Health Equity Policy Research Articles

Climate change mitigation policy for planetary health equity? An automated content analysis of countries’ nationally determined contribution reports

Abstract Introduction This study examines the extent to which national governments discuss the social determinants of planetary health equity (SDPHE) within their Nationally Determined Contribution reports (NDCs) to the UN Framework Convention on Climate Change. This is assessed relative to the frequency of discussion of economic factors and health outcomes, and how this varies between countries based on political, economic, and environmental factors.
Methods Using natural language processing, a dictionary-based automated content analysis was conducted of the frequency of terms within these reports. Correlation analyses examined the relationship between the frequency of dictionary categories and political, economic, and environmental variables to ascertain the role of contextual factors.
Results Overall, NDCs were found to feature a greater proportion of economic language compared to health outcome and SDPHE terms. Among the SDPHE, equity- and gender-related terms occurred most frequently. Correlations were identified primarily among high-income countries, that suggest moderate positive associations between levels of CO2 emissions per capita and per dollar of GDP and the use of economic terms, and a negative association of economic language with levels of democracy. Democracy was also positively associated with language related to social norms such as equity and justice, indicating potential scope for impact through democratic pressures.
Conclusion The relatively frequent use of economic frames in NDCs suggests that economic issues may receive more attention compared to the SDPHE. This analysis identifies potential enabling and constraining country-level factors for greater attention to the SDPHE in NDCs and more progressive climate change mitigation policymaking.

Addressing the Health Impacts of Racism on Children and Youth: Equity Until Equality

Race is a sociopolitical construct based on physical characteristics, not a biological construct. Racism is a system that ascribes value and resources based on the sociopolitical construct called “race.” In the United States and other countries around the world, racism is associated with disparate health outcomes and shortened life expectancies. Health equity employs health-related systems (eg, health care providers, insurance companies, hospitals, research, pharmaceutical companies) across multiple sectors (eg, housing, education, business, government) to allocate resources and services to correct and promote political and social determinants associated with health and wellness. Applying health equity practices and policies ensures that each child, youth, and adult receives comprehensive, evidence-informed, culturally relevant, and needs-based services to achieve optimum health. This article provides an overview of the impact of racism embedded in systems and policies that challenge optimal health for children and youth and offers evidence-supported paths forward to advance health and wellness in the United States. Until each child and adolescent enjoys optimal and equal health outcomes, health equity practices and social justice are mandatory.

HPR100 Health Technologies Value Assessment Through the Lens of Health Equity; How Far From Being Incorporated Routinely? An Environmental Scan of Health Equity Frameworks and Policy Gaps

HPR100 Health Technologies Value Assessment Through the Lens of Health Equity; How Far From Being Incorporated Routinely? An Environmental Scan of Health Equity Frameworks and Policy Gaps

Leveraging Science to Advance Health Equity: Preliminary Considerations for Implementing Health Equity Science at State and Local Health Departments.

In 2021, the Centers for Disease Control and Prevention (CDC) launched CORE, an agency-wide strategy to embed health equity as a foundational component across all areas of the agency's work. The CDC established a definition of health equity science (HES) and principles to guide the development, implementation, dissemination, and use of the HES framework to move beyond documenting inequities to investigating root causes and promoting actionable approaches to eliminate health inequities. The HES framework may be used by state and local health departments to advance health equity efforts in their jurisdictions. Identify implementation considerations and opportunities for providing technical assistance and support to state and local public health departments in advancing HES. A series of implementation consultations and multi-jurisdictional facilitated discussions were held with state and local health departments and community partners in 5 states to gather feedback on the current efforts, opportunities, and support needs to advance HES at the state and local levels. The information shared during these activities was analyzed using inductive and deductive methods, validated with partners, and summarized into themes and HES implementation considerations. Five themes emerged regarding current efforts, opportunities, and support needed to implement HES at state and local health departments. These themes included the following criteria: (1) enhancing the existing health equity evidence base; (2) addressing interdisciplinary public health practice and data needs; (3) recognizing the value of qualitative data; (4) evaluating health equity programs and policies; and (5) including impacted communities in the full life cycle of health equity efforts. Within these themes, we identified HES implementation considerations, which may be leveraged to inform future efforts to advance HES at the state and local levels. Health equity efforts at state and local health departments may be strengthened by leveraging the HES framework and implementation considerations.

