeking, lack of or inadequate healthcare, and worse health outcomes among these populations. DOTW caseworkers perceived policies such as charging regulations, to be unjust as they plunge patients into significant debt, which is reported to the Home Office and can lead to the detainment or deportation of patients and their families. Study participants called on the UK government to recognise health as a fundamental human right, to develop inclusive social policy and to create an empathetic health system that allows refugees, asylum seekers and undocumented migrants equitable access to health and social services. To achieve health for all, they argued the need for clearer guidelines regarding access to healthcare and charging regulations, with some suggesting the importance of revising current Department of Health and Social Care policies and Home Office measures. Our article concludes that there is a need to tackle the underlying causes of ill health, including discriminatory policies, racism, and exclusion; addressing the social and economic determinants of health; and providing meaningful and culturally sensitive healthcare and social support.

Looking Closely at Health Inequities

AbstractIn January 2022, The Hastings Center convened a two‐day virtual summit called “Righting the Wrongs: Tackling Health Inequities.” On day one, speakers including Isabel Wilkerson and Richard Rothstein discussed how the social and economic determinants of health came to be so unequal in the first place. Day two focused on solutions, with panels offering examples of what can be done to improve health policy, clinical care, research, and professional education.

Nurses' perceived barriers to the delivery of person-centred care to complex patients: A qualitative study using theoretical domains framework.

To determine nurses' perceived barriers to the delivery of person-centred care to complex patients with multiple chronic conditions in acute care settings. Complex patients have multiple physical and mental health problems, and their life is also greatly affected by sociocultural and economic determinants of health. These patients require person-centred care, but nurses often find it challenging to provide effective care to these patients due to their complex health needs. A descriptive qualitative design was used. The COREQ guidelines were followed for reporting. Semi-structured interviews were conducted with a purposive sample of 19 nurses in two hospitals. Data were analysed using deductive thematic analysis guided by the Theoretical Domains Framework, which entails 14 domains about factors affecting behaviours. The key barriers were identified under environmental context and resources, social influences, emotions, knowledge and skills domains. Deep-rooted social issues delay patients' health-seeking and nurses' abilities to understand patients' needs and discern appropriate care. Interpersonal hostility influenced nurse-patient-families interactions, and doctor-nurses conflicts affected collaborative efforts towards optimal care. Nurses' perceived barriers to care were intertwined with the deep-rooted social and cultural beliefs about nurses' image, patients' expectations and families' preference for home remedies over specialised nursing care. These barriers to person-centred care demonstrate an intricate interplay of personal, social and organisational issues and power struggles. Multifaceted implementation strategies targeting environmental context and resources, social influences, emotions, knowledge and skills domains may be beneficial to enable nurses to provide better person-centred care to complex patients. Designing implementation facilitation teams, organising person-centred care grand rounds, and allocation of stress management resources to address hostility, social-cultural influences, and organisational barriers is essential. Nurses could focus on their self-awareness and collaborative skills to address emotional and interprofessional conflicts.

The urban transport as social economic health determinant

The article considers role of transport as one of social economic health determinants. The aspects having positive and negative impact on health of population are presented. The necessity to design and plan transport systems considering population needs is postulated. It is emphasized that main priority in improving health is transition from using cars to ecological types of transport, for example, bicycles. The 8 concrete measures of improving health of urban residents are described, including increase of accessibility of points of destination, management of cars demand by reducing their accessibility and increasing parking costs, design of transport networks convenient for pedestrians and cyclists, achieve optimal population density, reduce distance to public transport and increase attractiveness of active modes of movement, etc. The strategies encouraging use of public transport are outlined.

