Health Assets Research Articles

Historical trends in health care-related financial holdings among members of Congress.

Revelations that some members of Congress, including members of key health care committees, hold substantial personal investments in the health care industry have raised concerns about lawmakers' financial conflicts of interest (COI) and their potential impact on health care legislation and oversight. 1) To assess historical trends in both the number of legislators holding health care-related assets and the value and composition of those assets. 2) To compare the financial holdings of members of health care-focused committees and subcommittees to those of other members of the House and Senate. We analyzed 11 years of personal financial disclosures by all members of the House and Senate. For each year, we calculated the percentage of members holding a health care-related asset (overall, by party, and by committee); the total value of all assets and health care-related assets held; the mean and median values of assets held per member; and the share of asset values attributable to 9 health asset categories. During the study period, over a third of all members of Congress held health care-related assets. These assets were often substantial, with a median total value per member of over $43,000. Members of health care-focused committees and subcommittees in the House and Senate did not hold health care-related assets at a higher rate than other members of their respective chambers. These findings suggest that lawmakers' health care-related COI warrant the same level of attention that has been paid to the COI of other actors in the health care system.

Multidimensionl Poverty and The Role of Social Capital in Poverty Alleviation Among Ethnic Groups in Rural Vietnam: A Multilevel Analysis.

This paper empirically examines the disparities over time across six dimensions of poverty (monetary, education, health, housing, basic services, and durable assets) between ethnic minority and majority households in rural Vietnam. Using the five-wave panel data of the Vietnam Access to Resources Household Survey (VARHS) 2008–2016, we observe improvements in most non-monetary dimensions of poverty for both ethnic groups, while the monetary dimension shows the highest degrees of deprivation and the lowest rate of decrease during the studied period. Health is the only dimension in which ethnic minority households are not only better off than those of majority households during the studied period, but also report improvement. We further explore the role of social capital in ethnic minorities and non-minorities at household and community levels in multiple dimensions of poverty by employing multilevel models. Our study reports the significant effects social capital have at the community level on reducing poverty in the monetary, education, housing, and basic services dimensions for ethnic minorities, while social capital at the household level shows significant effects on monetary, basic services, and durable assets. These findings indicate that policy makers ought to consider the role of social capital when designing poverty alleviation strategies for the country.

Comparison of pattern of death during Pre-lockdown period and COVID 19 lockdown period in Central Kerala – An Autopsy Study

Background: The coronavirus pandemic is one of the deadliest pandemic in history. The authorities worldwide responded to this pandemic by implementing business closures, travel restrictions, lockdowns and quarantines.
 Aims and Objectives: To determine the type of cases and compare the patterns of deaths which came for autopsy to Department of Forensic Medicine, Government Medical College, Kottayam during the Pre lockdown period in 2019 and COVID-19 Lockdown Period in 2020.
 Materials and Methods: This retrospective study was conducted in the Department of Forensic Medicine, Govt. Medical College, Kottayam. The study data was collected from postmortem reports of Department of Forensic Medicine, Govt. Medical College, Kottayam. Pre-lockdown period was taken as from 21 March to 31 May 2019.There were total 424 cases in 2019,whereas in the Lockdown period taken as from 21 March 2020 to31 May 2020,no: of cases reduced to 270. All these cases were grouped according to cause of death, manner of death and modalities of natural and unnatural deaths. Details of cases were entered utilizing a proforma.
 Results: There were total 424 cases in the pre-lockdown period in the year 2019, whereas in the lockdown period in 2020, number of cases declined to 270. Among the manner of deaths, accidents accounted for most of the deaths in the year 2019, i.e. 44.6% deaths due to accidents, whereas in the year 2020, deaths due to natural diseases topped the list, 46.3%. These differences in the manner of deaths were found statisticallysignificant.
 Conclusion: Two months into lockdown, statistically significant differences were noted in patterns of deaths. Further study should be conducted in the near future, when more data will become available. Providing early warning in patterns of mortality within the community could prove to be an invaluable public health asset.

Prenatal Exposure to Favorable Social and Environmental Neighborhood Conditions Is Associated with Healthy Pregnancy and Infant Outcomes.

