Equity For People Research Articles

Supporting a Healthy Planet, Healthy People and Health Equity through Urban and Territorial Planning

ABSTRACT The form of human settlements impacts on planetary health, population health and health equity. Yet goals for urban and territorial planning are only tangentially linked to public health outcomes. The WHO and UN-Habitat support actions to bring health to the fore in planning and design of human settlements, recently publishing ‘Integrating Health in Urban and Territorial Planning: a sourcebook’ focusing on ‘why’ action is needed, ‘how’ to initiate it; and curating several existing resources on ‘what’ to do. Recommendations for research, policy and practice include calls for rapid development of closer relationships between public health and spatial planning.

He, Him, His: Masculine Language in Professional Guidance and Assessed Equity and Inclusion of Women and LGBTQ People in the Profession

He, Him, His: Masculine Language in Professional Guidance and Assessed Equity and Inclusion of Women and LGBTQ People in the Profession

Intersectional Structural Stigma, Community Priorities, and Opportunities for Transgender Health Equity: Findings from TRANSforming the Carolinas.

In this manuscript, "Intersectional Structural Stigma, Community Priorities, and Opportunities for Transgender Health Equity," Poteat and Simmons outline the legal and policy barriers that impede efforts to end the HIV epidemic among transgender people in the South. They present qualitative and quantitative data from a community engaged research study conducted with transgender adults and other key stakeholders as well as finding from an analysis of policies impacting transgender people in both states. Violence prevention and decriminalization are highlighted as key policy initiatives that would advance health equity for transgender people.

Grafting Equity.

Achieving health equity for Black people and other people of color in America will be an impossible feat without dismantling racist systems and replacing them with new inclusive systems that create success for everyone. This article highlights activities in Rocky Mount, North Carolina, and the efforts of a community-based nonprofit, OIC, in collaboration with residents, community, and government partners to craft sustainable and replicable solutions.

Abstract PO-006: Building a new clinical trial diversity alliance to transform our ability to reach understudied and underserved patients

Abstract Not all segments of the population have benefited equally from advances in science and medicine. Distinct populations continue to be understudied in science, underrepresented in research, and underserved by medicine. Multiple complex factors, including the lack of diverse representation in research, are contributing to disparate health outcomes. For instance, among both men and women, Black patients have the highest cancer death rates. Without intervention, future medical innovations will not broadly benefit all patients and society. Genentech, a member of the Roche Group, believes data representative of real-world patient populations is required to optimize clinical outcomes for all patients. To make meaningful progress toward this goal, we created a system-level strategy. Last year, we began building a network of clinical trial sites to advance the representation of diverse patient populations in the company's oncology clinical trials, test recruitment and retention approaches, and establish best practices that can be leveraged across the industry to help achieve health equity for people with cancer. The first step in identifying potential partners for this alliance was to develop site criteria. We considered numerous attributes including: operational capabilities and performance in enrolling underrepresented patient populations, D&I reputation and community involvement with these patient populations, attitude and commitment to inclusive research, and scientific reputation. We used both internal and external data sources to stratify sites based on two key attributes. First, we compared sites' historical enrollment of Black, Latinx and other underrepresented patients in oncology trials. Second, we evaluated the size of the Black and Latinx populations within the catchment area of sites. Included in the data analysis were about 20,000 potential oncology sites. Within those sites that had a large number of underrepresented patient populations, we used enrollment and experience with Genentech oncology trials to further refine our search. We refined our list based on study teams' experience with site capability to conduct phase I-IV trials. We then conducted in-depth site interviews to identify those sites that were aligned with our mission and were making significant efforts to reach patients of color. After the interview process was completed, four inaugural sites were selected for the launch of the Advancing Inclusive Research Site Alliance. Each of the centers will focus on enabling historically underrepresented patient groups to participate in Genentech's oncology trials and work collaboratively to share key learnings and explore innovative ways of increasing clinical trial access for every patient who might benefit. The AIR Site Alliance plans to expand to more research centers and broaden its focus into additional disease areas in the future. Together, we will work to enrich science, eliminate disparity in outcomes and provide equitable access to innovative therapies for all patients. Citation Format: Ruma Bhagat, Meghan McKenzie, Melissa Gonzales, Gerren Wilson, Nicole Richie, Quita Highsmith. Building a new clinical trial diversity alliance to transform our ability to reach understudied and underserved patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-006.

