Financial Health Research Articles

The impact of "Aging with Medical and Caregiving" on family caregiving—Evidence from China's pilot cities for integrating medical and caregiving

Easing the pressure on family caregiving and addressing the shortage of manpower for family caregiving are significant challenges that China faces in responding to its aging population. This study utilizes data from the 2015 and 2020 China Health and Retirement Longitudinal Study (CHARLS) and employs a Difference-in-Difference method to investigate the impact of pilot policies that integration of medical and caregiving for aging individuals. The findings reveal that these pilot programs are successful in reducing the amount of time spent on family caregiving and the financial burden placed on families, effectively relieving the pressure associated with family caregiving. However, the effects of these programs differ depending on the level of disability, household registration, and the geographical location of the participants. Further analysis suggests that these pilot programs achieve these positive outcomes by increasing government investment in health and wellness funds and providing in-family medical and caregiving services.

A Scoping Review of Health Equity Interventions in Governmental Public Health.

Despite major efforts in research, practice, and policy, racial and ethnic disparities in health and health care persist in the United States. Interventions in collaboration with governmental public health may provide ways to address these persistent racial and ethnic health and health care disparities and improve health outcomes. To conduct a comprehensive review of health equity interventions performed in collaboration with public health agencies. This scoping review includes intervention studies from Ovid MEDLINE, PsycINFO, and Academic Search Premier, published between 2017 and 2023. The search strategy used terminology focused on 4 concepts: race/ethnicity, equity, health departments, and epidemiologic studies. The following inclusion criteria were determined a priori: (1) intervention tailored to reduce racial/ethnic health disparities, (2) public health department involvement, (3) health outcome measures, (4) use of epidemiologic study methods, (5) written in English, (6) implemented in the United States, (7) original data (not a commentary), and (8) published between January 2017 and January 2023. This review focused primarily on 4 dimensions of racial health equity interventions including intervention components, intervention settings, intervention delivery agents, and intervention outcomes. This review indicated that health equity interventions involving public health agencies focused on the following categories: (1) access to care, (2) health behavior, (3) infectious disease testing, (4) preventing transmission, and (5) cancer screening. Critical strategies included in interventions for reaching racial/ethnic minoritized people included using community settings, mobile clinics, social media/social networks, phone-based interventions, community-based workers, health education, active public health department involvement, and structural/policy change. This scoping review aims to provide an evidence map to inform public health agencies, researchers, and funding agencies on gaps in knowledge and priority areas for future research and to identify existing health equity interventions that could be considered for implementation by public health leaders.

U.S. Medical School Participation in Nationally Funded Biomedical Research: A New Accounting of NIH Award Dollars.

To better understand the amount of National Institutes of Health (NIH) funding received by U.S. medical schools with Liaison Committee on Medical Education-accredited medical education programs, the Association of American Medical Colleges (AAMC) developed a new methodology that crosswalks faculty NIH grants with medical schools and their affiliated organizations (e.g., teaching hospitals). This approach offers a more comprehensive and methodologically transparent accounting of NIH extramural funding to academic medicine than existing processes.The AAMC Crosswalk utilized publicly available grants data from the NIH and resources unique to the AAMC, such as the Faculty Roster and Council of Teaching Hospitals and Health Systems records. Using a multi-step algorithm, the AAMC Crosswalk linked individual faculty with NIH grants, their organizations, and partner medical schools, aggregated at the level of the medical school and its affiliated organizations for fiscal year (FY) 2017-2021.The AAMC Crosswalk attributed on average $3.7 billion more per year in NIH funding to U.S. medical schools, representing a 24% increase compared to the NIH and Blue Ridge Institute for Medical Research (BRIMR) methodologies. In FY 2021, the AAMC Crosswalk attributed 60% of NIH funding to U.S. medical schools compared with 47% by NIH and 50% by BRIMR. An exploration of limitations showed no medical school affiliations were missed by the AAMC Crosswalk among 90 randomly sampled organizations, and medical school affiliations for 30 randomly sampled principal investigator faculty members were attributed correctly.These findings indicate that academic medicine's contribution to biomedical research may be greater than historically reported. Systematically accounting for grants awarded to faculty across medical schools and their affiliated organizations provides a more comprehensive understanding of NIH funding to U.S. medical schools. The AAMC Crosswalk provides a new tool to better estimate the true investment and role of academic medicine in advancing biomedical research.