Neighborhood and individual level risks commonly co-occur for pregnant women and may cumulatively contribute to birth outcomes. Moreover, the relationship between favorable social and environmental neighborhood conditions and perinatal outcomes has been understudied. This study considered the accumulated impact of prenatal exposure to positive neighborhood social, environmental, and educational conditions in relation to maternal health during pregnancy and birth size outcomes. In a prospective study of a multi-ethnic and socioeconomically diverse cohort (n = 239) of pregnant women and their infants, neighborhoods were characterized by the Child Opportunity Index (COI), a census-tract composite indicator representing favorable social, environmental, and educational community conditions. Adjusted generalized estimating equations showed that favorable neighborhood conditions promoted the growth of longer and heavier infant bodies, and reduced the risk of intrauterine growth restriction. The associations were stronger for female versus male infants, though not significantly different. Moreover, COI was associated with better maternal mental health and diet during pregnancy; diet significantly mediated the association between COI and birth size outcomes. This study underscores the importance of considering the accumulated benefit of neighborhood assets for maternal and infant health. Interventions that capitalizes on the full range of contextual assets in which mothers live may promote pregnancy health and fetal growth.

Dimensions of Community Assets for Health. A Systematised Review and Meta-Synthesis

Since Aaron Antonovsky’s salutogenesis theory and Morgan and Ziglio’s health assets model were first proposed, there has been a growing concern to define the resources available to the individual and the community to maintain or improve health and well-being. The aim of the present study was to identify the dimensions that characterise community assets for health. To this end, we conducted a systematised review with a meta-synthesis and content analysis of research or projects involving asset mapping in the community. Articles that met our eligibility criteria were: (1) based on the salutogenic approach and (2) described an assets mapping process and among their results, explained what, how and why particular community assets for health had been selected. The search included primary studies in the published and grey literature which were selected from websites and electronic databases (Web of Science, MEDLINE, Scopus, EBSCOhost, Dialnet, SciELO). Of the 607 records examined by a single reviewer, 34 were included in the content analysis and 14 in the qualitative synthesis. Using an inductive process, we identified 14 dimensions with 24 categories, for which in-depth literature reviews were then carried out to define specific indicators and items. These dimensions were: utility, intention, previous use, accessibility (“circumstances–opportunity–affordability”), proximity-walkability, connectivity, intelligibility (visibility, transparency), identity (uniqueness, appropriability, attachment), design (configuration, functionality, comfort), safety (objective/subjective), diversity, the dimension of public and private, and sustainability (which includes maintenance, profitability or economic sustainability, environmental sustainability, centrality-participation and equity-inclusiveness).

Childhood Health Assets in a Spanish Neighborhood: Children and Families' Perception.

The health assets (HA; factors or resources that maintain or improves health) approach has hardly been incorporated in occupational therapy, and even less so in research focused on children's perception. The objective of this study was to provide context-specific empirical evidence regarding children and families' perception of childhood HA, paying special attention to the occupational dimension. We used a mixed methods design including qualitative research with 130 children using various techniques (brainstorming, focus groups, thematic drawing, and individual interview) and a descriptive study based on a questionnaire answered by 58 families. Most children related well-being to play occupations and belonging. We observed the influence of gender roles, ethnicity, and other socioeconomic factors in the identification and access to HA. We recommend delving into the relationship between the HA approach and occupational therapy, considering the children's perspective, interculturality, and gender perspectives.

10 STARTUPS TO WATCH 2021: Early-stage companies advance precision medicine by applying AI, clinical genomics, and other new technologies

10 STARTUPS TO WATCH 2021: Early-stage companies advance precision medicine by applying AI, clinical genomics, and other new technologies

Girl-only clubs\u2019 influence on SRH knowledge, HIV risk reduction, and negative SRH outcomes among very young adolescent girls in rural Malawi

