Health Equity Gaps Research Articles

Do summaries of evidence enable informed decision-making about COVID-19 and influenza vaccination equitably across more and less disadvantaged groups? Study protocol for a multi-centre cluster randomised controlled trial of 'fact boxes' in health and social care in Germany.

Evidence summaries on the benefits and harms of treatment options support informed decisions under controlled conditions. However, few studies have investigated how such formats support decision-making across different social groups. There is a risk that only disadvantaged people will be able to make informed health decisions-possibly increasing the health equity gap. It is also unclear whether they support decision-making in the field at all. The aim of our study is to assess whether evidence summaries based on the fact box format can help people from different social groups make informed decisions about COVID-19 and influenza vaccinations, and thus reduce inequity in health communication. In a multi-centre, cluster-randomised, controlled trial, health educators from usual care and outreach work in Germany will be randomised in a 1:1 ratio to provide either usual health communication plus an evidence summary ('fact box') or usual health communication. Health educators provide a flyer about COVID-19 or influenza vaccination which contains a link to an online study either with (intervention) or without (control) fact box on the reverse side. Flyer and online study will be available in Arabic, German, Turkish and Russian language. The primary outcome is informed vaccination intention, based on vaccination knowledge, attitudes, intentions and behaviour. Secondary outcomes include risk perception, decisional conflict and shared decision-making. We will use linear mixed models to analyse the influence of both individual (eg, education status) and cluster level factors and account for the expected cluster variability in realising usual health communication or the intervention. The statistical analysis plan includes the selection of appropriate measures of effect size and power calculation, assuming a sample size of 800 patients. The trial has been approved by the Ethics Committee of the University of Potsdam, Germany (application numbers: 34/2021 and 57/2022).Results will be disseminated through peer-reviewed journals, conferences and to relevant stakeholders. Version 6 (4 October 2024); Preprint available on Research Square: https://doi.org/10.21203/rs.3.rs-3401234/v3 TRIAL REGISTRATION NUMBER: NCT06076421.

Abstract PR004: Differential gene expression analysis comparing Black and White patients with HPV-positive oropharyngeal squamous cell carcinoma reveals suppressed immune response and higher rates P16/HPV DNA discordance in Black patients

Abstract Background-Human papilloma virus (HPV-positive (+)) oropharynx cancer (OPC) are a distinct neoplastic entity associated with a significant survival advantage compared to HPV- OPCs. The survival advantage is so great that the presence of regional cervical lymph node metastasis is no longer considered an advanced stage III/IV cancer. The survival advantage associated with HPV+ OPC is not the same for Black patients compared to all other races and emerging data now suggests Black patients with HPV+ OPC have survival outcomes similar to White patients with HPV- OPC. We conducted a differential gene expression analysis and high-risk HPV serotyping comparing genomic difference between treatment naïve Black and White patients with HPV+ OPC. Methods: Surgical samples were obtained from Duke, the University of Texas Medical Branch, and the University of Mississippi, through an IRB approved protocol. HPV status determined by p16 immunohistochemistry (IHC). We performed digital spatial profiling and conducted a differential gene expression analysis in 14 Black and 13 White patients using the Nanostring™ Whole Transcriptome Atlas. Morphology markers included CD45, PANCK, and alpha SMA to label lymphocytes, epithelium, and stroma, respectively. A component of the bioinformatics pipeline included conducing a KEGG pathway analysis using pre-ranked test statistics from self-reported Black and White patients HPV+ OPC. The presence of high-risk oncogenic HPV was determined in parallel by RT-PCR (Creative Biogene). P16, CD68 and CD3 expression was measured by IHC using standard techniques. Results: There was a significant decrease in antigen processing and presentation and T-cell receptor signaling pathways in CD45+ lymphocytes (p<0.0002) and B-Cell receptor and chemokine signaling pathways in PANCK+ tumor epithelial cells (p<0.03) in Black patients compared to White patients with HPV+ OPC. There was a significant difference in p16 expression and the absence of HPV DNA in Black patients compared to White patients (p<0.017). 32% of Black patients with p16+ OPC were HPV DNA negative. There was no p16/HPV16 DNA discordance observed in the White patient cohort. Three patients were co-infected with other carcinogenic HPV serotypes (45, 51, and 59) in addition to HPV16 (two Black and one White). CD68 expression, associated with M1-like anti-tumor macrophages, was significantly decreased in Black patients with p16+/HPV16+ OPC, compared to White patients (p<0.017), suggesting alterations in tumor immune response may be important in cancer disparities. Conclusion: The favorable prognosis associated with HPV+ OPC, including recruitment in currently ongoing radiation de-escalation clinical trials cannot be widely applied to all patients with HPV+ OPC and studies addressing racial disparities, HPV/p16 discordance, and predictors of poor response represent a significant health equity gap in the field of OPC disparities. Citation Format: Tammara L. Watts, Katerine Gonzalez, Xiangfeng Shen, Layne Rogers, Nosa Osazuwa-Peters, Gina D. Jefferson, Cecilia G. Clement, Danielle Range, Russel R Kahmke, Walter T Lee, Daniel J. Rocke, Trinitia Y Cannon, Yvonne Mowery, Kouros Owzar. Differential gene expression analysis comparing Black and White patients with HPV-positive oropharyngeal squamous cell carcinoma reveals suppressed immune response and higher rates P16/HPV DNA discordance in Black patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr PR004.