Economic burden and economic impact associated with non-communicable diseases among countries of World Health Organization South-East Asia Region - a systematic review protocol.

The objective of this systematic review is to synthesize studies on economic burden and economic impact of noncommunicable diseases (NCDs) in the World Health Organization South-East Asian Region (WHO SEAR) countries. WHO SEAR countries represent 8.6% of the world's population and 75% of all deaths in this region are attributable to NCDs. In addition, there is a pattern of low government spending on health in SEAR countries, leading to a high proportion of health financing by patients', risking impoverishment for households. We will consider observational (cross-sectional, cohort, and case-control) and interventional (either single arm or comparative) studies that report economic burden (direct and indirect costs, out-of-pocket expenditure) and economic impact (catastrophic health expenditure, hardship financing, impoverishment, and gross domestic product impact at individual, household, and/or country levels). This includes government surveys, surveillance, and secondary data analyses for one or more NCDs prevalent in the WHO SEAR. We will conduct a comprehensive search for relevant studies in databases, including PubMed (MEDLINE), Embase (Ovid), Scopus, Web of Science, Google Scholar, and gray literature with no date limits. Two independent reviewers will screen titles and abstracts, followed by full-text screening. Included studies will be critically appraised for quality. Data will be extracted accordingly and, if possible, random effects meta-analyses will be conducted on the pooled data for resource utilization and costs (including burden and impact), presenting the degree of variation between studies. The characteristics and results of the included studies will be narratively summarized with accompanying tables. PROSPERO CRD42023421302.

The role of governance in the digital transformation of healthcare: Results of a survey in the WHO Europe Region

Optimal governance is among the key facilitators of the digital transformation of health systems intended to improve access to healthcare, quality, safety, and efficiency, and to attain universal health coverage. This paper highlights the findings of a survey assessing the status of governance of digital health in the WHO European Region.The 2022 survey is a continuation of the 2015 WHO Global Survey on eHealth. The survey focused on national digital health governance, monitoring and evaluation of digital health interventions, and funding and investment in digital health and was conducted through April to October 2022. All 53 Member States of the WHO European Region participated in the survey.The results showed that 83% of the Member States reported having a national digital health strategy in place, and 79% of the Member States reported having a health information system strategy. Most of the priorities of the national digital health strategies were devoted to increasing the accessibility, quality, safety, and efficiency of the health systems, strengthening health information systems, and improving information sharing and interoperability of data. Measures to ensure equity in access to digital healthcare services were directed towards improving broadband connectivity, information and communication technology, digital literacy, and digital health promotion. Oversight for the implementation and operation of the national digital health strategies are mostly delegated to government agencies. The prime source of funding for digital health programs was public funding, though a combination of funding sources was also noted. This analysis revealed increasing adoption of national digital health strategies for access to healthcare and creation of digital health agencies and funding programs for digital health.

Can health financing programmes reduce food insecurity in a developing country?

Despite the devastating effects of out-of-pocket healthcare expenditures on households' financial outlays, which potentially stifle household resources needed for food consumption, the health financing program-food insecurity nexus is yet to receive much needed attention in the literature. This study makes a significant contribution by investigating the effect of health financing program, conceptualised as membership of a National Health Insurance Scheme, on household food insecurity using the food insecurity experience scale (FIES) and several quasi-experimental methods. Using data from the seventh round of the Ghana Living Standards Survey, our endogeneity-corrected results indicate that membership of a health financing program can contribute to reduction in household food insecurity. The results are robust to alternative conceptualisations of food insecurity and different quasi-experimental methods. The effect of health financing programme membership on food insecurity is more pronounced among urban and female-headed households. Our findings further point to household savings as an important channel through whichmembership ofhealth financing program reduces food insecurity.