BackgroundEarly adolescence is an important period to lay the foundation for positive sexual health development that can overcome sexual and reproductive health (SRH) challenges faced by very young adolescents (VYAs) as they reach puberty and sexual debut. In this study, we explored the following questions: first, what are the experiences of VYA girls on DREAMS’ Go Girl club participation? Second, how does club participation influence the VYAs SRH knowledge to reduce their risk for HIV and negative sexual health outcomes?MethodsThis was a qualitative study in which twenty-three in-depth interviews were conducted with VYA girls aged 12–14 years. These girls were enrolled in girl-only clubs in two rural southern districts in Malawi. The clubs were a part of larger comprehensive HIV prevention project called DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) which provided an evidence-based core package of interventions to VYAs to prevent HIV. Interventions included improved access to key health services, education support, social skills, asset building, and economic strengthening. Narrative inquiry was used to generate first-hand accounts of the girls’ experiences with club participation. Thematic analysis was used to generate themes from the transcribed stories.ResultsSix main themes were generated: 1) reasons for joining the clubs with desire to learn about SRH as a motivation for joining the clubs.; 2) influence on gender norms and roles whereby participants described a change of gender roles and norms at home; 3) influence on child abuse practices whereby participants reported a decline in child abusive practices at home;4) influence on life skills and social networks whereby participants described learning about networking; 5) support to go back to school whereby out-of-school girls described how economic empowerment of their guardians facilitated their return to school; and 6) influence of clubs on SRH knowledge acquisition and behaviours whereby participants described acquiring knowledge on sexual health issues.ConclusionGirls-only HIV and SRH programs coupled with economic empowerment for their families can be effective in keeping VYA girls in school and improving SRH knowledge and health seeking behavior.

Preventing infectious diseases at the community level: an asset ecosystems approach

BackgroundInterlocking planetary health crises can reveal the complex nature of human and environmental interactions and highlight the importance of broader health ecosystems. Reductionist approaches to human health overlook broader systems factors, such as informal economies and environmental factors. However, these systems play an key role in the promotion of health and prevention of infectious diseases such as HIV and malaria. To better understand these factors, we applied a community and health asset ecosystem approach to infectious disease prevention, drawing on systems thinking and asset-based methods. MethodsWe did a systematic review and qualitative synthesis, including English-language literature from community and participatory programmes in low-income and middle-income countries worldwide that were focused on Sustainable Development Goal 3.3, with no date restrictions. We applied a systems-minded, asset-based approach to analysis, to construct a community and health asset ecosystem and understand how community and health systems assets come together to prevent infectious diseases in dynamic, multilevel, and non-linear ways. FindingsWe included eight papers in the final review, which were original qualitative and quantitative research articles and systematic reviews from community-based HIV and malaria prevention interventions. Systems of health assets spanned micro, meso, and macro levels, and were identified across the informal community setting and the formal health system setting. Community assets represented primary (those inherent to the individual or community), secondary (knowledge, technologies, and rules to harness primary resources), and tertiary (higher-level community processes promoting quality and stewardship of local assets) resources. Process factors driving the success of community programmes involved partnerships, engagement, sufficient resource availability, and community leadership. InterpretationBeyond identifying systems of local assets for health, our approach emphasises the process of how these assets are best converted into meaningful outcomes. The community and health asset ecosystem reflects the complex human–environmental interface and sheds light on how individuals or communities can effectively and sustainably place a claim on assets necessary to achieve health. FundingNone.

The Value of Community Health Literacy Assessments: Health Literacy in Maryland.

Community health assessments have typically not measured health literacy at the community level. We developed the Community Health Literacy Assessment (CHLA) framework to describe county and regional health literacy activities, assets, gaps, and opportunities in Maryland. We implemented the CHLA framework in Maryland from January to August 2018. We conducted an environmental scan of Maryland's 24 counties to identify community resources, health indicators, and organizations. We targeted local health improvement coalitions and health departments for interviews in each county. We conducted qualitative interviews to understand what key community organizations throughout Maryland are doing to implement health literacy best practices and policies. We used summative content analysis to review, quantify, and interpret interview data. We conducted 57 interviews with participants from 56 organizations representing all 24 counties in Maryland. We captured data on multiple dimensions of health literacy and identified 3 main themes: health literacy assets and activities, health literacy gaps, and health literacy opportunities. The most cited asset was collecting data to inform health literacy practices, the most cited gap was using jargon with community members, and the most cited opportunity was increasing public awareness of existing health programs through improved outreach and teaching health information-seeking behaviors. A systematic community health literacy assessment is a feasible way to collect a large amount of health literacy data, which can inform strategic planning, determine community interventions, and ultimately lead us toward a health-literate society. We recommend that others replicate the CHLA framework to operationalize health literacy as a health indicator and include it as a community health assessment measure.

An asset-based community development approach to reducing alcohol harm: Exploring barriers and facilitators to community mobilisation at initial implementation stage.

