Equity Goals Research Articles

Medicaid And SNAP Advance Equity But Sometimes Have Hidden Racial And Ethnic Barriers.

Medicaid and the Supplemental Nutrition Assistance Program were developed during the Civil Rights era to help poor people and reduce racial and ethnic differences in health care access and food security. Although the two programs have succeeded in narrowing health and nutrition disparities, certain policies hinder goals of racial and ethnic equity, even though they do not explicitly mention race or ethnicity. These policies, including administrative policies (such as work requirements) and more basic decisions about whether to cover immigrants or expand Medicaid, can create barriers that promote racial and ethnic disparities, contrary to the programs' underlying goals.

Composite Indices of Social Determinants of Health: Overview, Measurement Gaps, and Research Priorities for Health Equity.

The goal of health equity is for all people to have opportunities and resources for optimal health outcomes regardless of their social identities, residence in marginalized communities, and/or experience with oppressive systems. Social determinants of health (SDOH)-the conditions in which we are born, grow, live, work, and age-are inextricably tied to health equity. Advancing health equity thus requires reliable measures of SDOH. In the United States, comprehensive individual-level data on SDOH are difficult to collect, may be inaccurate, and do not capture all dimensions of inequitable outcomes. Individual area-based indicators are widely available, but difficult to use in practice. Numerous area-level composite indices are available to describe SDOH, but there is no consensus on which indices are most appropriate to use. This article presents an analytic taxonomy of currently available SDOH composite indices and compares their components and predictive ability, providing insights into gaps and areas for further research.

Country ownership as a guiding principle for IA2030: A case study of the measles and rubella elimination programs in Nepal and Nigeria

Country-owned, as opposed to donor-driven, is a principle within the development sector that recognizes the centrality of countries’ leadership, systems, and resources in executing programs and achieving sustainable development. In alignment with this notion, the Immunization Agenda 2030 was developed with country ownership as one of four core principles of the ambitious ten-year plan. This means that the success of immunization programs, including those with eradication and elimination goals such as polio, measles, and rubella, and those with broader equity goals to “leave no one behind” on immunization, would be largely driven by country systems. In this paper we deconstruct country ownership into five operational principles: commitment, coordination, capacity, community participation, and accountability. Through this lens, we illustrate how two countries, Nepal and Nigeria, have exemplified country ownership in their measles and rubella elimination programs and we infer the ways in which country ownership drives system performance and sustains program efforts.

U.S. cities’ integration and evaluation of equity considerations into climate action plans

While cities in the United States play an active role developing and implementing climate policy, urban centers are often sites of socio-spatial inequity. Thus, we explore how cities grapple with these inequities in their Climate Action Plans (CAPs). While CAPs can empower cities to engage in equitable planning practices that prioritize marginalized communities, little empirical research examines how equity goals are measured and evaluated. We find that among large U.S. cities with CAPs, less than one third include measurable indicators to evaluate progress towards achieving equity goals. Across climate adaptation and mitigation planning, nineteen cities consider equity goals as they relate to ten thematic areas, six outcomes, and five dimensions of equity. We suggest ways forward for cities to develop, implement, and measure a diverse and holistic set of equity indicators to use in their climate planning efforts and beyond.

Is green growth happening? An empirical analysis of achieved versus Paris-compliant CO2–GDP decoupling in high-income countries

Scientists have raised concerns about whether high-income countries, with their high per-capita CO2 emissions, can decarbonise fast enough to meet their obligations under the Paris Agreement if they continue to pursue aggregate economic growth. Over the past decade, some countries have reduced their CO2 emissions while increasing their gross domestic product (absolute decoupling). Politicians and media have hailed this as green growth. In this empirical study, we aimed to assess whether these achievements are consistent with the Paris Agreement, and whether Paris-compliant decoupling is within reach. We developed and implemented a novel approach to assess whether decoupling achievements in high-income countries are consistent with the Paris climate and equity goals. We identified 11 high-income countries that achieved absolute decoupling between 2013 and 2019. We assessed the achieved consumption-based CO2 emission reductions and decoupling rates of these countries against Paris-compliant rates, defined here as rates consistent with national fair-shares of the remaining global carbon budgets for a 50% chance of limiting global warming to 1·5°C or 1·7°C (representing the lower [1·5°C] and upper [well below 2°C] bounds of the Paris target). The emission reductions that high-income countries achieved through absolute decoupling fall far short of Paris-compliant rates. At the achieved rates, these countries would on average take more than 220 years to reduce their emissions by 95%, emitting 27 times their remaining 1·5°C fair-shares in the process. To meet their 1·5°C fair-shares alongside continued economic growth, decoupling rates would on average need to increase by a factor of ten by 2025. The decoupling rates achieved in high-income countries are inadequate for meeting the climate and equity commitments of the Paris Agreement and cannot legitimately be considered green. If green is to be consistent with the Paris Agreement, then high-income countries have not achieved green growth, and are very unlikely to be able to achieve it in the future. To achieve Paris-compliant emission reductions, high-income countries will need to pursue post-growth demand-reduction strategies, reorienting the economy towards sufficiency, equity, and human wellbeing, while also accelerating technological change and efficiency improvements. None.