Identifying Challenges and Solutions for Improving Access to Mental Health Services for Rural Youth: Insights from Adult Community Members.

Semi-structured, key informant interviews were conducted by telephone with adult community members, including parents, teachers, and healthcare providers. Participants answered questions related to barriers to mental healthcare access that confront youth and approaches to improving access. Detailed, de-identified field notes were analyzed using conventional content analysis. Limited resources and stigma were the two primary barriers to accessing mental healthcare that youth encounter in the community. Limited resources included lack of services and transportation, inconsistent funding and mental health programming, and workforce shortages. Stigma associated with seeking mental healthcare was of particular concern for youth with diverse identities who experience additional stigma. Improving access to mental healthcare for rural youth will require building a strong mental health workforce and championing efforts to reduce stigma associated with help-seeking.

Assessing the Impact of COVID-19 on the Financial Health of Health Insurance Companies in India

Assessing the Impact of COVID-19 on the Financial Health of Health Insurance Companies in India

Digital technologies for health financing in low-income and middle-income countries: a scoping review protocol

IntroductionUniversal health coverage (UHC) is a global priority, ensuring equitable access to quality healthcare services without financial hardship. Many countries face challenges in progressing towards UHC. Health financing is pivotal...

Exploring sexual and reproductive health among adolescent and young adult patients with cancer: A patient-oriented qualitative study using novel, serial focus groups.

e23080 Background: While treatment advances for adolescent and young adult (AYA, ages 15 - 39) cancers are improving survival, there is a lack of information and support regarding impacts of AYA cancer on sexual and reproductive health (SRH) during and after treatment. Our study explored SRH experiences of AYA cancer patients using novel, serial focus groups. Methods: With online and in-person approaches, we recruited folks who: 1) Were diagnosed with cancer at age 15 – 39; 2) Reside in Canada; and 3) Are over 18. Participants were grouped into cohorts based on akin characteristics (e.g., sex, stage). Each cohort engaged in three focus groups, mimicking support groups, to foster community and trust. An interview guide was iteratively developed with patient research partners. We used framework analysis to identify recurring themes and patterns, offering full insight of participants’ SRH perspectives and experiences from deductive and inductive views. Results: We recruited 4 focus group cohorts, with 6–10 participants each (N = 24 females, 6 males), representing various cancer types (e.g., pelvic, hematologic) and stages (1–4). Cohorts had representation of transgender (n = 1) and gender diverse folks (n = 3), non-heterosexual sexual orientation (n = 11), and racial diversity (n = 9). We identified three themes describing participants’ experiences: 1) internally (“looking inwards”) – impact of AYA cancer on SRH; 2) externally (“looking outwards”) – impact of cancer on interpersonal relationships; and 3) role of the healthcare system. Internally, folks described complex impacts of AYA cancer on themselves, revealing shifting definitions, perspectives, expectations, and goals of SRH over time. Dynamic interplays of AYA cancer also surfaced, unveiling mental, physical, and financial health changes that positively or negatively impacted participants’ SRH and influenced short and long-term well-being. Externally, changes in romantic relationships and family planning underscored the complex interplay of societal pressures on SRH and reproductive choices. Regarding the healthcare system, findings highlight facilitators (i.e., self-advocacy, nurses, recent pregnancy, provider with similar identity, etc.) and barriers (i.e., gender, SRH stigma, age, fertility treatment costs, heteronormativity, SRH deprioritization, etc.) that influence access to appropriate and available SRH resources and support. Conclusions: SRH challenges have significant internal and external impacts among AYA cancer patients and their interpersonal relationships during and after treatment. By understanding their SRH experiences throughout their cancer care, providers and the healthcare system can identify opportunities to implement SRH care more effectively into the cancer care continuum, significantly improving health outcomes for AYA cancer patients.

Male breast cancer survival in Mexico between 2007 and 2016: A retrospective cohort.