Globally there is a need to engage communities in actions to reduce alcohol harm. This paper reports on the initial implementation phase of an asset-based community development (ABCD) approach to reducing alcohol harm in ten pre-identified areas across Greater Manchester (UK). This qualitative study highlights the experiences of stakeholders responsible for, or engaged in, implementation. Findings show that it is challenging to recruit sufficient volunteers in a specific, small area/community, which may limit the ability to build health assets. Wider policy and organisational factors that should be understood prior to implementing a place-based volunteer-led health promotion programme are also identified.Trial registrationhttps://www.isrctn.com/ISRCTN81942890.

Do Spiritual Health Connections Protect Adolescents When They Are Bullied: A National Study of 12,593 Young Canadians.

It has long been established that bullying has many negative impacts on the mental health of adolescents. Young people who are victimized by bullying may cope by drawing on available assets to protect themselves from harm. One such asset with ancient roots but with the potential for contemporary application is the concept of spiritual health—the idea that the connections in our lives (whether to ourselves, others, nature, or something transcendent) affect our well-being. In this study, we examined 12,593 Canadians aged 11–15 years to determine the effects of being victimized by bullying on their mental health, as measured by frequent subjective health complaints. We then explored whether strong spiritual health connections were effect modifiers that buffer such negative pathways, thereby acting as protective health assets. Data were obtained from the 2017/18 Canadian Health Behaviour in School-aged Children study. Generalized linear regression models were used to estimate associations and evaluate effect modification in different age and gender groups. Approximately 21% of participants reported being victimized by bullying. Strength of “connections to self” (i.e., a sense of meaning/purpose or joy and happiness in one’s life) was found to act as an effect modifier, but in girls alone. Contrary to expectations of a buffering effect, the strongest associations between victimization and frequent health complaints were identified for girls with high connections to self. Relative risks for poor mental health among these highly self-connected girls were 1.63 [95% CI: 1.26–2.12] and 1.25 [1.06–1.47] for younger and older girls, respectively. We interpreted this unexpected finding in light of cognitive theories of trauma, which suggest that adverse events may lead to worse health outcomes among those who place particular value on their world being meaningful, controllable or benevolent. Implications for clinical intervention and health promotion are considered.

Faith Communities as a Social Immune System: Recommendations for COVID-19 Response and Recovery

This article describes how faith communities often function like an organic social immune system during times of crisis, particularly our current COVID-19 pandemic. We share the strengths of faith communities pertaining to healthcare and public health, as well as name the religious health assets with which faith communities and other health partnerships have to work. These religious health assets have helped the Centers for Disease Control and Prevention (CDC), as well as World Health Organization (WHO) and the National Academies of Science (NAS), imagine substantive and sustained partnerships in diverse contexts across many presenting conditions. We share how COVID-19 has affected these faith assets and offer a case study in how the Leading Causes of Life (LCL) and Positive Deviance (PD) frameworks have been implemented in faith partnerships to impact health and racial disparities in the past and now, during the pandemic. We offer recommendations on how the CDC might frame a comprehensive recovery strategy, including faith-based assets in an appropriate and sustained manner to move us towards health and well-being, focusing on leadership capacity of both faith and health domains. Finally, we suggest what not to do as part of a COVID-19 response and recovery in these partnerships.

Hacia el buen gobierno por la salud: incorporación de la diversidad de percepciones en salud urbana

ObjectiveTo analyse the similarities and differences in the discourse surrounding the conceptualisation of health and the perceived health assets and needs in the neighborhoods and city of Bilbao in a participatory process. MethodParticipatory workshops were held with professionals, neighbors and associated citizens. The differences in perceptions of the three content blocks were analysed on the basis of the health model referred, as well as the typologies —of a more individual or structural nature— of identified health needs and assets. ResultsThe conceptualisation of health from a biopsychosocial perspective was clearer among professionals, although both profiles pointed to the importance of its social determinants. The formulation of needs and assets in health by the neighbors was made from the impact on their daily life and from a position of users with respect to a service provider administration. Among the associated citizens and professionals, intermediate and structural determinants were more frequently mentioned, as well as issues related to the administration's scope of action. ConclusionsThe inclusion of the multiplicity and diversity of perceptions in planning is key to good local government for health. To address their contradictions, a commitment by governments to effectively incorporate citizen participation is needed.

IACUC and Veterinary Considerations for Review of ABSL3 and ABSL4 Research Protocols.