Abstract P326: Measuring Health Equity Gaps for a Blood Pressure Control Quality Improvement Program: Results from Cook County Health

Background: High blood pressure (BP) affects nearly half of U.S. adult population and was responsible for 13.0 deaths per 100,000 in 2022, with significant differences in age-adjusted mortality rates by sex, race, and ethnicity. Previous research has also highlighted that lower BP control rates are more prominent in Hispanic and Non-Hispanic Black patients, and well as those 60 years or older. This study assesses the role of the AMA MAP™ Hypertension quality improvement (QI) program to improve potential inequities in blood pressure control at a large public health care institution. Methods: 18,252 patients diagnosed with hypertension were identified at Cook County Health. BP values were obtained for patients in the 2 -years prior to implementation of the QI program (July 2019 to June 2021) compared to BP in the 2-years after implementation (July 2021 to July 2023). A multivariable logistic regression model of BP control status, paired t-tests, and ANCOVA analyses, stratified by race, ethnicity, sex, and age are conducted to assess SBP and measure the gaps by demographic characteristics. Results: Prior to the QI program, BP control (<140/<90) was significantly less for Black as compared to White patients (OR 0.82 [0.74-0.92]). The racial difference remained after the program, although it was slightly diminished (OR 0.86 [0.76 – 0.97]). Patients who were older were less likely to have controlled BP prior to the program, but these differences were no longer evident following the QI program. The QI program led to a decline in SBP in all demographic groups, including between ethnicity as shown in Figure 1 (Hispanic: -5.74 [CI:6.19- -5.29] vs Non-Hispanic -4.92 [-5.21- -4.63]), White (-5.96 [CI: -6.45- -5.47]) and Black (-4.80 [CI: -5.11- -4.49]) patients, and by age as shown in Figure 2 between 45-64 years ( -5.79 [CI: -6.12- -5.46] and 65-85 years (-4.31 [CI: -4.68- -3.94]). Conclusion: The results indicate an overall improvement in BP control and SBP, however, gaps persisted in SBP across ethnicity, race, and certain age groups. Quality improvement coaching and dashboards may support clinical care teams in addressing inequities in patient BP control.

Sociodemographic Factors Associated With Using eHealth for Information Seeking in the United States: Cross-Sectional Population-Based Study With 3 Time Points Using Health Information National Trends Survey Data.

