Health Equity Goals Research Articles

Reducing or reproducing inequalities in health? An intersectional policy analysis of how health inequalities are represented in a Swedish bill on alcohol, drugs, tobacco and gambling

BackgroundAccording to post-structural policy analyses, policies and interventions aiming at reducing social inequalities have been found to be part in producing and reifying such inequalities themselves. Given the central role of health inequalities on the public health policy agenda globally it seems important to examine the way policy on health inequalities may potentially counteract the goal of health equity. The aim of this intersectional policy analysis, was to critically analyze the representation of health inequalities in a government bill proposing a national strategy on alcohol, drugs, tobacco and gambling, to examine its performative power, and to outline alternative representations.MethodA post-structural approach to policy analysis was combined with an intersectional framework. The material was analyzed through an interrogating process guided by the six questions of the “What’s the problem represented to be?” (WPR) approach. Thus, the underlying assumptions of the problem representation, its potential implications and historical background were explored. In a final step of the analysis we examined our own problem representations.ResultsThe recommendations found in the gender and equity perspective of the bill represented the problem of health inequalities as a lack of knowledge, with an emphasis on quantitative knowledge about differences in health between population groups. Three underlying assumptions supporting this representation were found: quantification and objectivity, inequalities as unidimensional, and categorization and labelling. The analysis showed how the bill, by opting into these partly overlapping assumptions, is part of enacting a discourse on health inequalities that directs attention to specific subjects (e.g., vulnerable) with special needs (e.g., health care), in certain places (e.g., disadvantaged neighborhoods). It also showed how underlying processes of marginalization are largely neglected in the bill due to its focus on describing differences rather than solutions. Finally, we showed how different intersectional approaches could be used to complement and challenge this, potentially counteractive, problem representation.ConclusionsThe problem representation of health inequalities and its underlying assumptions may have counteractive effects on health equity, and even though some of its strengths are raised, it seems to be profoundly entangled with a system resisting the kind of change that the bill itself advocates for. If carefully used, intersectionality has the potential to support a more comprehensive and inclusive equality-promoting public health policy and practice.

Resisting the Effects of Neoliberalism on Public Policy Comment on "Implementing Universal and Targeted Policies for Health Equity: Lessons From Australia".

Fisher and colleagues carefully review the extent to which health equity goals of availability, affordability, and acceptability have been achieved in the areas of national broadband network policy and land-use policy, in addition to the more traditional areas of primary healthcare and Indigenous health in Australia. They consider the effectiveness of policies identified as either universal, proportionate-universal, targeted or residualist in these areas. In this commentary we suggest future areas of inquiry that can help inform the findings of their excellent study. These include the impacts of Australia being a liberal welfare state and how acceptance of neoliberal approaches to governance makes the achieving of health equity in these four policy areas difficult.

Abstract 1915: Addressing cancer health disparities among US minority populations with patient-derived xenografts

Abstract Despite the tremendous advances in cancer prevention and treatment strategies that have been achieved since the war on cancer plan in the 1970’s, it is clear that not all communities are equally benefiting from such advances and that minority populations nearly always have worse cancer health outcomes. These cancer health disparities are the result of complex interactions between social determinants of health, population-specific cultural behaviors and lifestyles, and unique biological differences that associate with ancestry. Two major limitations to the advancement of precision medicine in minority groups include the lack of: i) race/ethnic appropriate genomic data, which will facilitate identifying priority targets for therapeutic development, and ii) patient-derived models, such as patient-derived xenografts (PDXs) that recapitulate the unique interactions of germline and somatic genetics that exist in minority patients. In this presentation we describe the development of an analytical pipeline to quantify continental genetic ancestry that we have developed for the Cancer Genomics Cloud as part of the PDX Development and Trials Center Research Network (PDXnet). This pipeline leverages a novel reference panel for the program SNPweights, which includes a greater representation of genomic data from Native and Latin American populations than previously published reference panels, and thus provides improved assignment of American continental ancestry. We use this pipeline to characterize the diversity of the PDX models in PDXnet, which represent a manifold increase in models with African and American continental genetic ancestry compared with those available in other public resources. Finally, we present power analyses to demonstrate that additional PDX models derived from patients from minority populations are critically needed to effectively address health equity goals in the US. Citation Format: Brian J. Sanderson, Paul Lott, Anuj Srivastava, PDXNet Consortium, Jeffrey H. Chuang, Luis G. Carvajal-Carmona. Addressing cancer health disparities among US minority populations with patient-derived xenografts [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1915.

