Implications For Health Inequalities Research Articles

Health inequalities and health-related economic inactivity: Why good work needs good health

Tackling health inequalities demands whole systems strategies with reach beyond the traditional sphere of influence of health care systems. Practitioners and researchers have long recognised that wider social determinants, where people are born, the communities they live in, their built environment, access to education and resources and, most significantly for this discussion, their relationship to the labour market, profoundly shape health experiences and expectations over the lifecourse. At macro-level, economic structures and systems play a fundamental role in the distribution of good health and incidence of inequalities. Regionally, the health of local labour markets, a phenomenon shaped by macro, national and global economic forces, is a powerful determinant of opportunities to access and remain in work. Simultaneously, health status impacts significantly on ability to participate in paid employment. Absence from the labour market is both a cause and symptom of health inequalities.Economic inactivity, where people are both not participating in the labour market, or actively seeking or available for work, is strongly correlated with poor health. In the UK, over one third of the economically inactive experience long-term health problems. The implications for health inequalities, as both cause and symptom are clear. Participation in paid work, where appropriate, can be beneficial both economically and for health and wellbeing. Continued absence from the labour market is directly correlated with ill health. The determinants of health-related economic inactivity are complex and can only be understood using ecological models of public health. This presents significant challenges for politicians and policymakers alike concerned with reducing economic inactivity, delivering economic growth and redressing regional disparities.

Intersectional Microaggressions and Implications for Health Inequities and HIV Among Latino/x Sexual Minority Males in Puerto Rico.

Latino/x sexual minority males (SMM) continue to be disproportionately impacted by health inequities. This study aims to understand the lived experience of Puerto Rican (PR) SMM related to how intersectional microaggressions influence health-related risk and protective factors. Young adult (ages 21-30) PR SMM from San Juan, Puerto Rico, completed a bilingual in-depth individual interview (14 in Spanish and 1 in English). A thematic analysis based on the original language of the interviews was conducted using NVivo. Six prominent themes were identified through the data analysis: (1) religious microaggressions, being gay is bad because God doesn't like it; (2) gender microaggressions, gay is not good because it's not for men; (3) sexuality microaggressions, this one is a homosexual, coming out as a sexual minority; (4) trans microaggressions, drag queens create an illusion; (5) internalized microaggressions, battling with internalized homophobia; and (6) mitigating microaggressions, establishing a supportive community. Findings suggest that multiple forms of microaggressions based on the intersectionality of sexuality and gender manifest from straight as well as gay communities. PR SMM demonstrated their resiliency by assessing interactions with others to mitigate risks and enhance supportive networks.

Age associations with tacrolimus and mycophenolic acid pharmacokinetics in stable Black and White kidney transplant recipients: Implications for health inequities.

Tacrolimus (TAC) and mycophenolic acid (MPA) provide maintenance immunosuppression and is dosed empirically in elderly kidney transplant recipients (KTRs) resulting in health inequities. Limited immunosuppressive pharmacokinetics are available comparing adult ages. This secondary analysis compared TAC and MPA pharmacokinetics and adverse effects (AEs) among young, middle-aged, and elderly Black and White KTRs. The 12-h TAC and MPA pharmacokinetics with AE evaluation were conducted in 67 stableKTRs greater than or equal to 6 months post-transplant. TAC regimens were adjusted to target troughs. MPA regimens were adjusted using clinical response. Participants were: young: less than or equal to 40 years; middle age: greater than 40 to 60 years, and elderly greater than 60 years. Noncompartmental pharmacokinetic analysis determined area under the concentration-time curve 0-12 h (AUC0-12h ), clearance (CL), and CL/body mass index (BMI) with 0-h troughs. MPA enterohepatic recirculation (EHR), MPA-AUC6-12h /MPA-AUC0-12h , and MPA glucuronide (MPAG)-AUC0-12h /MPA-AUC0-12h were determined. Univariate analysis of variance (ANOVA) was conducted using SAS version 9.4. No group differences were noted for estimated glomerular filtration rate, MPA, and TAC doses. EHR was reduced in elderly with decreased MPA-AUC6-12h /MPA-AUC0-12h (p=0.049) and increased MPAG-AUC0-12h /MPA-AUC0-12h (p=0.036). MPA troughs (p=0.045) were reduced in the elderly. TAC CL/BMI (p=0.043) was reduced in the elderly. For therapeutic MPA AUC0-12h : 30-60 mg·h/L, 34.3% KTRs achieved this target with 55.2% greater than the therapeutic range. 77.6% KTR were in the TAC AUC0-12h target: 100-190 ng·h/mL and 19.4% were below this range with no age relationship. In 44% young, 26% middle-age and 7.8% elderly subjects achieved target AUC0-12h for both medications (p=0.036). Neurologic AEs were manifested in the elderly (p=0.014). Immunosuppressive pharmacokinetics demonstrated age-related differences with reduced TAC CL/BMI and MPA EHR and increased neurologic AE in the elderly. This immunosuppressive regimen may require age-adjusted individualization to optimize allograft function.