Despite the potential benefits of using eHealth, sociodemographic disparities exist in eHealth use, which threatens to further widen health equity gaps. The literature has consistently shown age and education to be associated with eHealth use, while the findings for racial and ethnic disparities are mixed. However, previous disparities may have narrowed as health care interactions shifted to web-based modalities for everyone because of the COVID-19 pandemic. This study aims to provide an updated examination of sociodemographic disparities that contribute to the health equity gap related to using eHealth for information seeking using 3 time points. Data for this study came from the nationally representative 2018 (n=3504), 2020 (n=3865), and 2022 (n=6252) time points of the Health Information National Trends Survey. Logistic regression was used to regress the use of eHealth for information seeking on race and ethnicity, sex, age, education, income, health status, and year of survey. Given the consistent association of age with the dependent variable, analyses were stratified by age cohort (millennials, Generation X, baby boomers, and silent generation) to compare individuals of similar age. For millennials, being female, attaining some college or a college degree, and reporting an annual income of US $50,000-$74,999 or >US $75,000 were associated with the use of eHealth for information seeking. For Generation X, being female, having attained some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, better self-reported health, and completing the survey in 2022 (vs 2018; odds ratio [OR] 1.80, 95% CI 1.11-2.91) were associated with the use of eHealth for information seeking. For baby boomers, being female, being older, attaining a high school degree, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2020 (OR 1.56, 95% CI 1.15-2.12) and 2022 (OR 4.04, 95% CI 2.77-5.87) were associated with the use of eHealth for information seeking. Among the silent generation, being older, attaining some college or a college degree, reporting an annual income of US $50,000-$74,999 or >US $75,000, and completing the survey in 2022 (OR 5.76, 95% CI 3.05-10.89) were associated with the use of eHealth for information seeking. Baby boomers may have made the most gains in using eHealth for information seeking over time. The race and ethnicity findings, or lack thereof, may indicate a reduction in racial and ethnic disparities. Disparities based on sex, education, and income remained consistent across all age groups. This aligns with health disparities literature focused on individuals with lower socioeconomic status, and more recently on men who are less likely to seek health care compared to women.

Health Equity Research Outcomes and Improvement Consortium Prostate Cancer Health Precision Africa1K: Closing the Health Equity Gap Through Rural Community Inclusion

Health Equity Research Outcomes and Improvement Consortium Prostate Cancer Health Precision Africa1K: Closing the Health Equity Gap Through Rural Community Inclusion

Digital Footprints of Obesity Treatment: GLP-1 Receptor Agonists and the Health Equity Divide.

Our research investigates the societal implications of access to glucagon-like peptide-1 (GLP-1) agonists, particularly in light of recent clinical trials demonstrating the efficacy of semaglutide in reducing cardiovascular mortality. A decade-long analysis of Google Trends indicates a significant increase in searches for GLP-1 agonists, primarily in North America. This trend contrasts with the global prevalence of obesity. Given the high cost of GLP-1 agonists, a critical question arises: Will this disparity in medication accessibility exacerbate the global health equity gap in obesity treatment? This viewpoint explores strategies to address the health equity gap exacerbated by this emerging medication. Because GLP-1 agonists hold the potential to become a cornerstone in obesity treatment, ensuring equitable access is a pressing public health concern.

How Do Curricula for Medical Students and Physician Learners Address the Social Determinants of Health? A Scoping Review.

Curricula about social determinants (drivers) of health (SDOH) are becoming more common in medical education, reflecting increasing expectations from payers and accreditors that health care systems do more to address health-related social needs and close pervasive health equity gaps. Few previous reviews have addressed the content of SDOH-related curricula. This review examines the scope and focus of medical education on SDOH and adjacent concepts. The authors screened 2,442 articles describing curricula delivered in undergraduate, graduate, and continuing medical education settings between 2010 and 2023 using PubMed and 2 field-specific databases, yielding 289 articles. Data on course duration, pedagogic approach, assessment methods, and curricular content were extracted and analyzed. Curricular content was categorized using the National Academies of Science, Engineering, and Medicine's (NASEM's) 5As framework, which recommends 5 key activities health care can undertake to mitigate social risk (awareness, adjustment, assistance, alignment, and advocacy). A total of 289 articles were included in this review. Curricula covering SDOH-related concepts have increased over time. Of the included articles, 190 (65.7%) referenced at least 1 of NASEM's 5 key activities. Training on social risk screening and other awareness activities were noted most frequently (123 [42.6%]), followed by curricula on helping patients get social care (assistance; 86 [29.8%]) and providing social risk-adjusted health care (adjustment; 81 [28.0%]). Curricula on system- and policy-level activities, including alignment of health care and social care organizations (alignment), and advocacy (advocacy) were described less frequently (43 [14.9%] and 49 [17.0%], respectively). Ninety-four articles (32.5%) referenced only general information about SDOH without describing specific actions to adjust care or reduce social adversity. NASEM's 5As framework provides a useful construct for characterizing SDOH-related curricula. Medical educators should teach not only the prevalence and pathophysiology of SDOH but also what physicians can do to address these factors.