1116 Background: Male breast cancer represents around 1% of all breast cancers worldwide. Due to its rarity, it is more likely to be diagnosed at advanced stages than in women, and survival rates tend to be lower than in female patients. Information about survival in male breast cancer in low- and middle-income countries (LMIC) is scarce. Methods: We conducted a retrospective cohort study cross-linking nationwide reimbursement claims for breast cancer cases between 2007 and 2016 treated within the Seguro Popular health financing scheme to a national mortality registry in Mexico. Age, municipality of residence, clinical stage, and year of treatment initiation were described. Facilities were classified according to location, total breast cancer patient volume, and type of funding. We estimated 5-year overall survival (OS) with 95% confidence intervals (95% CI) through the Kaplan Meier method and used the log-rank test to compare differences between patient groups. Patients with in situ disease and missing data for clinical stage were excluded from survival analyses. Results: We identified 268,703 claims representing 60,846 patients, from which 328 were male (0.53%). Median age was 56 years (IQR 48-67). At treatment initiation, 20.7% of patients had early disease, 46.3% had locally advanced (LA) disease and 15.5% metastatic disease; clinical stage information was missing in 16% of patients Most patients (86.6%) were treated at public facilities, and 40.5% were treated at high volume facilities. With a median follow-up of 4.1 years, five-year OS in the whole cohort was 64.3% (CI 95% 58.1-71.2). In patients with early-stage disease, 5-year OS was 78.7% (95% CI 67.0-92.4), in LA disease 66.3% (95% CI 58.4-75.3) and in metastatic disease 39.7% (95% CI 27.5-57.5) (p <0.001). Patients with LA disease treated at a private facility had improved 5-year OS (88.9%) compared to those who were treated at a public facility (62.8%) (p=0.033). We did not find any other significant differences in survival according to patient or facility characteristics, including patient volume. Conclusions: These results represent the largest cohort to describe survival in men with breast cancer in Latin America. We found a larger proportion of men diagnosed with metastatic disease than described in women in Mexico, and lower than expected survival in patients with early-stage and LA disease.

Quantification of the environmental impact of radiotherapy and associated secondary human health effects: a multi-institutional retrospective analysis and simulation

The health-care industry is a substantial contributor to global greenhouse gas emissions, yet the specific environmental impact of radiotherapy, a cornerstone of cancer treatment, remains under-explored. We aimed to quantify the emissions associated with the delivery of radiotherapy in the USA and propose a framework for reducing the environmental impact of oncology care. In this multi-institutional retrospective analysis and simulation study, we conducted a lifecycle assessment of external beam radiotherapy (EBRT) for ten anatomical disease sites, adhering to the International Organization for Standardization's standards ISO 14040 and ISO 14044. We analysed retrospective data from Jan 1, 2017, to Oct 1, 2023, encompassing patient and staff travel, medical supplies, and equipment and building energy use associated with the use of EBRT at four academic institutions in the USA. The primary objective was to measure the environmental impacts across ten categories: greenhouse gases (expressed as kg of carbon dioxide equivalents [CO2e]), ozone depletion, smog formation, acidification, eutrophication, carcinogenic and non-carcinogenic potential, respiratory effects, fossil fuel depletion, and ecotoxicity. Human health effects secondary to these environmental impacts were also estimated as disability-adjusted life years. We also assessed the potential benefits of hypofractionated regimens for breast and genitourinary (ie, prostate and bladder) cancers on US greenhouse gas emissions using an analytic model based on the 2014 US National Cancer Database for fractionation patterns and patient commute distances. We estimated that the mean greenhouse gas emissions associated with a standard 25-fraction EBRT course were 4310 kg CO2e (SD 2910), which corresponded to 0·0035 disability-adjusted life years per treatment course. Transit and building energy usage accounted for 25·73% (1110 kg CO2e) and 73·95% of (3190 kg CO2e) of total greenhouse gas emissions, respectively, whereas supplies contributed only 0·32% (14 kg CO2e). Across the other environmental impact categories, most of the environmental impact also stemmed from patient transit and energy use within facilities, with little environmental impact contributed by supplies used. Hypofractionated treatment simulations suggested a substantial reduction in greenhouse gas emissions-by up to 42% for breast and 77% for genitourinary cancer-and environmental impacts more broadly. This comprehensive lifecycle assessment of EBRT delineates the environmental and secondary health impacts of radiotherapy, and underscores the urgent need for sustainable practices in oncology. The findings serve as a reference for future decarbonisation efforts in cancer care and show the potential environmental benefits of modifying treatment protocols (when clinical equipoise exists). They also highlight strategic opportunities to mitigate the ecological footprint in an era of escalating climate change and increasing cancer prevalence. Mount Zion Health Fund.