From food price crisis to an equitable food system

In 2022, the world is experiencing the greatest cost of living crisis in a generation.1 Crises have always highlighted inequities in our societies. With food prices at near record levels globally, rapidly rising inflation, and economic instability, many people living in situations of constraint have no choice but to skip meals, reduce the amount they eat, prepare meals with fewer nutritious foods, and buy cheaper, starchy staples and ultra-processed foods.2–3 The implications for health inequalities are dire: increased dietary disparities will worsen food insecurity, undernutrition, obesity, and diet-related disease among those who are struggling most.

An Exploratory Study of Gender Role Stress and Psychological Distress of Women in Kosovo.

Introduction:Although investigations of changing gender roles have been performed globally, most studies have been conducted in high-income countries, and studies from emerging and developing countries are lacking. This study aims to examine the factor structure of the feminine gender role stress scale among women (FGRS) and explore its relationship with psychological distress (PD).Methods:A cross-sectional study was carried out with 656 women from Kosovo using a convenience sampling technique during October 2017 and March 2018. The data were collected through face-to-face interviews and analyzed using the Statistical Package for the Social Sciences version 21 and Mplus 7.3. Confirmatory factor analysis (CFA) and path analysis were used to understand the goodness-of-fit of the FGRS scale in the Kosovo context and explore the relationship between the FGRS scale and PD when treated as latent variables. Multivariance analysis of variance (ANOVA) was used to understand the differences between groups of women based on employment and FGRS. Multinomial logistic regression was used to assess the prediction of different domains of FGRS for PD separately for each category while controlling for age.Results:After demonstrating that the five-factor model of the FGRS showed a good fit to the data in this sample of Kosovo women, analyses revealed that the FGRS domains (fear of victimization and behaving with assertiveness) were positively associated with psychological distress.Conclusion:The findings validate the usefulness of the FGRS scale in a sample of Kosovar women. The intersectionality perspective was used to interpret the importance of multiple layers of vulnerabilities and their coexistence, including education, socioeconomic status, and their implications for health inequalities.

Invited Commentary: The Need for Repeated Measures and Other Methodological Considerations When Investigating Discrimination as a Contributor to Health.

To determine potential measurement error related to the assessment of lifetime discrimination, Van Dyke et al. (Am J Epidemiol. 2022;191(3):370-378) investigated inconsistencies in reporting of racial, socioeconomic status, and sex discrimination over time among Black and White adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The authors found that "ever" reports of discrimination (as assessed by the Experiences of Discrimination Scale) decreased over time and that populations who most experience discrimination (i.e., Black/African-American people, younger persons, persons of low socioeconomic status, and women) were often also the most likely to inconsistently report discrimination over the course of the study period (from 1992 to 2010). The authors have raised an important issue related to the potential underestimation of lifetime discrimination that may depend on when discrimination is assessed, as well as the social identity of individuals surveyed. With implications for health inequities, these findings highlight study design and methodological issues that should be addressed to accurately estimate the true burden discrimination places on health. In this commentary, we further illuminate potential methodological challenges and opportunities to consider when investigating the impact of discrimination on health.

Education-smoking gradient and upstream health policies: comparing Generation X with millennials

PurposeOver the years, many upstream health policies have sought to reduce smoking across populations. While smoking has been substantially reduced, the effects of these policies on education-smoking gradient remain unclear. The present paper compares the education-smoking gradient among the Generation X and the millennials, who grew up with different types of upstream policies.Design/methodology/approachThe study relies on regression analysis. The data are from the Canadian Tobacco, Alcohol and Drugs Survey of 2017, with the sample restricted to those born between 1965 and 1995.FindingsAt the zero-order, the education-smoking gradient has not significantly flattened from Generation X to millennials. And, accounting for the channels of impact of education on smoking does not substantially change this pattern.Social implicationsThe implications for health inequalities associated with socioeconomic status, and tobacco consumption reduction policies, are discussed.Originality/valueThis paper is the first study of the kind using Canadian data.