Women in Health and their Economic, Equity and Livelihood statuses during Emergency Preparedness and Response (WHEELER) protocol: a mixed methods study in Kenya

IntroductionKenya reported its first COVID-19 case on 13 March 2020. Pandemic-driven health system changes followed and unforeseen societal, economic and health effects reported. This protocol aims to describe the methods...

Implementation of rapid genomic sequencing in safety-net neonatal intensive care units: protocol for the VIrtual GenOme CenteR (VIGOR) proof-of-concept study

IntroductionRapid genomic sequencing (rGS) in critically ill infants with suspected genetic disorders has high diagnostic and clinical utility. However, rGS has primarily been available at large referral centres with the...

Sexual and Reproductive Health Service Access among Aboriginal and Torres Strait Islander Young People in Regional NSW, Australia

Owing to the historical and ongoing impacts of colonisation, there is a large health equity gap in sexual and reproductive health (SRH) outcomes between Aboriginal and Torres Strait Islander peoples and non‐Indigenous populations. Whilst qualitative research has identified the barriers and enablers to sexual healthcare engagement among young Aboriginal and Torres Strait Islander people in remote settings, little is known about the ways in which young people navigate sexual healthcare in a regional setting. This study aims to address this gap. Sixty‐five young (aged 15–29) Aboriginal and Torres Strait Islander people participated in semistructured interviews across three regional communities in New South Wales, Australia. The candidacy framework informed this analysis. A large proportion of participants expressed having agency and resources to attend health services for SRH needs (primarily STI testing and contraception). Women in particular described being supported by social networks to access SRH services. Male participants were less likely to identify their own candidacy for healthcare. Services that were culturally safe and had trustworthy, nonjudgemental staff and a feeling of community were easier to access (more permeable). Factors that decreased accessibility were confidentiality concerns, difficulty making appointments, and lack of visibility of services, or what they offer. Using the candidacy framework, this study identified the importance of culturally safe service provision, reducing barriers to accessing appointments and the provision of nonjudgemental care in engaging young Aboriginal and Torres Strait Islander people in SRH care. This study also highlighted the various strategies and actions that young Aboriginal and Torres Strait Islander people are already taking to protect their sexual health and that of their partners.

Prioritizing Equity in Antimicrobial Stewardship Efforts (EASE): a framework for infectious diseases clinicians.

Health equity gaps persist across minoritized groups due to systems of oppression affecting health-related social needs such as access to transportation, education and literacy, or food and housing security. Consequently, disparities in the prevalence of multidrug-resistant infections, infectious disease outcomes, and inappropriate antimicrobial use have been reported across minoritized populations. The Joint Commission and Centers for Medicare and Medicaid Services (CMS) have formally acknowledged the importance of integrating health equity-focused initiatives into existing hospital quality improvement (QI) programs. Here, we review documented disparities in antimicrobial stewardship and offer a framework, derived from components of existing health equity and QI tools, to guide clinicians in prioritizing equity in antimicrobial stewardship efforts (EASE).