Prevalence of Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus by Race and Ethnicity in Illinois, 2018 to 2020.

Use administrative discharge data from 2018 to 2020 to determine if there are differences in the prevalence of hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) by race and ethnicity in Illinois. This retrospective cross-sectional study used administrative discharge records from all patients who had live births in Illinois over a 3-year period; 2018, 2019, 2020. Multivariate analyses were performed to control for covariates and determine if associations vary by race and ethnicity for HDP and GDM. A total of 287,250 discharge records were included. Multivariate analyses showed that after adjusting for covariates, non-Hispanic Black women had 1.60 increased odds of HDP compared to non-Hispanic White women (OR, 1.60; 95% CI, 1.55-1.65). Hispanic women (OR, 1.45; 95% CI, 1.40-1.50), Asian/Pacific Islander women (OR, 2.07; 95% CI, 1.97-2.17), and American Indian/Alaska Native women (OR, 1.43; 95% CI, 1.17-1.74) had an increased odds of GDM compared to non-Hispanic White women. Women of color were at increased odds for HDP and GDM in Illinois. To eliminate poor maternal outcomes in women of color at risk for HDP and GDM, more culturally congruent health equity practices, policies, and comprehensive care interventions must be adopted.

Perceived Impact and Feasibility of Health Equity Policy Actions among Obesity Practitioners, Researchers, and Policymakers

Perceived Impact and Feasibility of Health Equity Policy Actions among Obesity Practitioners, Researchers, and Policymakers

Local Public Health Departments at the Intersection of Climate Change, Health Equity, and Public Health Laws and Policies.

Public health laws and policies are uniquely able to mitigate the adverse and inequitable health impacts of climate change. This article summarizes some key considerations in developing such laws and policies and a variety of approaches local public health departments are using to increase climate resilience and health equity.

The segregation of physician networks providing care to black and white patients with heart disease: Concepts, measures, and empirical evaluation

Black-White disparities in cardiac care may be related to physician referral network segregation. We developed and tested new geographic physician network segregation measures. We used Medicare claims to identify Black and White Medicare heart disease patients and map physician networks for 169 hospital referral regions (HRRs) with over 1000 Black patients. We constructed two network segregation indexes ranging from 0 (integration) to 100 (total segregation): Dissimilarity (the unevenness of Black and White patient distribution across physicians [Dn]) and Absolute Clustering (the propensity of Black patients’ physicians to have closer ties with each other than with other physicians [ACLn]). We employed conditional logit models to estimate the probability of using the best (lowest mortality) geographically available hospital for Black and White patients undergoing coronary artery bypass grafting (CABG) surgery in 126 markets with sufficient sample size at increasing levels of network segregation and for low vs. high HRR Black patient population. Physician network segregation was lower than residential segregation (Dissimilarity 21.9 vs. 48.7, and Absolute Clustering 4.8 vs. 32.4) and positively correlated with residential segregation (p < .001). Network segregation effects differed by race and HRR Black patient population. For White patients, higher network segregation was associated with a higher probability of using the best available hospitals in HRRs with few black patients but unchanged (ACLn) or lower (Dn) probability of best hospital use in HRRs with many Black patients. For Black patients, higher network segregation was not associated with a substantial change in the probability of best hospital use regardless of the HRR Black patient population size. Measuring physician network segregation is feasible and associated with nuanced effects on Black-White differences in high-quality hospital use for heart disease. Further work is needed to understand underlying mechanisms and potential uses in health equity policy.

Legislating Inequity: Structural Racism In Groups Of State Laws And Associations With Premature Mortality Rates.