Better Brain Health through Equity: Addressing Health and Economic Disparities in Dementia

Dementia disproportionately impacts the health and financial security of women and certain minority groups. Long-standing inequities create distrust of the medical system, fewer treatment options, and reduced access to care. Research predicts that from 2020 to 2060, the number of African Americans and Latinx living with dementia will grow by nearly 200 percent and 440 percent, respectively, while prevalence among non-Hispanic Whites will increase by 69 percent. As the prevalence of dementia rises, so will the costs associated with dementia care. African Americans bear 1/3 of the costs associated with dementia. And the costs for Latinx living with Alzheimer’s disease are expected to exceed $100 billion by 2060. To mitigate these growing health and economic concerns, efforts to improve dementia care must put equity front and center. This presentation highlights five actionable recommendations to build health equity by reducing disparities in dementia prevention, detection, diagnosis, and care. These recommendations center around two overarching themes: (1) Strengthening the infrastructure among health-care, long-term care, and community-based organizations to achieve greater health equity for people living with dementia and their caregivers and (2) Expanding dementia-friendly networks and workplaces in racially and ethnically diverse communities. The recommendations discussed in this presentation will offer guidance for policymakers, health services researchers, businesses, health systems, and communities to reduce the inequitable impact of dementia on African Americans and Latinx, which is even more vital amid demographic trends showing a population growing older and more racially and ethnically diverse.

U.S. Higher Education Institutions: Challenges and Opportunities Since COVID-19

[연구목적] 이 연구는 코비드 19 펜데믹 상황이 미국 고등교육기관에 어떠한 영향을 미쳤는지를 다루고 있다. 이 연구의 목적은 코비드 펜데믹 상황 속에서 미국 고등교육기관이 직면한 문제들을 발견하고 동시에 코비드 종료이후 활용 가능한 여러 가지 방안들을 논의하는데 있다. [연구방법] 이 연구는 세 가지 주제를 다루고 있다. 첫째, 코비드 상황 이후 2년제 대학의 대처방안을 살펴보았다. 둘째, 코비드 상황 이후 4년제 대학들의 변화 움직임을 살펴보았다. 셋째, 코비드 상황과 더불어 광범위하게 일어나고 있는 인종차별에 관한 사회운동이 미국 고등교육기관에 어떠한 영향을 미치고 있는가를 다루었다. [연구결과] 미국의 고등교육기관은 전반적으로 재학생 수의 감소와 더불어 정부의 재정지원 감축이라는 이중고를 겪고 있는데, 이러한 현상은 2년제 대학에서 더욱 확연하게 나타나고 있다. 전문대학에 다니고 있는 많은 유색인종과 저소득층 학생들은 자신의 학업의 계속성 여부를 가장 심각한 문제로 받아들이고 있다. 대학교수들도 단기간에 대면수업을 비대면 수업으로 전환해야 하는 급격한 상황변화에 따른 여러 가지 어려움과 압박감을 토로해 왔다. 이러한 압박감 속에서 특히 2년제 대학교수들의 이직률이 증가하는 추세를 보이고 있다. 4년제 대학의 경우는 많은 대학들이 입학시험성적을 요구하지 않는 방향으로 학부나 대학원 입시정책을 수정하고 있다. 펜데믹 기간 동안 아시안 아메리칸 학생들에 대한 인종차별 문제가 야기되었고, 유색인종과 저소득층 학생문제가 해결해야 할 시급한 과제로 제기되고 있다. 인종차별 해소, 교육의 형평성 확보, 건강과 안전 보장 등은 펜데믹 기간 중에, 더 나아가 펜데믹 종료 이후까지 중대한 과제로 남게 될 것으로 전망된다. [결론] 미국의 고등교육기관은 장기적 관점에서 자신의 역할을 새롭게 재 설정하고, 지역사회의 소중한 지적 자원으로 자리매김하며, 지속적인 교육의 형평성 제공을 위한 구조적 변화를 모색해 나가야 할 것이다.[Purpose]This paper reflects on ways that U.S. higher education has been affected by COVID-19. The purpose of this paper was to better understand both the challenges faced by U.S. higher education and the opportunities that may become available in a post-COVID world. [Methods]We addressed three themes: COVID-19 and community colleges; COVID-19 and four-year institutions; and social movements as a broader context within the United States. [Results]Higher education institutions in the United States saw a decrease in funding and enrollments, with community colleges experiencing the most loss. Community college students, who are often racially minoritized and low-income, therefore experienced the most challenges regarding access and persistence. Faculty felt pressure to switch to online learning and to play multiple roles, with many leaving higher education under these pressures, more often leaving community colleges. Four-year institutions changed their admissions policies for both undergraduates and graduates in a move that is likely to remain post-COVID. The pandemic inflamed racism against Asian Americans across the United States as many followed the former president’s lead and scapegoated Asian Americans for spreading the virus. Students and faculty have protested against racism towards Asian Americans and the Black community. Minoritized and low-income students remain the most vulnerable within higher education and U.S. society. Working to dismantle oppression against people of color and for equity for people of color through education, health, policies, and law are crucial responses to the societal problems in the United States during the COVID-19 period and will remain vital post-COVID. [Conclusion]U.S. higher education institutions need to reimagine their role and make long-term, structural changes to become resources within their communities and provide educational equity.