Health and healthcare equity in the cancer care sector in Canada: Results of a rapid scoping review.

e18536 Background: Despite advances in research and treatment, and a publicly funded healthcare system in Canada, alarming inequities exist across the cancer continuum. Although attention to these inequities is increasing, it is unclear how organizations are acting upon calls to address health equity. Our objective was to identify how health and healthcare equity are being discussed as a goal or aim within the Canadian cancer care sector. Methods: A rapid scoping review was conducted for published and unpublished literature on health equity in the Canadian cancer care sector. As this review was part of a larger initiative aimed at informing policy recommendations and research priorities with specific time constraints, we also drew on the WHO’s guidance for conduct of rapid reviews to strengthen health policy and systems. Five biomedical databases, 30 public health and multidisciplinary websites and databases, and Google were searched. Documents available in English, published between 2008 and 2021, and that discussed health or healthcare equity in the Canadian cancer context were included. Results: Of 3,678 documents screened, 83 were included for full text analysis. The focus on health equity within the Canadian cancer care sector increased 3-fold between 2015-2021 when compared with the period 2008-2014. Only 25% of documents included a definition of health equity. Concepts such as inequity, inequality, and disparity were frequently used interchangeably or in a tokenistic way, resulting in conceptual muddling. Less than half of documents included an explicit health equity goal. Stated health equity goals ranged from broad to specific, with examples from across the cancer continuum. A range of actions were described to address equity goals, including health system improvements and policy and planning considerations. Most actions were framed as recommendations rather than actions taken or underway, and few documents described measurement of progress toward health equity goals. Conclusions: Health equity is a growing priority in the cancer care sector, however conceptual clarity is needed to guide the development of robust equity goals, specific objectives, and meaningful action. Moreover, evaluation mechanisms to understand the impacts of actions on equity goals are urgently needed. If we are to advance health equity in the cancer care sector, a coordinated and integrated approach will be required to enact transformative and meaningful change.

Urban Climate Justice, Human Health, and Citizen Science in Nairobi’s Informal Settlements

Urban informal settlements or slums are among the most vulnerable places to climate-change-related health risks. Yet, little data exist documenting environmental and human health vulnerabilities in slums or how to move research to action. Citizen science, where residents co-define research objectives with professionals, collect and analyze data, and help translate findings into ameliorative actions, can help fill data gaps and contribute to more locally relevant climate justice interventions. This paper highlights a citizen-science, climate justice planning process in the Mukuru informal settlement of Nairobi, Kenya. We describe how residents, non-governmental organizations and academics partnered to co-create data-gathering processes and generated evidence to inform an integrated, climate justice strategy called the Mukuru Special Planning Area, Integrated Development Plan. The citizen science processes revealed that <1% of residents had access to a private in-home toilet, and 37% lacked regular access to safe and affordable drinking water. We found that 42% of households were subject to regular flooding, 39% reported fair or poor health, and 40% reported a child in the household was stunted. These and other data were used in a community planning process where thousands of residents co-designed improvement and climate change adaptation strategies, such as flood mitigation, formalizing roads and pathways with drainage, and a water and sanitation infrastructure plan for all. We describe the participatory processes used by citizen scientists to generate data and move evidence into immediate actions to protect human health and a draft a long-range, climate justice strategy. The processes used to create the Mukuru Special Planning Area redevelopment plan suggest that participatory, citizen-led urban science can inform local efforts for health equity and global goals of climate justice.

Precision Public Health and Structural Racism in the United States: Promoting Health Equity in the COVID-19 Pandemic Response.