Most evaluations of health equity policy have focused on the effects of individual laws. However, multiple laws' combined effects better reflect the crosscutting nature of structurally racist legal regimes. To measure the combined effects of multiple laws, we used latent class analysis, a method for detecting unobserved "subgroups" in a population, to identify clusters of US states based on thirteen structural racism-related legal domains in 2013. We identified three classes of states: one with predominantly harmful laws ([Formula: see text]), another with predominantly protective laws ([Formula: see text]), and a third with a mix of both ([Formula: see text]). Premature mortality rates overall-defined as deaths before age seventy-five per 100,000 population-were highest in states with predominantly harmful laws, which included eighteen states with past Jim Crow laws. This study offers a new method for measuring structural racism on the basis of how groups of laws are associated with premature mortality rates.

Bidirectional processes linking social determinants of health and pediatric sickle cell anemia management: A qualitative study.

Children with sickle cell anemia (SCA) have substantial medical needs and more unmet basic needs than children with other medical conditions. Despite a recent focus on social determinants of health (SDoH), there remains an incomplete understanding of the processes linking SDoH and disease management, particularly for youth with SCA. This study elucidated these processes and identified ways to mitigate deleterious effects of adverse SDoH on SCA management. Parents/primary caregivers (N=27) of children with SCA (≤12 years old) participated in semi-structured interviews regarding SCA management and SDoH and completed quantitative measures of basic needs. Qualitative data were systematically coded and analyzed using applied thematic analysis. Quantitative data were presented descriptively. Three qualitative themes were identified. First, SCA management is bidirectionally linked with the social environment, whereby challenges of SCA management can hinder basic needs from being met, and unmet basic needs and financial hardship hinder SCA management. Second, due to limited resources, parents/caregivers are faced with difficult choices between prioritizing basic needs versus SCA management. Third, addressing material, emotional, and informational needs may improve SCA management. Quantitatively, 73% of families endorsed≥1 basic need, including food insecurity (42%), housing instability (62%), and/or energy insecurity 19% (vs. 20%). Despite documented associations, there remains a poor understanding of the processes linking SDoH and health. Findings underscore how day-to-day conditions undermine the management of SCA treatments, symptoms, and complications, limiting treatment effectiveness. Understanding these processes may inform family-centered, health equity interventions and policies to improve living conditions, disease management, and health outcomes.

Preparing nurse scientists for health services and policy research: Five-year outcomes of interprofessional postdoctoral training in the National Clinician Scholars Program

BackgroundThe National Clinician Scholars Program (NCSP) is an interprofessional postdoctoral fellowship for physicians and nurses with a PhD. or DNP focused on health services research, policy, and leadership. PurposeTo evaluate 5-year outcomes of nurse postdoctoral scholars in the NCSP. MethodsWe describe the 5-year outcomes of nurse fellows and graduates from six NCSP sites (positions, number of peer-reviewed publications, citations, and h-index). ConclusionThere were 53 nurses in the sample (34 alumni, 19 fellows). Approximately half (47%, n = 16) of alumni had tenure-track faculty positions and had bibliometric performance indicators (such as h-indices) 2 to 4 times greater than those previously reported for assistant professors in nursing schools nationally. NCSP nurse scholars and alumni also had an impact on community partnerships, health equity, and health policy DiscussionThis study highlights the potential of interprofessional postdoctoral fellowships such as the NCSP to prepare nurse scientists for health care leadership roles.

Disability-a chronic omission in health equity that must be central to Canada's post-pandemic recovery.

As Canada begins to recover and learn from the COVID-19 pandemic, health equity and public health policies must be a central tenet of reform. Recent work has begun to provide guidance on an equitable pandemic recovery in Canada, which highlights many important groups that require specific consideration in recovery policies.1 There is a key omission in many of these guidelines and, in fact, most health equity efforts-people with disabilities.

Geographic heterogeneity of the epidemiological impact of the COVID-19 pandemic in Italy using a socioeconomic proxy-based classification of the national territory.