Global nutrient equity for people and the planet

The industrial world has converted inert soil and atmospheric nutrients into reactive fertilizer flows that endanger water quality, biodiversity and climate. Simultaneously, poor nations starve because of the shortage of these nutrients in agricultural soils. Here we propose a redistribution of accumulated nutrients to enhance food security while counteracting the current degradation of critical Earth system processes. Residue and sediment nutrients could be processed and transported to food-insecure regions through the opposite logistics used to ship rock phosphate across the globe. Financing through trading accumulated rights could trigger the required innovations in processing, logistics and thinking. Such a socially just 'one Earth currency' could leverage a transformation towards resilience, equity and dignity across the critical Earth system processes.

Equity for Older Adults and Those in Congregate Sites: Lessons from the First Year of a Local Public Health COVID-19 Response

This paper presents lessons on the equity of healthcare and health for older people that emerged from the experience of a COVID-19 incident commander during the pandemic. The lessons include the value of ongoing investment in trustworthy cross-sector relationships and value-added roles for learners; the importance of working together for the common good which can provide a deep well to draw upon during a crisis; in such times, the vulnerable often become more vulnerable and need extra attention thus meeting the needs of older people requires consideration of age, disability, and congregate living status; an equity lens and cultural humility foster new opportunities for community health and systems thinking, and when balanced with on-the-ground work and relationships, make it possible to take on seemingly intractable problems; in order to advance community health and equity, it is vital to meet both immediate needs and to focus on strategic efforts to simultaneously transform systems and structures; developing new knowledge creates opportunities for broader sharing; interprofessional teams enable collective action in a complex problem; transparency and continuous communication are important always, but vital in a crisis; and proactive investment in public health infrastructure could mitigate a future crisis. While the pandemic produced loss and pain for millions, the transportable lessons about investing in system science, equity-focused, cross-sector infrastructure, and relationships can inform the future of public health and health care policy, grounded in lived experience, to inform the re-emergence of collective efforts to foster health equity for older people and other vulnerable populations.

Disability inclusion: A missing ingredient for food system equity

Disability is the largest minority group in the world and includes over 1 billion people worldwide. Although people with disabilities are part of all our communities, health disparities remain largely unaddressed for this population, including food inequities. Current research has focused on documenting food access disparities for people with disabilities, but there are limited interventions that address food inequities for this population. To be effective, these interventions must go beyond the individual, and should include a food systems approach that advances equity for people with disabilities. The World Health Organization (WHO) Sustainable Development Goals (SDGs) calls for the disability community to be integrated into food system research and policy efforts. However, the 2021 United Nations Food Systems Summit is absent of disability perspectives. This is a missed opportunity, and people with disabilities must be invited to this table in order to advance food equity for everyone in our communities.