The COVID-19 pandemic has revealed deeply entrenched structural inequalities that resulted in an excess of mortality and morbidity in certain racial and ethnic groups in the United States. Therefore, this paper examines from the US perspective how structural racism and defective data collection on racial and ethnic minorities can negatively influence the development of precision public health (PPH) approaches to tackle the ongoing COVID-19 pandemic. Importantly, the effects of structural and data racism on the development of fair and inclusive data-driven components of PPH interventions are discussed, such as with the use of machine learning algorithms to predict public health risks. The objective of this viewpoint is thus to inform public health policymaking with regard to the development of ethically sound PPH interventions against COVID-19. Particular attention is given to components of structural racism (eg, hospital segregation, implicit and organizational bias, digital divide, and sociopolitical influences) that are likely to hinder such approaches from achieving their social justice and health equity goals.

Promoting Child Health Equity Through Medicaid Innovation.

Black, Latino/a/e, American Indian, and Alaska Native children often receive lower quality health care than White children. As the predominant health insurer for medically underserved populations, Medicaid plays a critical role in advancing socioeconomic and racial health equity. In this article, we focus on structural barriers to health equity in the Medicaid program and potential steps for improving long-standing socioeconomic and racial health inequities through programmatic innovation. We identify opportunities for expanding care models for holistically addressing the social determinants of health, aligning clinical care delivery around health equity principles, diversifying the clinical workforce, and promoting meaningful and consistent provider participation in Medicaid. Practitioners and policy makers can start to undertake many of these steps today to set the stage for more sweeping reforms that can help achieve national health equity goals for children. [Pediatr Ann. 2022;51(3):e118-e122.].

Cultural Humility Meets Antiracism in Nurse Leader Training

Following the tragic killing of George Floyd in May 2020, nurse leaders had the opportunity to take advantage of this national moment of collective reflection by establishing or renewing individual and organizational commitments to racial equity. Nursing at the University of California Davis Health used this unique window of sustained attention to develop a training approach that integrated the concept of cultural humility with antiracism and equipped nurse leaders to confront how the nation’s dysfunctional history of race relations continues to undermine achievement of the goal of health equity. This discussion highlights key pivotal leadership decisions that facilitated cocreation of strategies to advance equity in nursing practice and organizational change.

제5차 국민건강증진종합계획(HP2030)에서의 ‘건강형평성’ 목표: HP2020에 대한 평가와 국외 사례고찰을 바탕으로

Objectives: This study was conducted to enhance our understanding and execution of the National Health Plan 2030 (HP2030) by analyzing its health equity goals, based on an evaluation of the National Health Plan 2020 (HP2020) and international cases. Methods: The degree of change in the health gap based on gender, income, and region of the leading health indicators in HP2020 was analyzed. In addition, the National Health Plans of the United States, China, and Japan were comparatively analyzed from the perspective of health equity. Finally, health equity in the HP2030 was analyzed focusing on vision, basic principles, performance indicators, and target values. Results: Health disparities according to gender, income, and region were observed for all indicators of the HP2020. Moreover, for the United States, China, and Japan, there was a common emphasis on data monitoring, to identify vulnerable groups. Furthermore, they focused on social and national responsibilities for improving health levels and achieving health equity. In the HP2030, it was confirmed that health equity was considered for the entire process of planning, including the selection of vision, basic principles, key projects, performance indicators, and target values. Conclusion: For the success of the HP2030, it is necessary to establish an effective action plan, strengthen the policy feedback function, improve communication and legal systems for linkage and cooperation, and establish a sustainable monitoring system.