Social and spatial distribution of soil lead concentrations in the City of Santa Ana, California: Implications for health inequities

BackgroundLead (Pb) exposure is a problem that disproportionately impacts low-income communities and communities of color. We applied a community-based participatory research approach to assess the distribution of soil Pb concentrations and related social vulnerabilities across Census tracts in Santa Ana, CA. MethodsSoil Pb samples (n = 1528) were collected by the ¡Plo-NO! Santa Ana! Lead-Free Santa Ana! partnership in 2018 across Santa Ana, CA, at a high spatial resolution and measured using XRF analysis. Pb concentrations were mapped and spatial interpolation was conducted to generate a continuous smoothed map of soil Pb concentrations across the city. American Community Survey data was used to examine Pb across Census tracts based on social and economic factors, and to allow for the development of a Cumulative Risk Index to identify areas at high risk of health impacts. ResultsSoil Pb concentrations varied by landuse type and socioeconomic factors. Census tracts with a median household income below $50,000 had over five times higher soil Pb concentrations than high-income Census tracts. Soil samples collected in tertiles with the highest percent children, residents without health insurance, renter-occupied housing units, and lowest percent college educated residents had 90.0%, 96.1%, 75.2%, and 87.0% higher Pb concentrations on average, respectively, compared to their counterparts. Overall, 52.7% of residential samples had Pb concentrations in excess of the 80 ppm California EPA recommendation, and 11 Census tracts were characterized as high risk according to our Cumulative Risk Index. DiscussionThis study underscores the need for precautionary measures relating to disturbances of the soil, particularly for areas where children play outside, given children's higher absorption of lead. It also informs environmental justice initiatives and identifies vulnerable subpopulations at greater risk of Pb exposure, thus warranting community-driven recommendations for policies and initiatives to remediate soil Pb and protect public health and health equity.

Racial Non-equivalence of Socioeconomic Status and Self-rated Health among African Americans and Whites.

Racial health inequities are not fully explained by socioeconomic status (SES) measures like education, income and wealth. The largest inequities are observed among African American and white college graduates suggesting that African Americans do not receive the same health benefits of education. African Americans do not receive the same income and wealth returns of college education as their white counterparts indicating a racial non-equivalence of SES that may affect health inequities. The aim of this study is to determine whether racial non-equivalence of SES mediates race inequities in self-rated health by education and sex. Using data from the 2007–2016 National Health and Nutrition Examination Survey in the United States, the mediation of the associations between race and self-rated health through household income ≥400% federal poverty line, homeownership, and investment income were assessed among college graduates and non-college graduates by sex. Indirect associations were observed among college graduate women (odds = 0.08, standard error (s.e.) = 0.03), and non-college graduate men (odds = 0.14, s.e. = 0.02) and women (odds = 0.06, s.e. = 0.02). Direct associations between race and self-rated health remained after accounting for household income and wealth indicators suggesting that race differences in income and wealth partially mediate racial inequities in self-rated health. This study demonstrates that the racial non-equivalence of SES has implications for health inequities, but the magnitude of indirect associations varied by sex. Other factors like discrimination, health pessimism and segregation should be considered in light of the racial non-equivalence of SES and racial inequities in self-rated health.

A Rapid Review of Barriers to Volunteering for Potentially Disadvantaged Groups and Implications for Health Inequalities

Despite volunteering being a feature of community life in the UK, differences as to who volunteers are evident. Reporting on a rapid review of the evidence on volunteering and inequalities, the aim of this paper is to provide an overview of the breadth and interconnectedness of barriers to volunteering for potentially disadvantaged groups. Sixty-seven articles were identified, to produce a map of factors affecting volunteer participation. Findings suggest that whilst different demographic groups experience specific barriers to volunteering, there are areas of commonality. Analysis shifts the onus of volunteering away from the level of individual choice (a dominant emphasis in policy and practical discussions around promoting volunteering) and towards the influence of structural factors related to broader exclusionary processes. Those who potentially have the most to gain from volunteering are the least likely to participate. Whilst the benefits of volunteering are increasingly documented by research and championed by policy, there are questions about the success of this approach given that the underlying social inequalities present substantive barriers to volunteering and must be addressed to promote greater access.

