Health Equity Approach Research Articles

Best practice in COPD care: a health equity approach

There is a strong evidence base for the best care in chronic obstructive pulmonary disease (COPD) as outlined by the National Institute for Health and Care Excellence in its five fundamentals of COPD care: offer treatment and support to stop smoking; offer pneumococcal and influenza vaccinations; offer pulmonary rehabilitation if indicated; codevelop a personalised self-management plan; and optimise treatment for comorbidities. However, only a minority of those living with COPD receive or engage with all five interventions, with clear implications for outcomes. Further, barriers which prevent people who live with COPD accessing necessary care are unequally experienced. In order to overcome many of these barriers, clinicians caring for people with COPD must prioritise personalised treatment and continuity of care.

Variability in public health programming and priorities to address health inequities across public health units in Ontario, Canada.

In 2018, Ontario Public Health Standards were updated to include the foundational Health Equity Standard to guide planning, implementation, and evaluation of public health programs and services. Public health units (PHUs), the regional public health bodies, are now required to address health equity through four requirements: (a) Assessing and Reporting; (b) Modifying and Orienting Public Health Interventions; (c) Engaging in Multi-sectoral Collaboration; and (d) Health Equity Analysis, Policy Development, and Advancing Healthy Public Policies. This qualitative descriptive study explored how the 27 participating PHUs (out of 34) serving urban (N = 10), mixed urban-rural (N = 15), and rural (N = 9) populations addressed the Health Equity Standard. Using document analysis, we inductively and deductively coded the content of 68 PHU Annual Service Plan and Budget Submissions from a 3-year period (2018-2020) received from the 27 PHUs. Emergent categories were organized into the four requirements and one additional emergent theme: Organizational Implementation of Health Equity. The approaches of embedding health equity into PHUs' activities varied across groups. Urban PHUs presented more diverse strategies, including working with a larger number of organizations, and participating in academic research projects. We found more process standardization and greater discussion of capacity building in urban and mixed urban-rural PHUs. Rural PHUs strategically addressed the needs of their diverse populations through relationship building with Indigenous communities. Findings suggest broad implementation of health equity approaches in public health independent of PHUs' geographic size and population dispersion, though strategies and key challenges differ across units.

Examining How the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model Improves Health Equity for Underserved Communities and Safety Net Hospitals in New York State.

Safety net hospitals (SNHs) are essential to our healthcare ecosystem, providing quality healthcare to underserved communities. These institutions offer specialized services and acute medical care to populations facing structural or systemic healthcare barriers. However, for decades, the NYS Medicaid program reimbursed hospitals less than the cost of care, resulting in several independent SNHs becoming financially distressed, with many facing closure. Recently, the Center for Medicaid and Medicare Service Innovation Center (CMSI) introduced the State All-Payer Health Equity Approaches and Development (AHEAD) Model, which aims to support the financial needs of providers while also addressing the complex medical and social circumstances of underserved communities. This article will explore how the AHEAD model can be utilized as an alternative payment method for SNHs in New York State (NYS) to improve healthcare for underserved communities.

Strategies and indicators to integrate health equity in health service and delivery systems in high-income countries: a scoping review.