This study aimed to evaluate the differences in incidence, non-intensive care unit (non-ICU) and intensive care unit (ICU) hospital admissions, and COVID-19-related mortality between the "inner areas" of Italy and its metropolitan areas. Retrospective population-based study conducted from the beginning of the pandemic in Italy (20 February 2020) to 31 March 2022. The municipalities of Italy were classified into metropolitan areas, peri-urban/intermediate areas and "inner areas" (peripheral/ultra-peripheral). The exposure variable was residence in an "inner area" of Italy. Incidence of diagnosis of SARS-CoV-2 infection, non-ICU and ICU hospital admissions and death within 30 days from diagnosis were the outcomes of the study. COVID-19 vaccination access was also evaluated. Crude and age-standardized rates were calculated for all the study outcomes. The association between the type of area of residence and each outcome under study was evaluated by calculating the ratios between the standardized rates. All the analyses were stratified by period of observation (original Wuhan strain, Alpha variant, Delta variant, Omicron variant). Incidence and non-ICUs admissions rates were lower in "inner areas." ICU admission and mortality rates were much lower in "inner areas" in the early phases of the pandemic, but this protection progressively diminished, with a slight excess risk observed in the "inner areas" during the Omicron period. The greater vaccination coverage in metropolitan areas may explain this trend. Prioritizing healthcare planning through the strengthening of the primary prevention policies in the peripheral areas of Italy is fundamental to guarantee health equity policies.

Preparing Students for Post-COVID Nursing Careers: The Value of International Clinical Placements

Prior to the coronavirus disease 2019 (COVID-19) pandemic, international clinical placements (ICPs) for nursing students were used to build cultural humility and global awareness. This study explored the influence of ICPs on nursing students' career planning and views of the nursing role; the findings were considered against the evolving pandemic context. A qualitative, descriptive longitudinal study was conducted with 25 preregistration nursing students who participated in an international placement. Semistructured individual interview data were examined using thematic analysis. Participants were interested in patient equity and empowerment, high acuity and variety, health policy, and primary care. Participants developed resilience and nursing confidence. They saw the effects of poor health equity and health policy decisions on population health. ICPs expanded participants' understanding of global interconnectedness and also identified new career possibilities. Postpandemic, nursing education should continue to maintain a global focus on health. [J Nurs Educ. 2023;62(4):207-214.].

Universal and Targeted Policy for Health Equity in the Neoliberal Era; A Response to the Recent Commentaries.

Universal and Targeted Policy for Health Equity in the Neoliberal Era; A Response to the Recent Commentaries.

TCN Scholars: How Prepared Are Nurses in Advocacy and Influencing Policy for Health Equity?

TCN Scholars: How Prepared Are Nurses in Advocacy and Influencing Policy for Health Equity?

Role of Health Equity Research and Policy for Diverse Populations Requiring Hand Surgery Care.

Health equity requires allocation of resources to eliminate the systematic disparities in health, imposed on marginalized groups, which adversely impact outcomes. A socioecological approach is implemented to elucidate the role of health equity research and policy for underrepresented minority and socioeconomically disadvantaged populations. Through investigation of the individual, community, institution, and public policy, we investigate problems and propose solutions to ensure fair and just treatment of all patients requiring hand surgery.

Analysing the global and local spatial associations of medical resources across Wuhan city using POI data

BackgroundThere is a sharp contradiction between the supply and demand of medical resources in the provincial capitals of China. Understanding the spatial patterns of medical resources and identifying their spatial association and heterogeneity is a prerequisite to ensuring that limited resources are allocated fairly and optimally, which, along with improvements to urban residents’ quality of life, is a key aim of healthy city planning. However, the existing studies on medical resources pattern mainly focus on their spatial distribution and evolution characteristics, and lack the analyses of the spatial co-location between medical resources from the global and local perspectives. It is worth noting that the research on the spatial relationship between medical resources is an important way to realize the spatial equity and operation efficiency of urban medical resources.MethodsLocalized colocation quotient (LCLQ) analysis has been used successfully to measure directional spatial associations and heterogeneity between categorical point data. Using point of interest (POI) data and the LCLQ method, this paper presents the first analysis of spatial patterns and directional spatial associations between six medical resources across Wuhan city.Results(1) Pharmacies, clinics and community hospitals show “multicentre + multicircle”, “centre + axis + dot” and “banded” distribution characteristics, respectively, but specialized hospitals and general hospitals present “single core” and “double core” modes. (2) Overall, medical resources show agglomeration characteristics. The degrees of spatial agglomeration of the five medical resources, are ranked from high to low as follows: pharmacy, clinic, community hospital, special hospital, general hospital and 3A hospital. (3) Although pharmacies, clinics, and community hospitals of basic medical resources are interdependent, specialized hospitals, general hospitals and 3A hospitals of professional medical resources are also interdependent; furthermore, basic medical resources and professional medical resources are mutually exclusive.ConclusionsGovernment and urban planners should pay great attention to the spatial distribution characteristics and association intensity of medical resources when formulating relevant policies. The findings of this study contribute to health equity and health policy discussions around basic medical services and professional medical services.