Pairing Mindfulness and Social Justice

This case study explores how teacher candidates responded to the inclusion of mindfulness practices in a course and how they understand mindfulness’ relationship to equity. Findings show that participants responded positively and connected presence activities to social justice in several ways: fostering mental health, addressing systemic inequities, facilitating classroom management, making connections to curriculum, and empowering students. The study demonstrates that pairing mindfulness and equity goals has important potential; however, this is only one step of many needed to recruit and retain a thriving teaching force that can work for equity in schools.

Addressing Diversity, Equity, and Inclusivity Contributions in Academic Review.

The nursing profession and academic environments are increasingly calling for nurse educators to incorporate diversity, equity, and inclusion (DEI) goals and actions into their professional practice. Such work aligns with institutional and professional missions of social justice and antiracism. Historically, there has been an undervaluing and lack of recognition in academia of DEI contributions and qualitative or community-based research focused on health equity. This lack of recognition may disproportionately impact faculty who focus their scholarship and research on marginalized communities. The current state of the academic review of DEI contributions for appointment, promotion, and tenure is presented. Examples for teaching, research and scholarship, practice, and service are provided. Recommendations include expanding recognition and evaluation of academic scholarship and advocacy against efforts to dismantle social justice and antiracism advances within academia. Examining hegemonic norms is vital to promote more equitable power structures in academic environments.

Inequitable representation of Black boys in gifted and talented education, Advanced Placement, and special education

AbstractBlack boys are overrepresented in special education (SPED) and underrepresented in gifted and talented education, Advanced Placement, and other opportunities for advanced learners. Conversely, they are overrepresented in SPED. In this article, we address the vicious cycle of deficit thinking and intelligence test inequities—the consequences and impact on Black males. The impact of high‐stakes testing and racial prejudice and discrimination is stark. We present an equity formula to guide readers in all roles in setting quantifiable equity goals. Recommendations are provided.

Presenters at chiropractic research conferences 2010–2019: is there a gender equity problem?

BackgroundPresenting at professional and scientific conferences can be an important part of an individual’s career advancement, especially for researchers communicating scientific findings, and can signal expertise and leadership. Generally, women presenting at conferences are underrepresented in various science disciplines. We aimed to evaluate the gender of presenters at research-oriented chiropractic conferences from 2010 to 2019.MethodsWe investigated the gender of presenters at conferences hosted by chiropractic organisations from 2010 to 2019 that utilised an abstract submission process. Gender classification was performed by two independent reviewers. The gender distribution of presenters over the ten-year period was analysed with linear regression. The association of conference factors with the gender distribution of presenters was also assessed with linear regression, including the gender of organising committees and abstract peer reviewers, and the geographic region where the conference was hosted.ResultsFrom 39 conferences, we identified 4,340 unique presentations. Women gave 1,528 (35%) of the presentations. No presenters were classified as gender diverse. Overall, the proportion of women presenters was 30% in 2010 and 42% in 2019, with linear regression demonstrating a 1% increase in women presenting per year (95% CI = 0.4–1.6%). Invited/keynote speakers had the lowest proportion of women (21%) and the most stagnant trajectory over time. The gender of conference organisers and abstract peer reviewers were not significantly associated with the gender of presenters. Oceanic conferences had a lower proportion of women presenting compared to North America (27% vs. 36%).ConclusionsOverall, women gave approximately one-third of presentations at the included conferences, which gradually increased from 2010 to 2019. However, the disparity widens for the most prestigious class of keynote/invited presenters. We make several recommendations to support the goal of gender equity, including monitoring and reporting on gender diversity at future conferences.