The objective of this review was to describe how health service and delivery systems in high-income countries define and operationalize health equity. A secondary objective was to identify implementation strategies and indicators being used to integrate and measure health equity. To improve the health of populations, a population health and health equity approach is needed. To date, most work on health equity integration has focused on reducing health inequities within public health, health care delivery, or providers within a health system, but less is known about integration across the health service and delivery system. This review included academic and gray literature sources that described the definitions, frameworks, level of integration, strategies, and indicators that health service and delivery systems in high-income countries have used to describe, integrate, and/or measure health equity. Sources were excluded if they were not available in English (or a translation was not available), were published before 1986, focused on strategies that were not implemented, did not provide health equity indicators, or featured strategies that were implemented outside the health service or delivery systems (eg, community-based strategies). This review was conducted in accordance with the JBI methodology for scoping reviews. Titles and abstracts were screened for eligibility followed by a full-text review to determine inclusion. The information extracted from the included studies consisted of study design and key findings, such as health equity definitions, strategies, frameworks, level of integration, and indicators. Most data were quantitatively tabulated and presented according to 5 secondary review questions. Some findings (eg, definitions and indicators) were summarized using qualitative methods. Most findings were visually presented in charts and diagrams or presented in tabular format. Following review of 16,297 titles and abstracts and 824 full-text sources, we included 122 sources (108 scholarly and 14 gray literature) in this scoping review. We found that health equity was inconsistently defined and operationalized. Only 17 sources included definitions of health equity, and we found that both indicators and strategies lacked adequate descriptions. The use of health equity frameworks was limited and, where present, there was little consistency or agreement in their use. We found that strategies were often specific to programs, services, or clinics, rather than broadly applied across health service and delivery systems. Our findings suggest that strategies to advance health equity work are siloed within health service and delivery systems, and are not currently being implemented system-wide (ie, across all health settings). Healthy equity definitions and frameworks are varied in the included sources, and indicators for health equity are variable and inconsistently measured. Health equity integration needs to be prioritized within and across health service and delivery systems. There is also a need for system-wide strategies to promote health equity, alongside robust accountability mechanisms for measuring health equity. This is necessary to ensure that an integrated, whole-system approach can be consistently applied in health service and delivery systems internationally. DalSpace dalspace.library.dal.ca/handle/10222/80835.

Adapting to changing risk environments: examining overdose risk and socio-spatial patterns of unstably housed people who use drugs during converging public health crises

Background The COVID-19 pandemic exacerbated the US overdose crisis and disproportionately impacted unstably housed people who use drugs. Measures to address the pandemic within the context of crisis produced differential effects, particularly among people who use drugs. Examining how unstably housed people who use drugs adapted to shifting risk environments is imperative to responding to future crises. Methods Rapid ethnographic data was collected from June 2020 to April 2021 in Rhode Island. Data include in-depth interviews with 39 unstably housed people who use drugs and approximately 50 hours of fieldwork. Findings COVID-related service disruptions and policing of public space (e.g. city curfews) reinforced participants’ marginality and increased surveillance. This heightened visibility disrupted participants’ socio-spatial patterns as they were regularly relocated and faced increased risk of arrest due to public drug use and housing instability. Participants regularly weighed overdose risk reduction against COVID-19 exposure and risk of arrest, which increased harm. Conclusion Findings demonstrate how COVID-related public health measures intersected with participants’ socio-spatial and drug use patterns in ways that increased overdose risk. Drawing on health equity approaches when responding to crisis situations is critical to address intersecting inequities faced by unstably housed people who use drugs.

Supporting Jjajjas Using a Health Equity Approach: A Scoping Review of the Impact of HIV/AIDS on the Health and Well-being of Grandparents in Sub-Saharan Africa

Supporting Jjajjas Using a Health Equity Approach: A Scoping Review of the Impact of HIV/AIDS on the Health and Well-being of Grandparents in Sub-Saharan Africa

States Advancing All‐Payer Health Equity Approaches and Development Model (CMS)

States Advancing All‐Payer Health Equity Approaches and Development Model (CMS)

Sexual and reproductive health among adolescents in vulnerable contexts in Mexico: Needs, knowledge, and rights.