With the recent upswing of infectious disease outbreaks (coronavirus, influenza, Ebola, etc), there is an ever-increasing need for biocontainment animal use protocols to better address the research of emerging diseases and to increase the health of both animals and humans. It is imperative that we as a research community ensure these protocols are conducted with the utmost scrutiny and regulatory compliance for the welfare of the animals as well as the health and safety concerns of the individual conducting these studies. Both the welfare of the animals and the health and safety of the research staff must be balanced with the integrity of the science being studied. Even prior to reviewing biocontainment protocols, the research stakeholders should have professional and collegial interactions across all levels of the proposed project. These stakeholders should include the attending veterinarian, the principal investigator, the sponsor, and any organic institutional health and safety assets (environmental health and safety, occupational health, biosafety personnel, medical personnel, facilities operations and maintenance, etc). At most institutions, these stakeholders are members of the Institutional Animal Care and Use Committee and may not possess the necessary tools to properly assess an Animal Biosafety Level 3 and 4 animal use protocol. It is the goal of this article to review some basic concepts of biocontainment, discuss critical communications and preapprovals, clinical observations, medical interventions and supportive care, scientific and study endpoints, euthanasia criteria, animal manipulations, documentation, training, emergency response and contingency plans, security, and decontamination and provide a scenario-based and informative thought-provoking process Institutional Animal Care and Use Committee members and veterinary staff may consider during Animal Biosafety Level 3 and 4 protocol review. These topics will enhance the ability of all stakeholders to balance the protection of the people with the integrity of the science and ultimately the welfare of the animal.

Les habilitats per a la vida com a estratègia pedagògica de salut

<p>En aquest article les autores ens presenten l’enfocament dels determinants socials de la salut, juntament amb la mirada salutogènica i el treball de les habilitats per a la vida per a entendre millor el recorregut vital i emocional dels joves en contextos de migració, fugint de visions estereotipades i paternalistes. Les autores consideren clau que s’ofereixin espais als infants i joves per desenvolupar les seves habilitats per a la vida, que són aquelles competències necessàries per assolir un comportament adaptatiu que els permeti afrontar efectivament les demandes i els desafiaments de la vida diària. Argumenten també que una recerca recent duta a terme amb infants i joves migrats sense referents adults a Irlanda, constatava que la idea de continuïtat i de donar un sentit a les seves vides els ajudava, en la majoria dels casos, en els seus processos identitaris personals i els ajudava a augmentar la seva resiliència. D’aquí el valor que donen al treball de les 10 habilitats per a la vida i a l’enfortiment del Sentit de Coherència. Finalment les autores presenten de quina manera treballen aquestes habilitats, posant com a exemple el programa “Sigues tu, eines i actius per a la salut” de Dipsalut.</p>

COVID-19 pandemic in Djibouti: Epidemiology and the response strategy followed to contain the virus during the first two months, 17 March to 16 May 2020.

First cases of COVID-19 were reported from Wuhan, China, in December 2019, and it progressed rapidly. On 30 January, WHO declared the new disease as a PHEIC, then as a Pandemic on 11 March. By mid-March, the virus spread widely; Djibouti was not spared and was hit by the pandemic with the first case detected on 17 March. Djibouti worked with WHO and other partners to develop a preparedness and response plan, and implemented a series of intervention measures. MoH together with its civilian and military partners, closely followed WHO recommended strategy based on four pillars: testing, isolating, early case management, and contact tracing. From 17 March to 16 May, Djibouti performed the highest per capita tests in Africa and isolated, treated and traced the contacts of each positive case, which allowed for a rapid control of the epidemic. COVID-19 data included in this study was collected through MoH Djibouti during the period from 17 March to 16 May 2020. A total of 1,401 confirmed cases of COVID-19 were included in the study with 4 related deaths (CFR: 0.3%) and an attack rate of 0.15%. Males represented (68.4%) of the cases, with the age group 31–45 years old (34.2%) as the most affected. Djibouti conducted 17,532 tests, and was considered as a champion for COVID-19 testing in Africa with 18.2 tests per 1000 habitant. All positive cases were isolated, treated and had their contacts traced, which led to early and proactive diagnosis of cases and in turn yielded up to 95–98% asymptomatic cases. Recoveries reached 69% of the infected cases with R0 (0.91). The virus was detected in 4 regions in the country, with the highest percentage in the capital (83%). Djibouti responded to COVID-19 pandemic following an efficient and effective strategy, using a strong collaboration between civilian and military health assets that increased the response capacities of the country. Partnership, coordination, solidarity, proactivity and commitment were the pillars to confront COVID-19 pandemic.