The double burden of maldistribution: a descriptive analysis of corporate wealth and income distribution in four unhealthy commodity industries

ABSTRACT The health and ecological harms created and spread by firms active in many unhealthy commodity industries (UCIs) have received considerable attention from the public health community. However, less focus has been paid to analysing the distribution of wealth and income – important social and economic determinants of health – by these industries. This study aimed to examine long-term trends in wealth and income distribution by publicly listed corporations active in four UCIs: fossil fuels; tobacco; ultra-processed foods; and alcohol. Quantitative analysis of a range of data was conducted for firms listed on stock exchanges in the United States (US). Wealth and income distribution metrics were analysed at the industry level, including effective corporate tax rates and shareholder value ratios. The equity ownership structures and investor location of 20 of the largest firms were also explored. Since the 1980s, US-listed firms in the examined UCIs have distributed much less of their wealth and income to governments and much more to shareholders and investors mostly based in high-income countries. The study provides evidence that firms active in UCIs create a ‘double burden of maldistribution’: their externalised social and ecological harms disproportionately affect disadvantaged population groups and governments in low- and middle-income countries; whilst, simultaneously, they are increasingly transferring wealth and income to a group over-represented by a small and privileged elite. The identified distributive injustice warrants increased policy attention.

THE CHALLENGE OF KNOWLEDGE MANAGEMENT IN GLOBAL HEALTH IN PANDEMIC TIME

In 1948, with the creation of the World Health Organization (WHO), the Right to Health gained a little more global prominence, since the very purpose of the international entity is to guarantee the highest level of health for all human beings, advocating that the state of physical and mental well-being does not only consist in the absence of diseases or illnesses, but mainly when a set of values and principles are established and available to all individuals, anywhere on the planet (WHO | The Right to Health, 2012). Health in this new millennium must be seen as a global problem. The globalization of health is a good for which we must work in an explicit and programmed way, as it becomes a desirable social purpose, either for its intrinsic value or as a symbol of the predominance of human values over other interests (Oliveira & Cutolo, 2018). In a global context with rapid changes in the disease patterns, the best understanding of the Health context is to consider the broad spectrum of the ecosystem containing the social, economic determinants of health and the diversity of institutional agents, given the considerable change in the global health scenario in recent years (Kickbusch & Berger, 2010). The conception that health should be seen from a comprehensive and plural perspective brings other aspects closer to its effectiveness.

Your neighborhood matters: A machine-learning approach to the geospatial and social determinants of health in 9-1-1 activated chest pain.

Healthcare disparities in the initial management of patients with acute coronary syndrome (ACS) exist. Yet, the complexity of interactions between demographic, social, economic, and geospatial determinants of health hinders incorporating such predictors in existing risk stratification models. We sought to explore a machine-learning-based approach to study the complex interactions between the geospatial and social determinants of health to explain disparities in ACS likelihood in an urban community. This study identified consecutive patients transported by Pittsburgh emergency medical service for a chief complaint of chest pain or ACS-equivalent symptoms. We extracted demographics, clinical data, and location coordinates from electronic health records. Median income was based on US census data by zip code. A random forest (RF) classifier and a regularized logistic regression model were used to identify the most important predictors of ACS likelihood. Our final sample included 2400 patients (age 59 ± 17 years, 47% Females, 41% Blacks, 15.8% adjudicated ACS). In our RF model (area under the receiver operating characteristic curve of 0.71 ± 0.03) age, prior revascularization, income, distance from hospital, and residential neighborhood were the most important predictors of ACS likelihood. In regularized regression (akaike information criterion = 1843, bayesian information criterion = 1912, χ2 = 193, df = 10, p < 0.001), residential neighborhood remained a significant and independent predictor of ACS likelihood. Findings from our study suggest that residential neighborhood constitutes an upstream factor to explain the observed healthcare disparity in ACS risk prediction, independent from known demographic, social, and economic determinants of health, which can inform future work on ACS prevention, in-hospital care, and patient discharge.

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.

CALL FOR EMERGENCY ACTION TO LIMIT GLOBAL TEMPERATURE INCREASES, RESTORE BIODIVERSITY, AND PROTECT HEALTH

CALL FOR EMERGENCY ACTION TO LIMIT GLOBAL TEMPERATURE INCREASES, RESTORE BIODIVERSITY, AND PROTECT HEALTH

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health

Call for emergency action to limit global temperature increases, restore biodiversity, and protect health