Cardiovascular risk prediction in a New Zealand cohort of patients with known cardiovascular disease - a regional individual patient-level data linkage study

Abstract Background National health databases have been underutilised in the development of cardiovascular disease (CVD) risk prediction equations for people with known CVD, yet can inform population level practice and policy—including identification of health equity gaps, high-risk groups, and high-risk localities. With the recent introduction of novel and expensive preventive cardiovascular drugs, stratifying risk in patients with prior CVD could be required to inform cost-effective use of these medications in the future. Purpose We sought to develop 5-year CVD risk equations in adults with known history of CVD in Aotearoa New Zealand, using data from administrative health databases and characterize distribution of risk according to sex. Methods All people above 18 years of age with a history of CVD hospitalization, living in the Auckland and Northland regions of Aotearoa New Zealand (approximately one-third of the national population) on 1 January 2014 were included. Participants were followed for 5 years (31 December 2018) or until death or the outcome of interest, being any fatal or non-fatal CVD hospitalization (ischemic heart disease, heart failure, ischemic stroke, or peripheral artery disease) during follow-up. Sex-specific 5-year CVD risk prediction equations were developed using multivariable Fine and Gray models taking competing risk of non-cardiovascular death into account. Predictor variables included were age; ethnicity; deprivation level; time since most recent CVD hospitalization, history of smoking, heart failure, atrial fibrillation, chronic renal disease, and diabetes mellitus; use of anti-thrombotic, blood pressure-lowering, and lipid-lowering drugs; and blood levels of glycosylated hemoglobin (HbA1c), non-HDL cholesterol, and creatinine. Results The cohort comprised 42,130 men (median age: 68 years [interquartile range (IQR): 59–76]) and 31,717 women (median age: 70 years [IQR: 60–78]) with 12,875 and 8,734 observed events during follow-up, respectively. Sex-specific 5-year CVD risk prediction equations with excellent calibration (accuracy) were developed (Figure 1). Increasing age; high deprivation level; more recent CVD hospitalization; history of smoking, heart failure, atrial fibrillation, chronic renal disease, diabetes mellitus; use of blood-pressure lowering drugs; and high blood levels of HbA1c, non-HDL cholesterol, or creatinine were predictors of elevated risk. There was a wide range of predicted 5-year risk, with 15% of men and 24% of women having a predicted risk below 15%, and 24% and 20%, respectively, having a predicted risk of 40% or above (Figure 2). Conclusion This study demonstrates that it is possible to develop accurate CVD risk prediction equations from administrative health databases for patients with known CVD. Marked heterogeneity in 5-year risk of a subsequent CVD event emphasise that the current ‘one size fits all’ approach to secondary prevention of CVD requires review.Figure 1Figure 2

From disease- to people-centred pandemic management: organized communities, community-oriented primary care and health information systems

BackgroundThe COVID-19 pandemic exposed the health equity gap between and within countries. Western countries were the first to receive vaccines and mortality was higher among socially deprived, minority and indigenous populations. Surprisingly, many sub-Saharan countries reported low excess mortalities. These countries share experiences with community organization and participation in health. The aim of this article was to analyse if and how this central role of people can promote a successful pandemic response.MethodsThis analysis was partly based on local and national experiences shared during an international and Latin American conference on person-and people-centred care in 2021. Additionally, excess mortality data and pandemic control-relevant data, as well as literature on the pandemic response of countries with an unexpected low excess mortality were consulted.ResultsTogo, Mongolia, Thailand and Kenya had a seven times lower mean excess mortality for 2020 and 2021 than the United States of America. More successful pandemic responses were observed in settings with experience in managing epidemics like Ebola and HIV, well-established community networks, a national philosophy of mutual aid, financial government assistance, more human resources for primary care and paid community health workers.DiscussionSince trust in authorities and health needs vary greatly, local strategies are needed to complement national and international pandemic responses. Three key levers were identified to promote locally-tailored pandemic management: well-organized communities, community-oriented primary care, and health information systems. An organized community structure stems from a shared ethical understanding of humanity as being interconnected with each other and the environment. This structure facilitates mutual aid and participation in decision making. Community-oriented primary care includes attention for collective community health and ways to improve health from its roots. A health information system supports collective health and health equity analysis by presenting health needs stratified for social deprivation, ethnicity, and community circumstances.ConclusionsThe difference in excess mortality between countries during the COVID-19 pandemic and various country experiences demonstrate the potential of the levers in promoting a more just and effective health emergency response. These same levers and strategies can promote more inclusive and socially just health systems.