Do the health benefits of education vary by sociodemographic subgroup? Differential returns to education and implications for health inequities

PurposeEvidence suggests education is an important life course determinant of health, but few studies examine differential returns to education by sociodemographic subgroup. MethodsUsing National Longitudinal Survey of Youth 1979 (n = 6158) cohort data, we evaluate education attained by age 25 years and physical health (PCS) and mental health component summary scores (MCS) at age 50 years. Race / ethnicity, sex, geography, immigration status, and childhood socioeconomic status (cSES) were evaluated as effect modifiers in birth year adjusted linear regression models. ResultsThe association between education and PCS was large among high cSES respondents (β = 0.81 per year of education, 95% CI: 0.67, 0.94), and larger among low cSES respondents (interaction β = 0.39, 95% CI: 0.06, 0.72). The association between education and MCS was imprecisely estimated among White men (β = 0.44; 95% CI: −0.03, 0.90), while, Black women benefited more from each year of education (interaction β = 0.91; 95% CI: 0.19, 1.64). Similarly, compared to socially advantaged groups, low cSES Blacks, and low and high cSES women benefited more from each year of education, while immigrants benefited less from each year of education. ConclusionsIf causal, increases in educational attainment may reduce some social inequities in health.

Do perceived job insecurity and annoyance due to air and noise pollution predict incident self-rated poor health? A prospective analysis of independent and joint associations using a German national representative cohort study

BackgroundCurrent economic and social change has contributed to increasing job insecurity and traffic-related pollution in residential areas. Both job insecurity and exposure to noise and air pollution are known determinants...

Social inequalities in health information seeking among young adults in Montreal.

Over their lifecourse, young adults develop different skills and preferences in relationship to the information sources they seek when having questions about health. Health information seeking behaviour (HISB) includes multiple, unequally accessed sources; yet most studies have focused on single sources and did not examine HISB's association with social inequalities. This study explores 'multiple-source' profiles and their association with socioeconomic characteristics. We analyzed cross-sectional data from the Interdisciplinary Study of Inequalities in Smoking involving 2093 young adults recruited in Montreal, Canada, in 2011-2012. We used latent class analysis to create profiles based on responses to questions regarding whether participants sought health professionals, family, friends or the Internet when having questions about health. Using multinomial logistic regression, we examined the associations between profiles and economic, social and cultural capital indicators: financial difficulties and transportation means, friend satisfaction and network size, and individual, mother's, and father's education. Five profiles were found: 'all sources' (42%), 'health professional centred' (29%), 'family only' (14%), 'Internet centred' (14%) and 'no sources' (2%). Participants with a larger social network and higher friend satisfaction were more likely to be in the 'all sources' group. Participants who experienced financial difficulties and completed college/university were less likely to be in the 'family only' group; those whose mother had completed college/university were more likely to be in this group. Our findings point to the importance of considering multiple sources to study HISB, especially when the capacity to seek multiple sources is unequally distributed. Scholars should acknowledge HISB's implications for health inequalities.

The role of added sugar in a healthy diet and implications for health inequalities

The role of added sugar in a healthy diet and implications for health inequalities Sugars provide a readily available, inexpensive source of energy, can increase palatability and help preserve some foods. However added sugars also dilute the nutrient density of the diet. Further, consumption of sugar-sweetened beverages is associated with increased risk of weight gain and reduced bone strength, and high or frequent consumption of added sugars is associated with increased risk of dental caries, particularly in infants and young children. The products of the 2013 NHMRC Dietary Guidelines work program at www.eatforhealth.gov.au include the comprehensive evidence base about food, diet and health relationships and the dietary modeling used to inform recommendations. This presentation will detail the scientific evidence underpinning the revised dietary recommendations on consumption of foods and drinks containing added sugar and compare recommendations with the most recently available relevant Australian dietary intake and trend data. Differences in intakes of relevant food and drinks across quintiles of social disadvantage and in particular between Aboriginal and Torres Strait Islander groups and non-Indigenous Australians will also be explored.

Determinants of self-rated health and the role of acculturation: implications for health inequalities

ObjctivesSelf-rated health (SRH) is an important indicator of overall health, predicting morbidity and mortality. This paper investigates what individuals incorporate into their self-assessments of health and how acculturation plays a part in this assessment. The relationship of acculturation to SRH and whether it moderates the association between indicators of health and SRH is also examined.DesignThe paper is based on data from adults in the Boston Puerto Rican Health Study, living in the greater Boston area (n=1357) mean age 57.2 (SD = 7.6). We used multiple regression analysis and testing for moderation effects.ResultsThe strongest predictors of poor SRH were the number of existing medical conditions, functional problems, allostatic load and depressive symptoms. Poor SRH was also associated with being female, fewer years of education, heavy alcohol use, smoking, poverty, and low emotional support. More acculturated Puerto Rican adults rated their health more positively, which corresponded to better indicators of physical and psychological health. Additionally, acculturation moderated the association between some indicators of morbidity (functional status and depressive symptoms) and SRH.Self-assessments of overall health integrate diverse indicators, including psychological symptoms, functional status and objective health indicators such as chronic conditions and allostatic load. However, adults' assessments of overall health differed by acculturation, which moderated the association between health indicators and SRH. The data suggest that when in poor health, those less acculturated may understate the severity of their health problems when rating their overall health, thus SRH might thus conceal disparities. Using SRH can have implications for assessing health disparities in this population.