Ensuring sexual and reproductive health, and rights for adolescents entails the prevention of early pregnancies, which are widely recognized as a public health problem. Based on the ecological model for early pregnancy, this article identifies the healthcare requirements for preventing unintended adolescent pregnancies in predominantly indigenous communities in Chiapas, Mexico. Using a convergent parallel mixed-methods study design, we surveyed adolescents (12-15 years old) and health personnel, organized focus groups with adolescents and their parents, and conducted in-depth interviews at the individual, family, school and community levels. Results showed that adolescents recognized their right to receive sexuality education (64.5%) as well as information on contraceptive methods (53.0%), with indigenous language speakers and individuals living in overcrowded households less likely to know about these rights. Parents of adolescents knew little about contraception and pregnancy. School teachers lacked necessary tools for offering comprehensive sexuality education. A traditional, patriarchal perspective predominated among participants, fostering gender inequalities. In conclusion, it is essential to implement multifocal strategies under a human-rights, intercultural, and health-equity approach. Special attention should be directed to the spheres in which adolescents interact, and efforts should focus on improving knowledge, empowering adolescents, and enhancing their access to sexual and reproductive health resources.

Do social vulnerability indices correlate with extreme heat health outcomes?

Introduction. Several frameworks exist to measure vulnerability to extreme heat events using a health equity approach, but little evidence validates these measures and their applications. We investigated the degree to which social vulnerability measures and their constituent elements correlate with excess emergency room visits as an outcome measure. Methods. The relationship between six commonly used social vulnerability indicators and measured excess emergency room visit rates (processed by including heat-related illnesses and all-internal causes diagnosis, with considerations for age and heat days) was tested through geospatial analytics and statistical regressions, for both California and Los Angeles County. Results. The vulnerability indicators and the outcome measure were significantly positively associated at the census tract-level but weaker (∼0.2 rs) at the scale of California and stronger (∼0.6 rs) at the scale of Los Angeles County. Hazard-specific vulnerability indicators showed stronger relationships with outcome measures regardless of scale. A Poisson regression model showed a significant inter-county variation, indicating the importance of localized assessments for equitable environmental policies. Conclusion. The findings identify communities that are overburdened by heat and pollution and highlight the need for use of both social vulnerability and indicators of adverse outcomes from excessive heat. Patterns are found across all measures that suggest that populations facing accessibility barriers may be less likely to visit emergency rooms. This suggestion needs to be tested in other environmental settings to draw broader conclusions but has direct implications for environmental scientists and mitigation planners who use these methods.

The community engagement course and action network: strengthening community and academic research partnerships to advance health equity.

Historically Black Colleges and Universities and Minority Serving Institutions are uniquely positioned to implement community-campus research partnerships based on a history of service, the pursuit of community trustworthiness and student demographics often similar to surrounding marginalized communities. The Morehouse School of Medicine Prevention Research Center collaborates with members of Historically Black Colleges and Universities, Minority Serving Institutes, and community organizations on the Community Engaged Course and Action Network. This network is the first of its kind and aims to strengthen members' ability to implement Community-Based Participatory Research (CBPR) principles and partnerships. Projects address public health priorities including mental health among communities of color, zoonotic disease prevention, and urban food deserts. To assess the effectiveness of the network, a Participatory Evaluation framework was implemented to conduct process evaluation which included review of partnership structures, operations, project implementation processes, and preliminary outcomes of the research collaborations. A focus group of Community Engagement Course and Action Network members (community and academic) was also conducted to identify benefits and challenges of the network with emphasis on key areas for improvement to further enhance the relationships between partners and to facilitate their subsequent community-campus research. Network improvements were tied to themes strengthening community-academic partnerships including sharing and fellowship, coalition building and collaboration, and greater connections and awareness of community needs through their current community-academic partnerships. The need to conduct ongoing evaluation during and after implementation, for determining the early adoption of CBPR approaches was also identified. Evaluation of the network's processes, infrastructure, and operation provides early lessons learned to strengthen the network. Ongoing assessment is also essential for ensuring continuous quality improvement across partnerships such as determining CBPR fidelity, assessing partnership synergy, and dynamics, and for quality improvement of research protocol. The implications and potential for advancing implementation science through this and similar networks are great towards advancing leadership in modeling how foundations in community service can advance to CBPR partnership formation and ultimately, health equity approaches, that are local defined and assessed.