Understanding the experiences of Black Nova Scotians with community pharmacists.

A history of medical abuse and social inequality confounded by persistent racial discrimination in health care has triggered mistrust between Black patients and health care providers. Although the consequences of systemic racism on health outcomes are well understood, little is known about how they manifest in pharmacy practice. The objective of this study was to explore the experiences of Black Nova Scotians with community pharmacists. This was a qualitative study that used focus groups and one-on-one interviews. Black Nova Scotians 18 years of age and older who have had interactions with community pharmacists were invited to participate. Focus groups and interviews were audio-recorded, transcribed and analyzed thematically. Two focus groups (n = 10) and 6 one-on-one interviews were held between May and June 2021. Three major themes were identified: 1) difficulties navigating a pharmacy as a Black person, 2) lack of inclusivity and cultural competence in the pharmacy and 3) transactional relationships with pharmacists. Most participants felt their race negatively affected the quality of care they received from the pharmacist and that pharmacists were not culturally competent. Most participants did not consider pharmacists to be part of their health care team and described feeling unsafe or uncomfortable in the pharmacy. Pharmacists have an important role in closing the health equity gap. This research highlights the need for pharmacy education to include cultural competence and will be used to guide strategies to improve access to culturally safe pharmacy services for Black Nova Scotians.

The development and initial feasibility testing of D-HOMES: a behavioral activation-based intervention for diabetes medication adherence and psychological wellness among people experiencing homelessness.

Compared to stably housed peers, people experiencing homelessness (PEH) have lower rates of ideal glycemic control, and experience premature morbidity and mortality. High rates of behavioral health comorbidities and trauma add to access barriers driving poor outcomes. Limited evidence guides behavioral approaches to support the needs of PEH with diabetes. Lay coaching models can improve care for low-resource populations with diabetes, yet we found no evidence of programs specifically tailored to the needs of PEH. We used a multistep, iterative process following the ORBIT model to develop the Diabetes Homeless Medication Support (D-HOMES) program, a new lifestyle intervention for PEH with type 2 diabetes. We built a community-engaged research team who participated in all of the following steps of treatment development: (1) initial treatment conceptualization drawing from evidence-based programs, (2) qualitative interviews with affected people and multi-disciplinary housing and healthcare providers, and (3) an open trial of D-HOMES to evaluate acceptability (Client Satisfaction Questionnaire, exit interview) and treatment engagement (completion rate of up to 10 offered coaching sessions). In step (1), the D-HOMES treatment manual drew from existing behavioral activation and lay health coach programs for diabetes as well as clinical resources from Health Care for the Homeless. Step (2) qualitative interviews (n = 26 patients, n = 21 providers) shaped counseling approaches, language and choices regarding interventionists, tools, and resources. PTSD symptoms were reported in 69% of patients. Step (3) trial participants (N = 10) overall found the program acceptable, however, we saw better program satisfaction and treatment engagement among more stably housed people. We developed adapted treatment materials for the target population and refined recruitment/retention strategies and trial procedures sensitive to prevalent discrimination and racism to better retain people of color and those with less stable housing. The research team has used these findings to inform an NIH-funded randomized control pilot trial. We found synergy between community-engaged research and the ORBIT model of behavioral treatment development to develop a new intervention designed for PEH with type 2 diabetes and address health equity gaps in people who have experienced trauma. We conclude that more work and different approaches are needed to address the needs of participants with the least stable housing.

Ten questions concerning smart and healthy built environments for older adults

In the past decade, the term ‘global aging’ has gained much attention among researchers, policymakers, civil societies, and governments worldwide. The continuous decline in fertility rates and increased life expectancy have resulted in an ongoing demographic transition where the share of adults aged 65 or older is increasing and outnumbering children younger than five years. In the United States and other developed countries, this rapid demographic transition is expected to continue to strain the existing health infrastructure as it becomes increasingly challenging to ensure healthy living environments for older adults. The ten questions and answers in this paper have been prepared by experts from gerontology, geriatrics, architectural engineering, and senior living operations to inform and characterize the current continuum of living environments and communities available to older adults. They also identify the common elements that influence the environmental needs of older adults and highlight factors (such as technical assistance, health equity gaps, and caregiver workforce development) that challenge the future of smart and healthy built environments for older adults. A special focus has been placed on contextualizing indoor environmental quality (IEQ) elements and smart building technologies for older individuals, caregivers, and their various requirements (perhaps in their own homes and communities). Together, these viewpoints create a new paradigm to assist in designing and managing intelligent, healthy built environments that respond to human demands. Although this paper focuses on factors in the United States, others can benefit from the framework incubated upon these experiences, making this effort relevant toward addressing global opportunities in environments for older adults.