Comparing the reasons for contraceptive discontinuation between parenting adolescents and young women in sub-Saharan Africa: a multilevel analysis

BackgroundAdolescent sexual and reproductive health remains a major public health and development issue of global importance. Given that adolescents and young people are heterogenous groups in terms of many characteristics, this study expands the literature by comparing the reasons for contraceptive discontinuation between parenting adolescents (aged 15–19) and parenting young women (aged 20–24) in sub-Saharan Africa (SSA).MethodsData for the study came from Demographic and Health Surveys of 22 SSA countries. The outcome variable was reasons for discontinuation. We performed multilevel binary logistic regression on analytic samples comprising 1485 parenting adolescents and 10,287 parenting young women across the selected SSA countries.ResultsFindings show that the proportion of respondents who used modern contraceptives was lower among parenting adolescents (35%) relative to their 20–24-year-old counterparts (43%). Higher percentages of parenting adolescents than young women discontinued contraceptives because of reasons such as pregnancy or method failure (i.e., 9.9% and 8.17% accordingly), husband disapproval, access or availability issues, wanting more effective methods, and inconvenience in using methods. The multilevel analysis further highlighted disparities between parenting adolescents and parenting young women who discontinued contraceptives. For instance, parenting young women had 30% lower odds of discontinuing contraceptives due to pregnancy or method failure than parenting adolescents.ConclusionThe study established disparities in the reasons for contraceptive discontinuation between parenting adolescents and parenting young women, with adolescents demonstrating greater vulnerabilities and higher risks. Considerable attention must be given to parenting adolescents in the efforts to achieve equity goals such as the Sustainable Development Goals and universal health coverage in SSA.

Racial Health Equity Plans in the 30 Largest US Cities.

Racial inequities in life expectancy vary significantly across US cities, with city-level gaps ranging from zero to more than 10years. Given that these inequities are rooted in racism and maintained through social structures and policies, population-level solutions are needed. Local health departments (LHD) are well-situated to lead these types of changes. We conducted an environmental scan and document review of formal health plans of the LHDs with jurisdictions covering the 30 most populous US cities. We assessed the inclusion of equity priorities and specific and measurable equity goals. Secondary outcomes related to organizational structures, data, formal declarations, and other practices were also assessed. Data were collected between January and August 2022. The extent of focus on racial equity in the identified strategic health plans varied. Less than half of the cities with a formal public health plan (13 of 29) listed racial health equity as an area of focus. Only seven cities (all of which had a health plan focusing on racial health equity) had specific goals related to racial health equity. Twenty-five LHDs provided local data on racial health inequities. All but seven cities had declared racism a public health crisis. About half of the LHDs had positions or divisions focused on racial equity, or specified equity as an area of focus for Covid-19 efforts. These findings reveal that few large cities translate growing support for anti-racism into their formal planning. While most LHDs acknowledge (and provide data pointing to) gaps in racial health equity in their jurisdictions, more attention is needed to incorporate specific and measurable racial health equity goals into strategic plans, and provide adequate structure and resources to attain those goals.

Alcohol, drug and tobacco prevention in Swedish municipalities - impact from the COVID-19 pandemic considering socio-demographic context.

The coronavirus disease 2019 (COVID-19) pandemic and measures to prevent the spread of the virus challenged public health practice at the local level in Sweden. The objective of this study was to explore the impact of the pandemic on the prevention of alcohol, drugs and tobacco (ADT) in Sweden during 2020-21 considering socio-demographic context. Data were collected through the Public Health Agency's survey on ADT prevention in Swedish municipalities (N = 290). This study used data from 2020 and 2021, with a response rate of 90% and 88%, respectively. Survey data were analyzed in logistic regression models (odds ratios, P < 0.05, 95% confidence intervals) against variables of education level, income level and population size from national registers. A majority (n = 198, 76%) of the municipalities reported a decrease in ADT prevention during the pandemic. No correlation between the decrease in ADT prevention and socio-demographic conditions was detected. A majority (2020: n = 165, 63%; 2021: n = 174, 68%) of the municipalities also reported that ADT prevention was adapted, however less common in smaller municipalities and municipalities where residents had lower levels of education and lower incomes. ADT prevention carried out by municipalities in Sweden was initially (2020) deeply affected by the preventive strategies against COVID-19. Adaptation of activities was less common in municipalities with more vulnerable socio-demographic situation. In policy, practice and research, the findings are important not only for continued progress on the national goal of equity in health but also for preparedness for future crises.

A Call for a Transformative Public Health Training: The Necessity of Abolition.