Connecting Faith and Health: Improving Health Outcomes Through Congregant Networks

Background and Hypothesis: People living in areas of high social vulnerability face health disparities in part due to disconnection. Health institutions recognize the importance of treating whole persons but are disconnected from local knowledge of community health assets and social and cultural barriers. People in health-challenged neighborhoods may experience disconnection and distrust in seeking the many resources and services needed for good health. Congregations are longstanding anchor institutions in marginalized communities. They build trusted relationships among members through shared values and care for wellness. Sometimes they extend these connections through on-the-ground service to neighboring communities. We hypothesize that a network of congregations can build trusted connections and share local knowledge and cultural competence to improve health outcomes and holistic wellness in vulnerable neighborhoods. 
 
 Methods: Community-engaged participatory research requires reciprocity in mapping assets, identifying priorities, narrating shared values, designing projects and messaging results. We developed mixed-methods tools to ensure community expertise drives an iterative research process. Methods include: an initial health and wellness survey, follow-up wellness interviews to collect stories and assets, an online learning community for 14 congregations with monthly focus groups, and visual maps of health data and wellness assets. 
 
 Results: While the study is ongoing, preliminary survey data demonstrates that congregations have local knowledge of issues affecting health and wellness among their congregants and the surrounding neighborhood. Their preexisting support for health and wellness through community outreach programs indicates building on their current network could expand their reach and improve health and wellness in vulnerable neighborhoods. 
 
 Conclusion and Potential Impact: Successful community engaged research prioritizes iterative methods that allow community participants to use their voice and tell their stories. 
 Congregations' practice of shared values and knowledge of lived experience can forge connections for greater resilience and health supports in socially vulnerable communities.

Developing a definition of spiritual health for Canadian young people: a qualitative study

ABSTRACT While the spiritual dimensions of health are often tangentially recognized in the health sciences, minimal direction is given as to what spiritual health is, or to what it means to policy or practice. In Canada, this lack of understanding is problematic because despite strong evidence suggesting that spiritual health can operate as a protective health asset in the lives of young people, it is difficult to create effective health promotion strategies for supporting spiritual health without clear definitional agreement. Guided by interpretive description as a methodological orientation, I conducted a qualitative study (n=74) with the goal of developing a definition of spiritual health that would have practical value for Canadian young people and could be used to support the optimization of their health. Data were generated through focus groups and interviews. Results yielded a child-informed definition that provides a clear starting place for operationalizing spiritual health in health-related contexts.

Exploring Community Mental Health Systems - A Participatory Health Needs and Assets Assessment in the Yamuna Valley, North India.

Background: In India and global mental health, a key component of the care gap for people with mental health problems is poor system engagement with the contexts and priorities of community members. This study aimed to explore the nature of community mental health systems by conducting a participatory community assessment of the assets and needs for mental health in Uttarkashi, a remote district in North India. Methods: The data collection and analysis process were emergent, iterative, dialogic and participatory. Transcripts of 28 in-depth interviews (IDIs) with key informants such as traditional healers, people with lived experience and doctors at the government health centres (CHCs), as well as 10 participatory rural appraisal (PRA) meetings with 120 people in community and public health systems, were thematically analysed. The 753 codes were grouped into 93 categories and ultimately nine themes and three meta-themes (place, people, practices), paying attention to equity. Results: Yamuna valley was described as both ‘blessed’ and limited by geography, with bountiful natural resources enhancing mental health, yet remoteness limiting access to care. The people described strong norms of social support, yet hierarchical with entrenched exclusions related to caste and gender, and social conformity that limited social accountability of services. Care practices were porous, pluralist and fragmented, with operational primary care services that acknowledged traditional care providers, and trusted resources for mental health such as traditional healers (malis) and government health workers (accredited social health activists. ASHAs). Yet care was often absent or limited by being experienced as disrespectful or of low quality. Conclusion: Findings support the value of participatory methods, and policy actions that address power relations as well as social determinants within community and public health systems. To improve mental health in this remote setting and other South Asian rural locations, community and public health systems must dialogue with the local context, assets and priorities and be socially accountable.