The single center experience with the war-related Ukrainian patients with various cancer diagnoses treated in clinical trials between 2022-2024.

e23040 Background: According to the WHO, 32% of active combat areas residents have been unable to obtain essential medicines since the beginning of the war in Ukraine. Clinical trials conducted in Poland have proven to assist oncological patients greatly. Many Ukrainian residents have Polish ancestors and are fluent in the Polish language. We decided to check whether the highest ethical standards of clinical trials make the ordinary intention to include a patient from Ukraine insufficient. Conducting a complete risk-benefit analysis allows choosing the best interest and safety of the clinical trial participant. Methods: The study aimed to evaluate the most frequent standards of oncological treatment of Ukrainian patients. We retrospectively verified the number of patients of Ukrainian nationality, in the age above 18 years treated at our center since the start of the invasion of Ukraine in February 2022 compared to the Polish patients. Results: Based on the National Health Fund data, Polish cancer centers in 2022 treated overall 994,767 patients including 8,000 patients from Ukraine. In the Pomeranian region, 3,815 patients received oncological therapies (data from the Central Statistical Office - of national). At our center in Gdansk between 01.01.2022 and 31.12.2023, therapy received 38,574 patients, including 34 Ukrainians. Clinical trials participants included 3,968 Polish and four Ukrainian patients (2 cases of malignant melanoma, one breast cancer, one lung cancer). Ukrainian patients represented 28.5%, 10%, and 8% of all patients included, respectively. Conclusions: Not prepared for the rapid influx of migrants Polish healthcare system encountered many problems like the language barrier, the need for a translator or approved documents by the Bioethics Committee, and the legal side of the informed consent form (ICF). At our center, all Ukrainian patients signed ICF in Polish. Regarding clinical trials participation, our study shows the unmet need of Ukrainian patients. The decision to include a patient has to be mutual (sponsor and investigator) and as soon as possible to ensure the required safety of each patient.

Indiana's Public Health Investment Holds Insights For Other States.

Indiana has a business-friendly environment, but historical underinvestment in public health has yielded poor health outcomes. In 2023, when trust in governmental public health was strained nationwide, Indiana increased public health spending by 1,500percent. In this article, we explain how Indiana achieved this unprecedented legislative victory for public health, describing the context, approach, and lessons learned. Specifically, an Indiana University report linking economic vitality and overall health sparked the creation of a governor's commission charged with exploring ways to address Indiana's shortcomings. Working with the Indiana Department of Health, the commission developed multisectoral coalitions and business and government partnerships, and it maintained consistent and coordinated communication with policy makers. Lessons learned included the value of uncoupling public health from partisan narratives, appointing diverse commission membership with strategically selected cochairs, involving local leaders, and ensuring local decision-making control. We believe that Indiana's approach holds insights for other states interested in strengthening public health funding in the current era.

Administrative burden of establishing health care coverage for the uninsured and its impact on timely access to care.