The societal distrust of public health alongside the complex, intersecting, and large public health crises of today and our future requires a transformation of the education of the next generation of public health leaders. The field of public health's goals of health equity for all cannot be advanced until our field interrogates and resists the prison industrial complex (PIC), which maintains White supremacy and (re)produces health inequities. As current and former public health students, we propose incorporating abolition of the PIC as a political vision, structural and power analysis, and organizing strategy into the public health curriculum. We highlight gaps in the public health curriculum and the existing similarities between stated goals of abolition and public health. We propose calls to action for individuals, faculty, and schools of public health to interrogate the carceral nature of public health and work toward contributing to the positive project of an abolitionist future.

How "Well" are We DEI-ing? Applying Technical and Professional Communication Theory and Disability Justice to Challenge Intersectional Ableism in Job Advertisements Through Coalitional Recruitment

Purpose:This article integrates an ableism studies framework with disability justice principles to interrogate how medical insurance job advertisements may circulate ableist assumptions that impede corporate diversity, equity, and inclusion (DEI) goals and social justice efforts. Method: I use critical discourse analysis and thematic coding to analyze how normative ableist assumptions present in job advertisements and DEI documents may exclude prospective employees with disabilities as well as multiply marginalized identities such as Black women. Results: Through my analysis, I demonstrate how normalizing assumptions related to productivity, rationality, independence, and corporate assimilation may contribute to the exclusion of multiply marginalized employees. Conclusion: I ultimately provide data-driven insights regarding what I refer to ascoalitional recruitment to help practitioners construct more equitable job advertisements attuned to disability justice.

Cargo Airport Planning: Discerning Spatial Distributions of Freight Development in Airport-Adjacent Communities

Recent initiatives from the federal government, such as Justice40, assert the need to ensure equitable distribution of economic benefits of infrastructure investment. Yet, there is little empirical work that assesses spatial-economic outcomes in airport-adjacent communities. To inform these equity goals in the context of cargo airport development, this study proposed a strategy for discerning the economic clustering characteristics of airport-adjacent communities relative to their metropolitan areas. The study focused on the 10 U.S. airports with the most airfreight in 2017. We used the local spatial statistic, the Getis–Ord [Formula: see text], to identify grid-based spatial clusters of regionally significant transportation and logistics economic activity. We further explored the extent to which those clusters were consistent across economic attributes (businesses, employees, and sales volume). The results demonstrated that the presence of business hot spots in the airport-adjacent community was not necessarily matched by hot spots of employment or sales volume. The study recommends the following spatial terminology to describe patterns of spatial-economic hot spots near airports: Compacted aerotropolis, Fragmented aerotropolis, Sector aerotropolis, Airea, Corridor, and Outlying. The study found that two airports fit the Fragmented aerotropolis model; two, the Compacted aerotropolis model; one, the Airea; one, Outlying; and four were inconsistent across economic variables. By dividing the study airports into these categories, we were able to discern the significance of the economic impacts on the airport-adjacent community and provide a spatial rhetoric that would be meaningful and accessible to a variety of stakeholders in the participatory planning process.

Unequal urban heat burdens impede climate justice and equity goals

Unequal urban heat burdens impede climate justice and equity goals

Women in the medical profession in 1900 from extended maternity to social equity. The life of Lucia Servadio.

The history of social medicine in Italy between the late nineteenth and early twentieth centuries was characterised by a marked presence of gender and the consequent commitment of women of Jewish origin to the issues of early childhood education, as well as safeguarding of work and motherhood and health prevention with regard to social and cultural fragility. Some of the roles of women engaged in social medicine campaigns have been widely studied in the historiography of medicine, having recognized their roles and commitment to attempting to create a fair society through their expertise in medicine and health. However, there are some biographies and professional lives that are still unpublished and worthy of attention by historical medical research. Lucia Servadio, who was of Jewish origin (1900-2006), was the youngest Italian doctor of the first twenty years of the twentieth century. She successfully worked, despite the degrading identification of women at the time, in the field of medicine and welfare, thanks to her qualified professional, cultural and social commitment. Dr Servadio's professionalism was constantly defined by a vision of health as a right that the doctor must protect by pursuing the goal of social equity. Precisely on the basis of these principles, solidified by the practical and social activism of women's groups of the time, Dr Servadio's professional and private life was continuously shaped between medicine and social activism. However, her story is also pervaded by the ambiguity of the role played by women, often highly educated and with considerable professional standing, engaged in forms of scientific intellectual collaboration of a conjugal nature.

The gap in capacity building on climate, health, and equity in built environment postsecondary education: a mixed-methods study.