Vaccine willingness: Findings from the COVID-19 effects on the mental and physical health of Asian Americans & Pacific Islanders survey study (COMPASS)

Willingness to get the COVID-19 vaccine is crucial to reduce the current strain on healthcare systems and increase herd immunity, but only 71% of the U.S. public said they would get the vaccine. It remains unclear whether Asian Americans and Pacific Islanders (AAPI), a population with existing inequalities in COVID-19 infection and mortality, are willing to get the vaccine, and the factors associated with vaccine willingness.Given this imperative, we used data from a national, cross-sectional, community-based survey called COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), an ongoing survey study that is available in English and Asian languages (i.e., Simplified or Traditional Chinese, Korean, Vietnamese) to examine vaccine willingness among AAPI.A total of 1,646 U.S. adult AAPI participants completed the survey. Self-reported vaccine willingness showed the proportion who were “unsure” or “probably/definitely no” to getting the COVID-19 vaccine was 25.4%. The odds for vaccine willingness were significantly lower for were Native Hawaiians and Pacific Islanders (vs. Asian Americans), Korean Americans (vs. Chinese and Vietnamese Americans), women (vs. men), heterosexuals (vs. non-heterosexuals), those aged 30–39 and 50–59 (vs. aged < 30), and those who reported having any vaccine concerns (vs. no concerns).AAPIs’ willingness to get COVID-19 vaccine varied by groups, which underscores the need for disaggregated AAPI data. A multi-pronged approach in culturally appropriate and tailored health communication and education with AAPI is critical to achieve the goal of health equity for AAPI as it pertains to COVID-19 mortality and morbidity.

The Research Centers in Minority Institutions (RCMI) Consortium: A Blueprint for Inclusive Excellence.

The Research Centers in Minority Institutions, (RCMI) Program was established by Congress to address the health research and training needs of minority populations, by preparing future generations of scientists at these institutions, with a track record of producing minority scholars in medicine, science, and technology. The RCMI Consortium consists of the RCMI Specialized Centers and a Coordinating Center (CC). The RCMI-CC leverages the scientific expertise, technologies, and innovations of RCMI Centers to accelerate the delivery of solutions to address health disparities in communities that are most impacted. There is increasing recognition that the gap in representation of racial/ethnic groups and women is perpetuated by institutional cultures lacking inclusion and equity. The objective of this work is to provide a framework for inclusive excellence by developing a systematic evaluation process with common data elements that can track the inter-linked goals of workforce diversity and health equity. At its core, the RCMI Program embodies the trinity of diversity, equity, and inclusion. We propose a realist evaluation framework and a logic model that integrates the institutional context to develop common data metrics for inclusive excellence. The RCMI-CC will collaborate with NIH-funded institutions and research consortia to disseminate and scale this model.

Congratulations to ARIN: Achieving Our Health Equity Goals Through Teamwork

Congratulations to ARIN: Achieving Our Health Equity Goals Through Teamwork

What are the greatest health challenges facing people who are incarcerated? We need to ask them

What are the greatest health challenges facing people who are incarcerated? We need to ask them

Planning for health equity in the Americas: an analysis of national health plans.

ABSTRACTThere is growing recognition that health and well-being improvements have not been shared across populations in the Americas. This article analyzes 32 national health sector policies, strategies, and plans across 10 different areas of health equity to understand, from one perspective, how equity is being addressed in the region. It finds significant variation in the substance and structure of how the health plans handle the issue. Nearly all countries explicitly include health equity as a clear goal, and most address the social determinants of health. Participatory processes documented in the development of these plans range from none to extensive and robust. Substantive equity-focused policies, such as those to improve physical accessibility of health care and increase affordable access to medicines, are included in many plans, though no country includes all aspects examined. Countries identify marginalized populations in their plans, though only a quarter specifically identify Afro-descendants and more than half do not address Indigenous people, including countries with large Indigenous populations. Four include attention to migrants. Despite health equity goals and data on baseline inequities, fewer than half of countries include time-bound targets on reducing absolute or relative health inequalities. Clear accountability mechanisms such as education, reporting, or rights-enforcement mechanisms in plans are rare. The nearly unanimous commitment across countries of the Americas to equity in health provides an important opportunity. Learning from the most robust equity-focused plans could provide a road map for efforts to translate broad goals into time-bound targets and eventually to increasing equity.

A Renewed Focus on Health Disparities in the Year 2020: Reexamining Geospatial Disparities.

