Inclusive Health Research Articles

Strategizing global health governance: unpacking opportunities and challenges for least developed nations within the WHO pandemic treaty framework.

Exploring the intricacies of the proposed WHO pandemic treaty, this paper underscores its potential benefits and challenges for Least Developed Nations (LDNs) in the global health landscape. While the treaty could elevate LDNs' access to vital resources, fortify health systems, and amplify their voice in global health governance, tangible challenges in safeguarding equitable access, protecting sovereignty, and ensuring compliance are illuminated. Concluding with targeted recommendations, the paper advocates for treaty revisions that assure resource access, safeguard LDNs' autonomy, and foster capacity-building. In essence, the paper emphasizes the imperative of genuinely empowering LDNs, crafting a pandemic treaty that establishes a more equitable, resilient, and inclusive global health future.

Interventions to improve access to primary care for inclusion health groups in England: a scoping review

BackgroundEveryone in England has the right to primary care without financial charges. Nevertheless, evidence shows that barriers remain for inclusion health populations such as vulnerable migrants, people experiencing homelessness, Gypsy, Roma, and Traveller (GRT) communities, and people who sell sex. There is little evidence for what works to improve access. This study was a scoping review of interventions to improve access to mainstream primary care for inclusion health groups in England. MethodsIn this scoping review, we searched databases (Embase, Medline, APA PsychInfo, the Cochrane Collaboration Library, Web of Science and CINAHL) and grey literature sources, including the National Health Service and National Institute for Clinical Excellence, for articles published in English between Jan 1, 2010, and Dec 31, 2020, with no limit on study design. Data were extracted according to inclusion criteria, including interventions taking place in England and targeting people with insecure immigration status, people who sell sex, people experiencing homelessness, and GRT communities. Results were presented in a narrative synthesis. Findings39 studies describing one or more interventions were included: four peer-reviewed articles (one randomised trial, two quality improvement projects, and one mixed-methods study protocol) and 25 grey literature items (38 interventions in total). Interventions mostly targeted people with insecure immigration status (17/38, 45%), and a majority (12/38, 32%) took place in London. The most common types of intervention were training, education, and resources (such as leaflets or websites) for patients or staff (25/38, 66%), and most interventions targeted GP registration processes (28/38, 74%). Interventions commonly involved voluntary and community sector organisations (16/38, 42%). Most interventions were not evaluated to understand their effectiveness (23/38, 61%). Sources with evaluations identified staff training, direct patient advocacy, and involvement of people with lived experience as effective elements. InterpretationInterventions to improve access to primary care for inclusion health groups in England were heterogeneous, commonly undertaken at community level, and developed to serve local inclusion health groups. Considerations for policymakers and practitioners include groups and geographical areas less commonly included in interventions, the elements of positive practice identified in evaluations, and the need for evaluation of future interventions. FundingNational Institute for Health and Care Research (NIHR 202050).

Perspectives on registration to primary care from inclusion health groups in England: a mixed-method study

BackgroundAlthough everyone living in the UK is entitled to access free primary care within the National Health Service (NHS), evidence shows that people in need of health care are wrongly being refused access. This study aimed to explore the perspectives of individuals from inclusion health groups on primary care registration and accessibility. MethodsThis was a mixed-methods study. From Oct 5, 2022, to Feb 20, 2023, we surveyed 49 people (36 [73%] men; 12 [24%] women) and interviewed 25 other (14 [56%] men; 11 [44%] women) who were service users of the University College London Hospital Find & Treat mobile service. This service included people with lived experience of homelessness, asylum seeking, addiction, selling sex, and irregular immigration. We recruited these participants through hostels for people with ongoing addiction and complex needs, initial asylum accommodation centres, and day shelters. Our research team included two peer researchers. FindingsOf those surveyed, 25 (51%) perceived their access to primary health-care services as good, and 17 (35%) reported obstacles to going to the general practitioner (GP). Participants described multiple barriers to registering for GP surgeries, including a lack of understanding and poor communication with NHS services, a fear of discrimination, and a lack of digital access that prevents information seeking and access to services. Respondents also reported using emergency services instead of primary care because they were more immediately accessible without previous registration. Facilitators to GP registration included one-on-one support and outreach work that helps people navigate into services and know their rights, and the use of specialist GP services, which are perceived as more accepting, especially for people experiencing homelessness. InterpretationThe barriers to registration identified are related to both individual and group level characteristics and produce both similar and divergent needs between different inclusion health groups. The need for additional support during registration was clear, and our work highlights the requirement for interventions to improve access to primary care for underserved groups, as well as coordinated policy action. One-on-one support in particular, either outreach or provided in services where inclusion health groups spend time, appears to be a key facilitator to ensuring comprehensive and fast access to GP services. FundingNational Institute for Health and Care Research (NIHR).