Undetectable=Untransmittable=Universal Access (U=U=U): transforming a foundational, community-led HIV/AIDS health informational advocacy campaign into a global HIV/AIDS health equity strategy and policy priority.

Undetectable=Untransmittable (U=U) first emerged in 2016 as a health information campaign to promote rigorous scientific evidence that people living with HIV (PLHIV) on effective treatment who have reached an undetectable or suppressed viral load cannot pass on the virus sexually. Within 7years, U=U underwent transformation from a global community-led, grassroots movement into a global HIV/AIDS health equity strategy and policy priority. For this narrative review, a targeted literature search on 'history'+'Undetectable=Untransmittable' and/or 'U=U' on Google and Google Scholar, in addition to a search of online documents on the Prevention Access Campaign (PAC) website, was conducted. The article utilises an interdisciplinary policy studies approach that recognises the roles of multi-stakeholder, especially that of the community and civil society, to effect policy change. The narrative review first provides a synopsis of the scientific origination of U=U. The second section highlights the progress and leadership on U=U led by the PAC and civil society partners and efforts of the PLHIV and ally communities in advocating for the broad recognition and dissemination of the evidence, which has proven to be a game-changer within the HIV/AIDS response. The third section spotlights the recent developments of U=U within the local, national, and multilateral spheres. The article ends with recommendations for community and HIV/AIDS multi-stakeholders on how they can further integrate, implement, and strategically utilise U=U as an essential and complementary HIV/AIDS pillar to the current Global AIDS Strategy 2021-2026 to end inequalities to end AIDS by 2030.

Abstract B094: Cancer awareness and prevalence in the Black Belt of Alabama: A geospatial analysis

Abstract Objective: Socioeconomic status (SES) disparity is one of the primary factors for cancer disease. The majority of research on cancer disease and SES has been conducted for African American and white populations. This study explores the relationship between SES and cancer prevalence (Breast Cancer and Prostate Cancer) in Alabama's Black Belt for major ethnic groups. Historically, Alabama's Black Belt counties are embedded with SES disparities, health care inequality, politics, race, ethnicity, oppression, and most importantly, lack of awareness of the cancer epidemic. Methods: Geospatial technology (GIS) has been employed to analyze the last two decades SES and cancer statistics from the U.S. Census, Alabama Department of Health (ADH), American Cancer Society (ACS), Center for Disease Control (CDC), and National Cancer Institute (NCI). The GIS analysis indicates an apparent SES disparity between the Black Belt (BB) and Non-BB (NBB) counties of Alabama and especially among African American population. Results: The geospatial analysis indicates SES is positively associated with cancer prevalence. Research also shows that African American cancer prevalence rates are higher than whites due to poor social and health equity, including access to health care, green food, transportation, and education. Conclusions: Alabama is one of the top states concerning the cancer epidemic. The research employed SES and cancer prevalence using geospatial technology. Data shows a close relation between SES and cancer prevalence in the African American population in the Black Belt of Alabama. The research strongly recommends the state adopt cancer awareness programs and social and health equity policy planning. Citation Format: Ram Alagan, Seela Aladuwaka, Upender Manne, Rajesh Singh, Manoj K Mishra. Cancer awareness and prevalence in the Black Belt of Alabama: A geospatial analysis [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B094.