To achieve the ultimate goal of health equity for all people in the United States, new methods are necessary to further understand health disparities in cancer. Geospatial approaches to examine outcomes in cancer control and population sciences in the United States is an area of growing interest, but traditional methods are hindered by the use of a single location at the time of diagnosis. Incorporating residential histories into geospatial analyses overcomes this challenge and is a step forward in improving our understanding of geospatial disparities in cancer outcomes.See related article by Wiese et al., p. 2119.

HEADS-UP: Understanding and Problem-Solving: Seeking Hands-Down Solutions to Major Inequities in Stroke.

There are substantial and longstanding inequities in stroke incidence, prevalence, care, and outcomes. The Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving (HEADS-UP) symposium is an annual multidisciplinary scientific and educational forum targeting major inequities in cerebrovascular disease, with the ultimate objective of helping to bridge major inequities in stroke, and promptly translating scientific results into routine clinical practice, for the benefit of vulnerable and underserved populations. HEADS-UP is a collaborative undertaking by the National Institute of Neurological Disorders and Stroke and the American Stroke Association and is held the day before the annual International Stroke Conference. In 2020, the HEADS-UP focused on the topic of racial/ethnic disparities in stroke and comprised invited lectures on determinants of racial/ethnic inequities in stroke as well as emerging interventions or promising strategies designed to overcome these inequities. Competitively selected travel award scholarships were given to 19 early stage investigators who presented posters at professor moderated sessions; engaged in several career development activities aimed imparting grant writing skills, knowledge about climbing the academic ladder, and striving for work-life balance; and participated in networking events. This Health Equity edition of Focused Updates will feature an overview of the HEADS-UP 2020 symposium proceedings and articles covering the key scientific content of the major lectures delivered during the symposium including the presentation by the award-winning plenary speaker. Starting in 2021, HEADS-UP will expand to include 5 major inequities in stroke (racial/ethnic, sex, geographic, socioeconomic, and global) and seeks to be a viable avenue to meet the health equity goals of the American Heart Association/American Stroke Association, National Institutes of Neurological Disorders and Stroke, and World Stroke Organization.

Gender balance in an unprecedented time

As the NHS responds to the ongoing COVID-19 pandemic, the strain is being felt across the entire workforce. Both direct effects of COVID-19 and the response to the crisis are unearthing a number of societal inequalities, not least, those relating to gender. The fact that women play a disproportionate role in frontline health and social care roles and perform the majority of caregiving responsibilities is more exposed than ever before. Concurrently, the underrepresentation of women in senior clinical and leadership roles is being brought into stark relief. Redressing gender imbalance across health and social care is vital if we are to translate experience and learnings from our frontline workforce into our national preparedness and response effort. It is also important as we continue to promote wider gender and health equity goals within society. While we focus on responding to the current situation, an opportunity arises for greater value to be assigned to frontline health and caregiver roles. We must raise the profile of women leaders who are taking a stand during this crisis and use this opportunity to ensure that our future health and social care leadership reflects the wider workforce and the population.

Sociodemographic Determinants of Life's Simple 7: Implications for Achieving Cardiovascular Health and Health Equity Goals.

Life's Simple 7 (LS7; nutrition, physical activity, cigarette use, body mass index, blood pressure, cholesterol, glucose) predicts cardiovascular health. The principal objective of our study was to define demographic and socioeconomic factors associated with LS7 to better inform programs addressing cardiovascular health and health equity. National Health and Nutrition Examination Surveys 1999-2016 data were analyzed on non-Hispanic White [NHW], NH Black [NHB], and Hispanic adults aged ≥20 years without cardiovascular disease. Each LS7 variable was assigned 0, 1, or 2 points for poor, intermediate, and ideal levels, respectively. Composite LS7 scores were grouped as poor (0-4 points), intermediate (5-9), and ideal (10-14). 32,803 adults were included. Mean composite LS7 scores were below ideal across race/ethnicity groups. After adjusting for confounders, NHBs were less likely to have optimal LS7 scores than NHW (multivariable odds ratios (OR .44; 95% CI .37-.53), whereas Hispanics tended to have better scores (1.18; .96-1.44). Hispanics had more ideal LS7 scores than NHBs, although Hispanics had lower incomes and less education, which were independently associated with fewer ideal LS7 scores. Adults aged ≥45 years were less likely to have ideal LS7 scores (.11; .09-.12) than adults aged <45 years. NHBs were the least likely to have optimal scores, despite higher incomes and more education than Hispanics, consistent with structural racism and Hispanic paradox. Programs to optimize lifestyle should begin in childhood to mitigate precipitous age-related declines in LS7 scores, especially in at-risk groups. Promoting higher education and reducing poverty are also important.