Global Disparities in COVID-19 Vaccine Distribution: A Call for More Integrated Approaches to Address Inequities in Emerging Health Challenges

The advent of the COVID-19 vaccine signified a historic milestone in the field of vaccinology, showcasing remarkable scientific collaboration and global solidarity. However, the most prominent hurdle in maximizing the global public health impact of vaccines remains the absence of comprehensive and inclusive health systems in both high- and low-resource settings. Our discussion centers around the major contributing factors that played a key role in formulating the rapid and efficacious COVID-19 vaccines. Simultaneously, we illuminate the disparities that have marred the vaccine delivery process throughout the pandemic. In particular, we highlight the case scenarios of two minority and vulnerable communities from the Global South and North—the undocumented migrants in Thailand and the Roma community in Europe—who continue to experience inequitable vaccine access regardless of their location. We note that a crucial programmatic solution that is rooted in inclusive and equitable global public health policy, characterized by empathy and trust and bolstered by digital innovation, is lacking. These examples underscore the significance of establishing a comprehensive and integrated health system at multiple levels across countries and the entire world. Furthermore, we highlight the need for both local and global actors to collaboratively engage in vaccine distribution efforts. By gaining a concise grasp of these intricacies, the global community will be better poised to effectively combat future pandemics and emerging health challenges.

Correlates of residents' enrolment intention toward inclusive commercial health insurance in China: involvement, perceived benefit, perceived sacrifice, and government participation.

As an application of inclusive finance in health insurance, inclusive commercial health insurance (ICHI) is a new public-private partnership-based health insurance scheme and has been vigorously promoted by the Chinese government in recent years to develop China Multi-level Health Insurance System, a system that aims to seek a mix of public and private sources to provide more affordable financial protection to all levels of society in line with their needs. However, the overall enrolment of ICHI scheme is still at a low level, and little is known about what influences residents' enrolment intentions. The aim of this study was to examine the multidimensional factors influencing residents' behavioral intentions and to develop a multivariate conceptual model to explore the psychographic process in the formation of enrolment intention. The empirical data used for model validation were obtained from a cross-sectional study conducted in Nanjing, China, a representative pilot city of ICHI scheme in 2022. Exploratory factor analysis, ANOVA, standard multiple regression, and hierarchical multiple regression were mainly employed for hypothesis testing. The findings revealed that involvement, perceived benefit, and perceived sacrifice are all crucial psychographic process factors in the formation of residents' enrolment intentions. Government participation positively moderates the influence path of "perceived benefit-enrolment intention" but negatively moderates the path of "perceived sacrifice-enrolment intention". Moreover, it was discovered that perceived benefit mediates the effect of involvement on enrolment intention, while perceived sacrifice does not. Improving residents' perceived benefit and involvement degree of the product, as well as reducing their perceived sacrifice, are both key to increasing their enrolment intentions. This study also points out that one of the main dilemmas in the current development of ICHI scheme is the low level of involvement among residents, and that optimizing the product design to make it more relevant to residents' lives is a more beneficial strategy to increase overall involvement.

Kernel Estimation of the Quintile Share Ratio index of Inequality for Heavy-tailed Income distributions

Evidence from micro-data shows that capital incomes are exceedingly volatile, which makes up a disproportionately high contribution to the overall inequality in populations with the heavy-tailed nature on the income distributions for many countries. The quintile share ratio (QSR) is a recently introduced measure of income inequality, also forming part of the European Laeken indicators and which cover four important dimensions of social inclusion (health, education, employment and financial poverty). In 2001, the European Council decided that income inequality in the European Union member states should be described using a number of indicators including the QSR. Non-parametric estimation has been developed on the QSR index for heavy-tailed capital incomes distributions. However, this method of estimation does not give satisfactory statistical performances, since it suffers badly from under coverage, and so we cannot rely on the non-parametric estimator. Hence, we need another estimator in the case of heavy tailed populations. This is the reason why we introduce, in this paper, a class of semi-parametric estimators of theQSR index of economic inequality for heavy-tailed income distributions. Our methodology is basedon the extreme value theory, which offers adequate statistical results for such distributions. Weestablish their asymptotic distribution, and through a simulation study, we illustrate their behaviorin terms of the absolute bias and the median squared error. The simulation results clearly showthat our estimators work well.