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Addressing the Maternal Mental Health Crisis Through a Novel Tech-Enabled Peer-to-Peer Driven Perinatal Collaborative Care Model

Educating future physicians for francophone official language minority communities in Canada: a case study.

Over one million Francophone Canadians live in official language minority communities (OLMC) outside of Québec. Availability and accessibility of linguistically appropriate care to these OLMCs is lacking, resulting in poorer quality of care. To help address this health equity gap, the FrancoDoc program was created in 2015 to identify Francophone/Francophile medical students enrolled at medical faculties that use English as their primary language of instruction and equip them with skills to increase their medical French abilities. Little is known, however, about the affordances and limitations of this educational endeavour. Our qualitative instrumental single case study explored participants' experiences with FrancoDoc, while also examining factors shaping the delivery of linguistically appropriate healthcare services to OLMCs. We conducted semi-structured interviews with medical students from across Canada and thematically analyzed these using a reflexive, inductive approach. Four main themes were derived from 12 interviews: factors facilitating French language learning; barriers to French language learning; contextual factors shaping linguistically appropriate healthcare provision; and recommendations to improve healthcare education to better prepare learners to provide care to OLMCs. Medical student participants are highly motivated to engage in educational activities linked to FrancoDoc. Their efforts are nonetheless frequently impeded by barriers such as time constraints, irregular event programming, lack of regular clinical learning opportunities, and lukewarm support from faculties of medicine. If medical faculties are to realize their obligations to the OLMCs that they serve, recognition of language as a specific social determinant of health and more robust institutional supports for initiatives like FrancoDoc are paramount.

Next generation sequencing (NGS) testing for cancer patients at a safety NET hospital.

e18563 Background: Next Generation Sequencing (NGS) testing is gradually becoming an essential aspect of cancer care. However, numerous studies have shown that non-White patients are under-represented in both precision oncology clinical trials and molecular testing. Highland General Hospital (HGH) is a community safety-net hospital in Oakland, California serving primarily Black, Hispanic and Asian patients. In an effort to increase health equity, in August 2020 we began to offer NGS testing with Tempus Labs, Inc. for our cancer patients. The purpose of this study is to document this experience and highlight the genomic profile of our patient population. Methods: This is a retrospective chart review study. Patients were included if their tumor biopsy was sent for NGS testing from August 2020 to December 2022. A total of 165 patients had their samples sent for NGS, of which 148 were included in this study and 17 were excluded due to lack of sufficient tissue. Patient demographic data and predictive biomarkers were collected. For the purposes of this study, we defined predictive biomarkers as those that predict likelihood of response or lack of response to therapy as recommended by National Comprehensive Cancer Network guidelines. Results: The racial distribution of our patient sample is shown in the table below. Consistent with the patient population of HGH, our sample included mostly Black (32.4%), Hispanic (26.4%), and Asian (21.6%) patients. Non-Small Cell Lung Cancer (NSCLC) and colorectal cancer (CRC) were the two most common malignancies sequenced at 34.5% and 25.7%, respectively. For NSCLC patients, 54.9% had predictive biomarkers, with EGFR and KRAS being the most common driver mutations. For CRC patients, 60.5% had predictive biomarkers, with 73.9% of those being NRAS/KRAS and 13.0% being high tumor mutational burden. Full results to be presented. Conclusions: Based on our experience, it is feasible and informative to provide NGS testing for patients at safety-net hospitals. NGS testing allows for the most appropriate treatment selection for each patient, which can translate into better outcomes. Moreover, due to the unique demographics of patients from these hospitals, NGS tests can provide valuable information about the tumor genomic profiles of these underrepresented patients. This data can help improve drug development research and close the health equity gap. [Table: see text]