Preliminary Program Guide: Sunday, May 21, 2023

Preliminary Program Guide: Sunday, May 21, 2023

Association between frailty, chronic conditions and socioeconomic status in community-dwelling older adults attending primary care: a cross-sectional study using practice-based research network data

ObjectivesFrailty is a multidimensional syndrome of loss of reserves in energy, physical ability, cognition and general health. Primary care is key in preventing and managing frailty, mindful of the social...

Providers’ Perspectives on Women’s Healthcare Disparities and Barriers

ABSTRACT Women face persistent disparities in healthcare quality, access to care, and treatment rates and outcomes, with women from marginalized identities facing greater difficulties. Little is known about providers’ understanding of these disparities, despite the vital role they play. This qualitative study explored interdisciplinary providers’ (psychologists and primary care physicians) perceptions of healthcare disparities and challenges across marginalized groups of women (women of color, women with disabilities, and women from low SES, elderly, and LGBTQ backgrounds). Providers frequently focused on individual patient barriers over systemic and relational barriers. Narratives varied by provider type and when discussing different groups of women. Continued provider training and health equity approaches are needed to combat healthcare disparities for diverse women.

Distracted and Impaired Driving Among U.S. Adolescents, 2019, USA.

Distracted driving, the act of focusing on something else while operating a vehicle, is a significant health problem among adolescents. Although some studies have reported on prevalence among adolescents in the United States, limited studies have examined differences by sexual identity status. The purpose of the present study was to examine past 30-day distracted driving by sexual identity status among a large, national sample of adolescents ages 14 to 18 years. A secondary analysis was conducted on the 2019 Youth Risk Behavioral Surveillance System (YRBSS) data, and associations between distracted driving and demographics (e.g., biological sex, age, race/ethnicity) were assessed with weighted logistic regression analyses. A total of 13,590 adolescents ages 14 to 18 years were part of the final analytic sample. Twenty-three percent of adolescents reported distracted driving in the past 30 days. Compared with heterosexual adolescents, gay/lesbian (14.3%), bisexual (18.1%), and questioning (12.9%) adolescents reported lower distracted driving in the past 30 days. Findings through a health equity approach may inform harm reduction efforts and behavioral interventions.

A Health Equity Approach for Implementation of JYNNEOS Vaccination at Large, Community-Based LGBTQIA+ Events - Georgia, August 27-September 5, 2022.

Gay, bisexual, and other men who have sex with men (MSM) have been disproportionately affected during the 2022 U.S. monkeypox outbreak, with Black or African American (Black) MSM being the most affected demographic group (1). As of September 28, 2022, Georgia had reported 1,784 monkeypox cases; 98% of which occurred in males and 77% among Black persons (2). As of September 13, 2022, 60% of reported cases were among persons with HIV infection, and 50% of persons with monkeypox had a sexually transmitted infection within the past year (3). Because of racial disparities in the incidence of monkeypox cases and a large proportion of cases among MSM in Georgia, early vaccination beginning in July focused on improving equitable access by establishing new and leveraging existing partnerships with community-based organizations that serve affected populations, including persons with HIV infection. Despite these efforts, disparities persisted because of high demand and limited vaccine supply. The Georgia Department of Public Health (DPH) requested CDC support for a vaccine pilot and received an additional allocation of 5,500 doses of JYNNEOS vaccine for administration at events leading up to and throughout a Black gay Pride festival in Atlanta, a multiday event held Labor Day weekend (September 2-5, 2022). The event celebrates lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other (LGBTQIA+) communities of color and hosts more than 125,000 attendees each year. Before the festival (as of August 24), 17,546 persons had been vaccinated in Georgia, of whom 96% were male, 34% aged 25-36 years, 44% Black, and 8% Hispanic or Latino (Hispanic) (4).

A Health Equity-Oriented Research Agenda Requires Comprehensive Community Engagement.