12.K. Workshop: Gender-sensitive and intersectional health monitoring and reporting: putting theory into practice

Abstract Public health monitoring and reporting (PHMR) provides compilations of up-to-date epidemiological data from multiple sources and their interpretation. Health reports are aimed at users in public health policy but should also inform civil society, healthcare professionals, or students. Recently, stakeholders from civil society were increasingly involved in the process of PHMR to identify topics that are relevant for diverse population groups. PHMR inter alia seeks to identify population groups at need of health promotion or healthcare and, thus, to contribute to achieve health equity. High-, middle- and low-income countries alike have developed reporting systems that describe the health of populations according to categories of difference such as sex/gender, race/ethnicity, or socioeconomic status. In the past, most of these reports have focused on single categories and dichotomous presentations. Scholars involved in PHMR have pointed out that health reports focusing on sex/gender should compare disease burden between women and men, display heterogeneity within the groups of women and men, consider the social context and make use of theory to interpret findings in order to be gender-sensitive. We argue that an intersectional framework might be suited to inform gender-sensitive health reporting. Intersectionality posits that categories of difference cannot be thought of independently because systems of power and oppression that create inequalities are mutually constituting and reinforcing. An intersectional perspective, for example, visualises heterogeneity within supposedly homogenous societal groups such as women and men. Moreover, intersectionality was proposed as a ground-breaking theoretical framework for public health because its aim to achieve social justice by considering socio-structural systems of differentiation and subordination and by empowering all parts of society is well in line with the goal of health equity. In this workshop, we aim to discuss implications of intersectionality for the practice of gender-sensitive PHMR. To create a foundation for the panel discussion, we will present a theoretical argument about why PHMR should consider the epistemological and methodological principles of intersectionality, and present suggestions for a gender-sensitive and intersectional practice of PHMR, based on research of the joint project AdvanceGender. AdvanceGender brings together interdisciplinary researchers to translate principles of intersectionality into methods and suggestions for gender-sensitive health reporting and population health research. A panel consisting of members of AdvanceGender and experts in public policy, data analysis and health reporting will draw on research and practice internationally and on a range of methods and applications of intersectionality to research and policy. The panel discussion will focus on the feasibility of suggested methods and applications in PHMR, and their contributions towards health equity. Key messages We will present a theoretical rationale to consider the epistemological and methodological principles of intersectionality in public health monitoring and reporting. A panel will discuss implications of intersectionality for the practice of gender-sensitive public health monitoring and reporting and possible contributions to achieving health equity.

Conceptualizing Ethnicity: How Dimensions of Ethnicity Affect Disparities in Health Outcomes Among Latinxs in the United States.

Using regression methods to analyze data from the 2006 Portraits of American Life Study, we examined how attributional and relational dimensions of ethnicity affect: 1) intragroup differences in Latinx mental and physical health status, as measured by feelings of worthlessness and self-rated health, respectively; and 2) intergroup differences between Latinxs and non-Hispanic Whites in these health outcomes. Latinxs have higher odds of feelings of worthlessness and lower odds of self-reporting good/excellent health compared with non-Hispanic Whites. Additionally, intragroup differences in health are observed among Latinxs, conditioned on attributional or relational dimensions of ethnicity. Multidimensional measures of ethnicity that distinguish between characteristics associated with ethnicity (attributional) or race (relational) offer a nuanced explanation of health disparities by revealing aspects of ethnicity that shape health outcomes differently, contributing to the goals of health equity.