11050 Background: Although safety net coverage programs like Medicaid exist to fund health care for low-income patients, the administrative burden of the lengthy application limits uptake by eligible individuals. Therefore, many patients do not attempt to enroll until they become ill, which is common among uninsured adults diagnosed with cancer. The literature reports worse cancer outcomes for those with Medicaid, but reasons for this are unclear. The delays in enrollment for patients with uncertain coverage at the time of diagnosis – those in limbo – are understudied and may explain some of this persisting disparity. We estimated the patient and health system burdens for those with uncertain coverage status at the time of cancer diagnosis at Parkland Health, the main provider of cancer treatment for the uninsured in Dallas, Texas. Methods: We assembled the electronic health record financial encounter data of patients with an incident cancer diagnosis in the Parkland tumor registry, diagnosed from 2010 – 2022. We defined patients as being “in limbo” if they had self-pay, pending, or missing insurance plans at the date of diagnosis. We also included patients whose coverage verification date occurred after diagnosis date, since coverage programs can apply retroactively for 90 days. We used plan verification dates to identify when limbo status resolved. We used coarsened exact matching to balance across age, race, Spanish-language preference, Charlson, and screenable cancer type, then multivariate regression to compare patients that were in limbo to those that had established coverage before cancer diagnosis. Results: We identified 17,468 adults newly diagnosed with cancer, 80% of whom were < age 65, 55% female, 73% Hispanic and/or Black, and 30% Spanish-language preferring. The most common cancer types were GI/colorectal (19%), breast (17%), and lung (9%); 23% were advanced stage at diagnosis and 13% died within 180 days of diagnosis. 52.1% were already enrolled in Medicaid/charity care, but one-third (35%) were in limbo at diagnosis, which lasted for a median 31 days (IQR 13 – 126). Over half (55%) of patients in limbo resolved to Medicaid or charity care. Patients who experienced limbo had a median of 596 financial account notes in the first year after diagnosis, 121 more than the comparison group (95% CI 86.7 - 156.1) and began treatment 10 days later (95% CI 7.7 - 12.7). They also had a median of 1 ED visit in the year after diagnosis, 0.2 more than patients never in limbo (95% CI 0.11 - 0.26). Conclusions: The administrative burden of enrolling into coverage programs for the uninsured may impose direct and indirect costs on patients and safety-net health systems and may contribute to worse cancer care outcomes. A more comprehensive accounting of the effects of administrative burdens might suggest ways to redesign coverage enrollment for the uninsured to improve care and reduce costs.

Determinants of Corporate Indebtedness in Portugal: An Analysis of Financial Behaviour Clusters

Corporate indebtedness is a powerful tool in determining a company’s financial health with impacts on its image and reputation. The main objective of this research is to study the determining factors in corporate indebtedness in Portugal. It also has the secondary objectives of creating clusters of companies’ behaviour in relation to the use of credit and verifying their differences in relation to the characteristics of the companies. It uses a quantitative methodology based on a questionnaire survey of 1957 Portuguese companies. The results of the factor analysis show the formation of six determining factors in corporate indebtedness, namely the negotiating relationship with banks, financing, cycle and indebtedness, company operating performance, guarantees used to obtain bank financing and financing risk analysis as well as secondary forms of bank financing. The application of cluster analysis to the six factors formed led to the classification of companies into three clusters: the resilient financial cluster, the operational excellence cluster and the strategic financial cluster. There are several statistically significant differences in the corporate financing factors in relation to the clusters to which they belong. The evidence of the factors and clusters explaining company financing provides insights for improving credit access practices and for implementing public policies that facilitate access to credit and promote economic development.

What's Good for the Land is Good for the Farmer: Investigating Conservation‐Related Variables as Predictors of Farmers' Job Satisfaction☆

AbstractRising stress, mental health issues, and suicide rates among farmers highlight the need to understand factors influencing their job satisfaction. Farming presents distinct challenges with its unique mix of positive and negative characteristics. This study utilized dual‐factor theory to investigate how various factors, such as economic dynamics, farm financial health, stewardship views, experience with extreme weather, and climate change concerns, influence farmers' job satisfaction and dissatisfaction. Data from a 2020 survey of Iowa farmers were analyzed using ordinal logistic regression. Financial health, stewardship motivations, and perceived adequacy of conservation practices emerged as significant predictors of both job satisfaction and dissatisfaction. Farmers' extreme weather events experiences were positively associated with job satisfaction, indicating successful coping enhances contentment. Conversely, climate change concern was negatively associated with job satisfaction. As a revenue protection strategy, faith in crop insurance was negatively related to job dissatisfaction. In summary, besides the anticipated positive impact of farm financial health, the findings show that job satisfaction in farming is linked to stewardship motivations and perceived adequacy of conservation practices on the farm. The results suggest an opening for policies and programs aligning financial and conservation goals, potentially enhancing long‐term farmer well‐being and sustainable agricultural practices.