Health policy and research communities have taken new approaches to addressing health equity, going beyond traditional methods that often excluded the contributions of health care consumers and persons with lived experience. This reevaluation has the potential to drive critical improvements in how we conduct research and innovate policy toward reducing health and health care disparities in the United States. Such considerations have led Fountain House, the founder of the Clubhouse model for peer-based psychosocial rehabilitation for persons with histories of serious mental illness, to incorporate community-based participatory action research (CBPAR) protocols within their research and service programs. The combination of CBPAR research methods within novel participatory care settings like Clubhouse programs presents unique and informative opportunities for the advancement of innovative health equity approaches to consumer empowerment in health care. In this piece, the authors (two staff researchers and one member researcher) propose how CBPAR research methods conducted in Clubhouses can uniquely advance equity-focused research methods, and how the benefit and enhancements from equity-focused research are continuously applied, practiced, and accountable to the communities within which the research is conducted. Embedding CBPAR practices within participatory care settings like Clubhouses, creates novel opportunities for research work to not only become more equitable but also become a part of the rehabilitative process, empowering the main beneficiaries of the research with the means to sustain and achieve further improvements for themselves. Such experiences are particularly important within rehabilitation settings, where there is a process of reclaiming empowerment and self-efficacy over a disability or illness and the social circumstances surrounding those conditions. Different stakeholders can all play important roles in advancing health equity–oriented research agendas by leveraging CBPAR principles. Academics and others in the research community can more comprehensively embed CBPAR methods into the design of their research studies. A critical link exists among how researchers conduct their studies, how providers organize care delivery and support, and how health plans pay for and evaluate care. CBPAR-generated research needs to fully engage clinical teams to ensure that ongoing community-involved care settings have direct applications to real-world care delivery. It is equally important that providers fully engage with their communities as they adjust their approaches to supporting the populations they serve.

Health equity guiding frameworks and indices in injury: A review of the literature

Background: In early 2021, CDC released the CORE Health Equity Strategy, which resolves to integrate a comprehensive health equity approach to the work of the Agency. One priority of the Injury Center’s Division of Injury Prevention is to move health equity research in injury forward. The purpose of this research is to perform an initial exploration of health equity guiding frameworks and indices to better understand which of these has been applied to injury research topics. Methods: A PubMed and CINAHL search of meta-analysis and systematic review articles was conducted from January 1998 through April 2022. Articles of any type and additional frameworks/indices were also identified from staff knowledge of the literature. Books were also considered, where accessible. The following areas were reviewed for each resource: population addressed, guiding framework/index, other health equity variables, gaps identified, and whether the articles addressed an injury topic. Findings: The PubMed/CINAHL search produced 230 articles, and an additional 29 articles and 8 books were added from previous knowledge of the literature, resulting in a total of 267 resources for review. There were 60 frameworks/indices compiled that were relevant to health equity. Out of all the resources, three reported on an injury topic and used the PROGRESS-Plus framework, the WHO Social Determinants of Health Conceptual Framework, and a social-ecological framework. Conclusions: This study found there were many frameworks/indices for measuring health equity; however, there were few injury-related meta-analysis and systematic review articles. Some frameworks/indices may be more appropriate than others for measuring health equity in injury topic areas, depending on which social determinants of health (SDOHs) they address. Practical Applications: Measuring health equity in injury and other public health research areas can help build a foundation of evidence. Moving forward, injury researchers can consider the frameworks/indices identified through this study in their health equity injury research.