Institutions of higher education are feeling increasing pressure from both students and the international climate community to offer more courses and joint degrees on the role of the built environment in advancing climate action, population health, and social equity. The built environment plays a leading role in this new, transdisciplinary approach. Thoughtfully designed buildings, neighborhoods, and communities can simultaneously lower per capita greenhouse gas emissions, reduce population exposure to dangerous climate-sensitive extreme weather events, reduce disparities in climate-related health outcomes, and advance social equity goals. This mixed-methods study explored the extent to which post-secondary courses and joint degree programs teach students the research methods and technical skills they will need to design and implement built environment interventions addressing the effects of climate change on population health and social equity. The study found that the number of universities offering courses addressing climate, health, and equity in the built environment grew from 2018 to 2022. The number of joint planning/public health degree programs rose from four in 2005 to 15 in 2022. No joint architecture/public health degree programs were identified. A detailed review of 99 course descriptions from three universities found that 17 courses (roughly 1/5 of the total) covered population health, built environment, and climate change; and, 2/3 of the set (n = 60) covered two out of the three topics. Schools of public health were more likely to offer courses covering all three topics, whereas schools of architecture were more likely to include the building scale in relevant courses. Exposure pathways and social equity/vulnerable populations were the most common methods included in relevant courses. Professors and administrators at institutions identified by the study as "transdisciplinary-ready" reported that accreditation requirements and university rules governing the allocation of student tuition had slowed efforts to offer cross-listed courses. However, faculty in these institutions regularly collaborate informally with their peers - both on transdisciplinary research and by offering guest lectures in each other's courses. The results of this study show that, while universities have made great strides over the past 18 years in beginning to support transdisciplinary research and pedagogy, institutional barriers and gaps in key content areas remain.

Advancing health equity through implementation science: Identifying and examining measures of the outer setting

BackgroundImplementation science (IS) could accelerate progress toward achieving health equity goals. However, the lack of attention to the outer setting where interventions are implemented limits applicability and generalizability of findings to different populations, settings, and time periods. We developed a data resource to assess outer setting across seven centers funded by the National Cancer Institute's IS Centers in Cancer Control (ISC3) Network Program. ObjectiveTo describe the development of the Outer Setting Data Resource and characterize the county-level outer context across Centers. MethodsOur Data Resource captures seven key environments, including: (1) food; (2) physical; (3) economic; (4) social; (5) health care; (6) cancer behavioral and screening; and (7) cancer-related policy. Data were obtained from public sources including the US Census and American Community Survey. We present medians and interquartile ranges based on the distribution of all counties in the US, all ISC3 centers, and within each Center for twelve selected measures. Distributions of each factor are compared with the national estimate using single sample sign tests. ResultsISC3 centers’ catchment areas include 458 counties and over 126 million people across 28 states. The median percentage of population living within ½ mile of a park is higher in ISC3 counties (38.0%, interquartile range (IQR): 16.0%–59.0%) compared to nationally (18.0%, IQR: 7.0%–38.0%; p < 0.0001). The median percentage of households with no broadband access is significantly lower in ISC3 counties (28.4%, IQR: 21.4%–35.6%) compared the nation overall (32.8%, IQR: 25.8%–41.2%; p < 0.0001). The median unemployment rate was significantly higher in ISC3 counties (5.2%, IQR: 4.1%–6.4%) compared to nationally (4.9%, 3.6%–6.3%, p = 0.0006). ConclusionsOur results indicate that the outer setting varies across Centers and often differs from the national level. These findings demonstrate the importance of assessing the contextual environment in which interventions are implemented and suggest potential implications for intervention generalizability and scalability.

What we can do to realise our excellence and equity goals in literacy

The research, practice and policy communities in Aotearoa New Zealand know a lot about literacy; the what and how of development, and what works for whom, under what conditions. But two issues stand in the way of better meeting the national excellence and equity goals. One is solving system challenges of variability, scalability, sustainability and capability. Solving this requires taking a life course approach to the evidence, including what optimises enjoyment and criticality from early learning through schooling; and guaranteeing collective clarity and accountability for effective practices. Solving the second, too much selective and limited reasoning about what is needed, requires better understanding our histories of practice and outcomes, and the evidence about these; taking seriously the collective need for evidence-based reasoning; better understanding the nature of the sciences involved; and careful and collective reasoning to understand what is robust evidence and what is inaccurate and misleading. Both issues have implications for capability building through resourcing, initial teacher education, and professional learning and development.