Towards equity for people who inject drugs in HIV prevention drug trials.

Towards equity for people who inject drugs in HIV prevention drug trials.

Equity for Older Adults and Those in Congregate Sites: Lessons from the First Year of a Local Public Health COVID‐19 Response

AbstractThis paper presents lessons on the equity of healthcare and health for older people that emerged from the experience of a COVID‐19 incident commander during the pandemic. The lessons include the value of ongoing investment in trustworthy cross‐sector relationships and value‐added roles for learners; the importance of working together for the common good which can provide a deep well to draw upon during a crisis; in such times, the vulnerable often become more vulnerable and need extra attention thus meeting the needs of older people requires consideration of age, disability, and congregate living status; an equity lens and cultural humility foster new opportunities for community health and systems thinking, and when balanced with on‐the‐ground work and relationships, make it possible to take on seemingly intractable problems; in order to advance community health and equity, it is vital to meet both immediate needs and to focus on strategic efforts to simultaneously transform systems and structures; developing new knowledge creates opportunities for broader sharing; interprofessional teams enable collective action in a complex problem; transparency and continuous communication are important always, but vital in a crisis; and proactive investment in public health infrastructure could mitigate a future crisis. While the pandemic produced loss and pain for millions, the transportable lessons about investing in system science, equity‐focused, cross‐sector infrastructure, and relationships can inform the future of public health and health care policy, grounded in lived experience, to inform the re‐emergence of collective efforts to foster health equity for older people and other vulnerable populations.

Equity for People of Color With Intellectual and Developmental Disabilities

Equity for People of Color With Intellectual and Developmental Disabilities

Legal Issues associated with Promotion of Health Equity for People with Disabilities - Focusing on the theory of health justice -

Legal Issues associated with Promotion of Health Equity for People with Disabilities - Focusing on the theory of health justice -

National Indigenous Science Education Program (NISEP): Outreach Strategies That Facilitate Inclusion

To ensure that the science, technology, engineering, and mathematics (STEM) workforce of the future is inclusive of diverse peoples and ideas, there is a need to ensure that STEM outreach activities that encourage students into STEM education and careers are inclusive of and provide equity for people from diverse racial/ethnic, socioeconomic, and academic backgrounds. Since 2004, the National Indigenous Science Education Program (NISEP), based at Macquarie University, Sydney, has been using best ethical and inclusion strategies to engage with Australian Aboriginal and Torres Strait Islander school students and their communities. This publication discusses the inclusion and equity strategies utilized by NISEP, including community consultation, student leadership and autonomy, volunteer mentors, and the respectful and best practice use of Indigenous knowledge. These factors have all contributed to NISEP's success in increasing Aboriginal and Torres Strait Islander students' aspiration toward and engagement with secondary and tertiary education.

Elevating Equity and Inclusion for People With Intellectual Disabilities: A Nursing Student Sexual Health Promotion Project.

People with intellectual disabilities experience barriers regarding sexual health education. Nursing education insufficiently addresses the care of people with disabilities. Sexual health promotion is a teaching opportunity for nursing students. Nursing students aimed to improve sexual health literacy among people with intellectual disabilities through educational seminars. Gender-matched group education conducted for people with intellectual disabilities in their home setting enhanced sexual health literacy. People with intellectual disabilities are at risk for sexual abuse and may possess insufficient information compared to their peers without disabilities. Sexual health promotion education for people with intellectual disabilities should occur on a regular basis.

Equity in national policies for Australians with kidney disease

ObjectiveTo describe how the Australian Government Department of Health policies address equity in the management of chronic kidney disease (CKD). MethodsWe searched the websites of the Australian Government Department of Health, Kidney Health Australia, Australian Indigenous HealthInfoNet and the National Rural Health Alliance for policies using the search terms: kidney, renal and chronic. ResultsWe included 24 policies that addressed groups of people that experience health inequities: 23 addressed Aboriginal and Torres Strait Islander peoples, 18 rural/remote communities, 12 low socioeconomic status groups, six culturally and linguistically diverse communities and four addressed gender disparities. The scope of the policies ranged from broad national frameworks to subsidised access to health services and medicines. Only two policies explicitly addressed equity for patients with CKD. ConclusionCKD outcomes are highly variable across population groups yet Australian Government policies that address access to and the experience of care are limited in both number and their attention to equity issues. Implications for public healthIn Australia, some groups of people with CKD have a substantially higher risk of mortality and morbidity than the general CKD population. We advocate for the development and implementation of policies to attain equity for people with CKD.