146 Health equity approach to statewide outreach to under-resourced communities during COVID

OBJECTIVES/GOALS: Despite a disproportionate impact of COVID-19 on minority and under-resourced communities, nearly all COVID-19 resources have only been online in English. A statewide coalition of community and academic partners used community-engaged strategies to provide tailored outreach to diverse populations. METHODS/STUDY POPULATION: The STOP COVID-19 CA statewide team had a workgroup focused on communications. Members of this group represented different sectors, racial/ethnic groups, disciplines, and regions across the state. They had regular meetings to discuss and strategize how to overcome the impact of historic and structural racism on access to COVID-19 resources, including testing, vaccines, and protective equipment. The team also shared regular updates about changes in community concerns and needs as well as new, tailored resources. RESULTS/ANTICIPATED RESULTS: Together, the team has been able to reach diverse populations across the state, including providing information about COVID-19 in multiple languages and formats, from radio to virtual town halls to local health fairs. The multiple sites also increased access to vaccines and testing through trusted community leaders and locations, including church-based locations to bringing vaccines and testing directly to workplaces. These community pop-up vaccination sites have helped to vaccinate large numbers of diverse populations, some of whom were initially unsure about getting the vaccine, which has helped to reduce the gaps in community vaccination rates by race/ethnicity. DISCUSSION/SIGNIFICANCE: This network of community-engaged strategies utilized for rapid COVID-19 response could also be used to for responses to future public health emergencies, addressing chronic diseases (e.g., diabetes, hypertension), or even other complex issues that affect society and health (e.g., climate change).

Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S.

Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition and is a critical tool in the Ending the HIV Epidemic in the U.S. initiative. However, major racial and ethnic disparities across the pre-exposure prophylaxis continuum, secondary to structural inequities and systemic racism, threaten progress. Many barriers, operating at the individual, network, healthcare, and structural levels, impede PrEP access and uptake within Black and Hispanic/Latino communities. This review provides an overview of those barriers and the innovative and collaborative solutions that health departments, healthcare organizations, and community partners have implemented to increase PrEP provision and uptake among disproportionately affected communities. Promising strategies at the individual and network levels focus on increasing patient support throughout the PrEP continuum, positioning and training community members to expand knowledge of and interest in PrEP, and leveraging mobile technologies to support PrEP uptake. Healthcare-level solutions include expanding the venues and types of healthcare professionals that can provide PrEP, and structural- and policy-level options focus on financial assistance programs and health insurance expansion. Key research gaps include demonstrating that pilot studies and interventions remain effective at scale and across varied contexts. Although the last 2 decades have provided effective tools to end the HIV epidemic, realizing this vision for the U.S. will require addressing persistent and pervasive HIV-related disparities in Black and Hispanic/Latino communities. Federal, state, and local partners should expand efforts to address longstanding health and structural inequities and partner with disproportionately affected communities to rapidly expand PrEP scale-up.

Developing State Health Improvement Plans: Exploring States' Use of Healthy People.

Background:While Healthy People outlines a national framework for improving the health of the nation, many states develop State Health Improvement Plans (SHIPs) to set priorities to improve the health of their residents. The purpose of this study was to understand the processes that states use to develop their SHIPs, how states align their SHIPs with Healthy People, and challenges that states face using Healthy People.Methods:NORC conducted semistructured interviews with 9 state health department representatives who were responsible for SHIPs. The responses were analyzed using qualitative thematic analysis.Results:State health departments used similar approaches to develop their SHIPs. Generally, states began the SHIP development process by performing community health assessments and then assembling diverse stakeholders to recommend key priority areas that should be addressed in the SHIP. States used a similar framework for their SHIPs, outlining priority areas, indicators, and targets. All respondents reported that they referenced Healthy People during the development of their SHIPs. Some states reported aligning their state plans with the Healthy People Framework, while others focused more on the specific Healthy People objectives or target setting guidance.Conclusions:Both the federal government and state public health agencies rely on input from stakeholders and cross-sector collaboration to ensure their initiatives reflect the diverse needs of their population. Stakeholder engagement is increasingly important as public health professionals are shifting toward a health equity approach that considers social determinants outside of the health care sector. Healthy People continues to strengthen this perspective by outlining national priorities on well-being while incorporating language around health equity issues. Reinforcing relationships between the federal government and state public health can help states better understand the role of Healthy People as well as encourage further dissemination of creative strategies and best practices.