Chronic Malnutrition Among Overweight Hispanic Children: Understanding Health Disparities

Obesity may be masking other health problems such as height deficit, or stunting. Stunting may reflect the cumulative effect of chronic malnutrition especially in underserved immigrant communities. Exploratory analysis of a sample of children 2-19 years old from the 2007-2008 NHANES was used to assess the relationship between chronic malnutrition and overweight/obesity in Hispanic children. Overall, overweight/obesity prevalence was nearly 1 in 3 children and stunting prevalence was 3.1%. The prevalence of stunting varied significantly across race/ethnicity, with prevalence among Hispanics of 6.6%. Prevalence of stunting varied significantly by socio-economic characteristics within the Hispanic population. Our exploratory study showed differences in the prevalence of stunting across racial/ethnic groups and highlighted that overweight/obese Hispanic children have a higher prevalence of stunting compared with Non-Hispanic White overweight/obese children. More studies are needed to better understand the phenomenon and the implications for health inequities.

Health Inequalities in Correctional Institutions: Implications for Health Inequalities in the Community

In this feasibility study, we conducted a meta-analysis of health inequalities, especially around issues of nutrition and exercise, in correctional institutions compared to the community. The project explored the extent to which the inequalities found in the health of people in the community are mirrored by inequalities found in prison. Existing data were examined to assess what light they might shed on existing health inequalities, with emphasis on lifestyle issues that contribute to obesity. The project raised questions about the sources of health inequalities and how they could be reduced. Specifically, the study compared the diet and exercise lifestyles of prisoners versus the community to examine whether they correlate with the frequency of obesity, hypertension, and type 2 diabetes mellitus in the two populations.

The relationship between communication and behaviour in children: a case for public mental health?

This paper examines the overlap between two groups of children, those with speech, language and communication needs (SLCN) and those with social, emotional and behavioural difficulties (SEBD). The case is made that these are common and overlap, with serious consequences for the children and families concerned. The difficulties experienced by the children and their families have implications for health inequalities and should influence the way in which both child and adolescent mental health and public health services are conceptualised and delivered.

Health Inequalities in Korea: Current Conditions and Implications

The aim of this study is to summarize the current conditions and implications of health inequalities in South Korea. Through a literature review of empirical studies and supplementary analysis of the data presented in the 1998, 2001, and 2005 KNHANEs, we evaluated the extent and trends of socioeconomic inequalities in both health risk factors, such as smoking, physical activity, and obesity, and outcomes, such as total mortality, subjective poor health status by self-reports and metabolic syndrome. Relative risks and odds ratios were used to measure differences across socioeconomic groups, and the relative index of inequality was used to evaluate the changes in inequalities over time. We found clear inequalities to various degrees in most health indicators. While little change was observed in mortality differences over time, the socioeconomic gaps in risk factors and morbidity have been widening, with much larger differences among the younger population. Socioeconomic inequalities are pervasive across various health indicators, and some of them are increasing. The trends in socioeconomic inequalities in health should be carefully monitored, and comprehensive measures to alleviate health inequalities are needed, especially for young populations.

‘Dirty looks’ and ‘trampy places’ in young people's accounts of community and neighbourhood: Implications for health inequalities

This paper draws on preliminary data collected in an ongoing school-based research project for the Health Education Authority (HEA) which is exploring Putnam's (1993) concept of 'social capital' in relation to children and young people's well-being and health. Putnam's conceptualization of social capital consists of the following features: trust, reciprocal support, civic engagement, community identity, and social networks; and the premise is that levels of social capital in a community have an important effect on people's well-being. A range of qualitative methods have been used to elicit 12-15 year olds' views of friendship networks and neighbourhoods: (1) written accounts of out-of-school activities, who is important, definitions of 'friend', future aspirations and social networks (2) visual methods including map drawing and photography by the participants and (3) group discussions exploring use of and perceptions of neighbourhoods, and community and institutional participation. The paper presents data, which suggest that young people face many paradoxes and contradictions in their environments that on the one hand support them and on the other hand exclude them. They often seem to develop their own 'communities' in the face of a strongly felt hostility from the adults around them. The paper concludes firstly that age is an important structuring principle which needs to be taken into account when considering entitlements to use of public space within neighbourhoods, and secondly that how young people use and experience communal areas is likely to have an important effect on their sense of community identity and ultimately their well-being.