Patient preferences and priorities for haemophilia gene therapy in the US: A discrete choice experiment.

IntroductionGene therapy has shown promise in clinical trials for patients with haemophilia, but patient preference studies have focused on factor replacement treatments.AimWe conducted a discrete choice experiment (DCE) to investigate the relative importance and differential preferences patients provide for gene therapy attributes.MethodsWe surveyed male adults with haemophilia in the United States recruited from patient panels including the National Hemophilia Foundation Community Voices in Research platform using an online survey over 4 months in 2020/21. Participants indicated preferences for gene therapy attributes including dosing frequency/durability, effect on annual bleeding, uncertainty related to side effects, impact on daily activities, impact on mental health, and post‐treatment requirements. The relative importance of each attribute was analysed overall and for subgroups based on haemophilia type and severity.ResultsA total of 183 males with haemophilia A (n = 120) or B (n = 63) were included. Half (47%) had severe haemophilia; most (75%) were White. Overall, participants gave effect on bleeding rate the greatest relative importance (31%), followed by dose frequency/durability (26%), uncertainty regarding safety issues (17%), and impact on daily activities (11%). Dose frequency/durability had the greatest importance for those with haemophilia B (35%).ConclusionPeople with haemophilia prioritised reduced bleeding and treatment burden; the former was more important in haemophilia A and the latter in haemophilia B, followed by safety and impact on daily life in this DCE of gene therapy attributes. These findings and differences can inform clinical and health policy decisions to improve health equity for people with haemophilia.

Closing obesity care gaps and achieving health equity for people living with obesity

Lack of access to obesity care is contributing to health inequalities for people living with obesity [1,2]. Public health systems have not established obesity care paths and there is insufficient funding for obesity prevention and treatment services. A profound lack of obesity knowledge, skills and competencies among healthcare professionals, lack of empowerment-based patient care, and deeply ingrained weight bias and stigma in our society contribute to obesity care gaps [3]. Achieving health equity for people living with obesity will require comprehensive interventions at individual, sociocultural, and policy levels [4].

Chronic pain experience and health inequities during the COVID-19 pandemic in Canada: qualitative findings from the chronic pain & COVID-19 pan-Canadian study

BackgroundChronic pain affects about 20 % of the Canadian population and can lead to physical, psychological and social vulnerabilities. However, this condition remains poorly recognized and undertreated. During 2020, as the COVID-19 pandemic disrupted daily living and health care systems, the situation of people with chronic pain has drawn little public attention.MethodsThis qualitative study was part of a pan-Canadian mixed-methods project and aimed to understand the experiences and challenges of people living with chronic pain during the COVID-19 pandemic in Canada. Between May and August 2020, we conducted in-depth semi-structured interviews with 22 individuals living with chronic pain across the country. We used reflexive thematic analysis to interpret data.ResultsOur findings underscored four dimensions of the chronic pain experience during the pandemic: (1) Reinforced vulnerability due to uncertainties regarding pain and its management; (2) Social network as a determinant of pain and psychological condition; (3) Increasing systemic inequities intermingling with the chronic pain experience; (4) More viable living conditions due to confinement measures. Though several participants reported improvements in their quality of life and reduced social pressure in the context of stay-at-home orders, participants from socio-economically deprived groups and minorities reported more challenges in accessing pain relief, health care services, and psychosocial support.ConclusionsThe COVID-19 pandemic has revealed and intensified pre-existing disparities and challenges among people living with chronic pain in terms of material resources, psychosocial condition, social support, and access to care. In post-pandemic times, it will be essential to address flaws in health and welfare policies to foster equity and social inclusiveness of people with chronic pain.