Towards anti-racist policies and strategies to reduce poor health outcomes in racialised communities: introducing the O'Neill–Lancet Commission on Racism, Structural Discrimination, and Global Health

Audre Lorde said, “There is no thing as a single-issue struggle because we do not live single-issue lives.” 1 Lorde A Sister outsider: essays and speeches. Crossing Press, Trumansburg, NY1984 Google Scholar The O'Neill–Lancet Commission on Racism, Structural Discrimination, and Global Health posits racism as one of the most consequential transnational phenomena to impact the health and lives of afflicted communities globally. This Commission aims to explore the axis of discrimination across structural determinants of health at intranational, international, and supranational levels and our objectives are shown in the panel. There is ample evidence of racism among health-care-provider behaviour in many contexts and as the cause of physical injury due to racial violence. 2 Batur P Heart of violence: global racism, war, and genocide. in: Vera H Feagin JR Handbook of the sociology of racial and ethnic relations. Springer, Boston, MA2007: 441-454 Crossref Scopus (3) Google Scholar , 3 Ben J Cormack D Harris R Paradies Y Racism and health service utilisation: a systematic review and meta-analysis. PLoS One. 2017; 12: e0189900 Crossref PubMed Scopus (160) Google Scholar , 4 Paradies Y Ben J Denson N et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015; 10: e0138511 Crossref PubMed Scopus (1145) Google Scholar Further, the Lancet Series on racism, xenophobia, discrimination, and health 5 Devakumar D Selvarajah S Abubakar I et al. Racism, xenophobia, discrimination, and the determination of health. Lancet. 2022; 400: 2097-2108 Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar joined earlier scholarship to characterise pathways of discrimination in health systems and other structures. The Commission will deepen the existing scholarship and explore racism and discrimination within global public health practice, policies, governance, and legal systems that are determinants of racial and ethnic health disparities. PanelObjectives of the O'Neill–Lancet Commission on Racism, Structural Discrimination, and Global HealthAccurately diagnose the problem of racism in health This will be achieved by reviewing existing national and cross-national evidence on racism in health in a global context, and using a set of empirical analytical work, to further describe the effects of racial and ethnic discrimination and its intersections on health at a national and international level. Identify best practices and actionable anti-racist strategies The Commission will achieve this goal by, among other activities, holding consultations with populations with lived experiences of structural discrimination in health, to discover how racist structures in select countries were addressed to close health equity gaps. Compile a report of the Commission's findings, highlighting the strategies, tactics, and actionable lessons We expect the Commission's recommendations to be used to develop anti-racist approaches in the sphere of health policy and service delivery to ensure equitable and just health outcomes. Widely disseminate the Commission's findings Broad dissemination will ensure that the anti-racist strategies and actionable lessons can be used by governments and health advocates to lobby for improved health outcomes for marginalised sections of the population in their respective countries and contribute a body of global knowledge to augment efforts to decolonise global health. Accurately diagnose the problem of racism in health This will be achieved by reviewing existing national and cross-national evidence on racism in health in a global context, and using a set of empirical analytical work, to further describe the effects of racial and ethnic discrimination and its intersections on health at a national and international level. Identify best practices and actionable anti-racist strategies The Commission will achieve this goal by, among other activities, holding consultations with populations with lived experiences of structural discrimination in health, to discover how racist structures in select countries were addressed to close health equity gaps. Compile a report of the Commission's findings, highlighting the strategies, tactics, and actionable lessons We expect the Commission's recommendations to be used to develop anti-racist approaches in the sphere of health policy and service delivery to ensure equitable and just health outcomes. Widely disseminate the Commission's findings Broad dissemination will ensure that the anti-racist strategies and actionable lessons can be used by governments and health advocates to lobby for improved health outcomes for marginalised sections of the population in their respective countries and contribute a body of global knowledge to augment efforts to decolonise global health.