The Association Between Food Insecurity and Intimate Partner Violence Among U.S. Army Soldiers.

Food insecurity in the military ranges between 25% and 33%, significantly higher than the 10.5% for civilians reported by the U.S. Department of Agriculture. The primary objective of this study is to analyze the association between food insecurity and intimate partner violence (IPV) victimization among U.S. Army Soldiers. The secondary objective is to determine if there are any moderating effects in the relationship between food insecurity and IPV victimization by demographic, financial, and mental health covariates. A cross-sectional, online survey was administered by the U.S. Army Public Health Center at an Army installation in 2019; 56% of respondents reported that they were married or in a relationship (n = 2,740). The main predictor was the two-item food insecurity screener (Hunger Vital Signs), which measures marginal food insecurity (encompassing marginal, low, and very low food security). The main outcome was IPV victimization as measured by the Hurt, Insult, Threaten, Scream scale. Multiple logistic regression was used to assess the association between marginal food insecurity and IPV victimization, controlling for demographic, financial, and mental health covariates. In a multivariable model, marginally food insecure respondents had 2.05-fold greater adjusted odds of reporting any IPV victimization when compared to highly food secure respondents (95% confidence interval [1.40, 3.00]). The only interaction that was statistically significant was between anxiety and food insecurity on IPV victimization (p = .0034). Interactions by soldier's military rank, birth sex, and race and ethnicity were not statistically significant. IPV has implications for the emotional and physical health of survivors. In addition, service members who are food insecure may experience similar decrements in emotional and physical health due to suboptimal nutrient intake. By addressing both food insecurity and IPV, the military has the potential to increase the overall well-being of its service members and their dependents.

Leaving no one behind in armed conflict-affected settings of Africa: is universal health coverage a possibility or mirage?

The world is off track six years to the 2030 deadline for attaining the sustainable development goals and universal health coverage. This is particularly evident in Africa’s armed conflict-affected and humanitarian settings, where pervasively weak health systems, extreme poverty and inequitable access to the social dimensions and other determinants of health continue to pose significant challenges to universal health coverage. In this article, we review the key issues and main barriers to universal health coverage in such settings. While our review shows that the current health service delivery and financing models in Africa’s armed conflict-affected settings provide some opportunities to leapfrog progress, others are threats which could hinder the attainment of universal health coverage. We propose four key approaches focused on addressing the barriers to the three pillars of universal health coverage, strengthening public disaster risk management, bridging the humanitarian-development divide, and using health as an enabler of peace and sustainable development as panacea to addressing the universal health coverage challenge in these settings. The principles of health system strengthening, primary health care, equity, the right to health, and gender mainstreaming should underscore the implementation of these approaches. Moving forward, we call for more advocacy, dialogue, and research to better define and adapt these approaches into a realistic package of interventions for attaining universal health coverage in Africa’s armed conflict-affected settings.

The resilient self-employability of women and senior people after sudden economic shocks

AbstractIn recent times, various crises have negatively affected the financial stability, job security, and health of countless individuals. According to research, different factors that operate at both the individual and contextual levels can play a prominent role in influencing people's self-employment during periods of economic downturn. This study investigates the changes in the likelihood of self-employment by gender and age across various contexts following sudden shocks. By analyzing the intersection of occupational choice and business cycle theories, this research offers insights into how crises affect people's ability to work for themselves. Using a sample of over 250,000 individuals from sixteen countries and applying a multilevel binary logistic regression analysis, the results confirm that women and older individuals are less inclined to be self-employed in general. However, unexpected economic recessions may lead to a slight increase in their likelihood of self-employment. Furthermore, when women and seniors live in a higher GDP per capita context, this context positively moderates the relationship between gender, age, and the propensity for entrepreneurship. These findings offer valuable insights for policymakers seeking to promote resilient self-employment among vulnerable individuals for post-crisis recovery.