Проблема отношения нормально развивающихся подростков к инклюзивному оздоровлению

<p style="text-align: justify;"><strong>Objectives. </strong>Health improvement in an inclusive environment allows adolescents with special needs not only to improve their health, but also promotes their socialization and integration. Normally developing adolescents have another opportunity to make new friends and to develop the most important quality — tolerance. The attitude of normally developing adolescents to inclusive health improvement in the conditions of summer country camps in the Republic of Belarus was studied in order to determine the characteristics of the formation of an inclusive culture. </p> <p style="text-align: justify;"><strong>Methods. </strong>The empirical study involved adolescent children (N=412), a total of 263 girls and 149 boys, who underwent health improvement in nine summer camps in the Republic of Belarus. Age of respondents: 13—16 years. We used the author’s questionnaire, which includes the following content blocks: understanding the importance of inclusive health improvement, readiness for health improvement, experience of interaction with children with special needs, problems of joint health improvement.</p> <p style="text-align: justify;"><strong>Results. </strong>Half of the adolescents surveyed recognize the importance of inclusive health improvement, but only 20% expressed their willingness to participate in it. The respondents identified non-acceptance and negative attitudes from peers, problems in communication and interaction as the main difficulties for the child with special needs. The majority of participants (90%) do not have regular experience of communicating with children with special needs, and 27% of adolescents identify the expected difficulties in communication as the main obstacle. None of the adolescents who participated in the study wrote about their negative attitude towards children with special needs, but 44% assume that others will offend such peers.</p> <p style="text-align: justify;"><strong>Conclusions. </strong>Participants in children’s health camps of adolescence generally have a positive attitude towards the idea of inclusive shifts, while their personal unpreparedness for inclusive health can be explained by the lack of experience interacting with children with special needs. 44% of adolescents have an unclear attitude towards inclusion and children with special needs, and competent educational work on the part of teachers will help change this attitude to a positive one, increasing an inclusive culture.</p>

Representation in Health Professions Education: Striving for an Inclusive Health Professions Education Community.

Author representation and inclusivity in health professions education (HPE) scholarship is receiving increasing attention in academic medicine, with multiple articles calling for greater equity related to gender, geographic, and institutional affiliations. Despite journal efforts to seek diversity, authors from high-income English-speaking countries are the most highly represented in HPE scholarship. Less attention, however, has been focused on the openness of medical education scholars, themselves, to engaging in international collaborations with authors and institutions from low-and-middle income countries. This eye-opener is inspired by the authors' personal experiences in HPE scholarship from an international medical educator perspective and advocates for the creation of an open and inclusive multinational medical education community. We offer suggestions that can help create opportunities for networking, collaboration, and promoting a sense of belonging among HPE scholars worldwide. As researchers, journal editors and associate editors, and faculty in HPE programs, we can work together to create a welcoming and accommodating environment that embraces non-dominant voices and perspectives, with the ultimate goal of achieving diversity and equity in HPE scholarship.

Components of hostility and discrimination in cardiology.

The Gender-Diverse (TGD) population in Mexico faces significant health challenges, such as limited access to healthcare and a prevalence of adverse conditions. Cardiology is crucial for this population due to a high prevalence of risk factors and cardiovascular diseases. Despite a lack of precise data, it is estimated that 0.5-1.5% of the population identifies as TGD. They encounter sociocultural challenges, including discrimination and stigma, contributing to health issues and a lack of treatment access. Cardiovascular risk factors, hormone self-administration, and barriers to healthcare access are prominent concerns. Opportunities for improvement involve strengthening medical education, implementing inclusive policies, and promoting research and data collection. The development of specific clinical guidelines and inclusive health programs is suggested. The theory of minority stress emphasizes addressing chronic psychosocial stressors and recognizing the influence of stress factors on health. Integrating healthcare services for all populations in cardiology and fostering resilience are key strategies. In summary, a comprehensive approach is needed to reduce disparities in cardiac care and enhance the health of all populations in Mexico.

8.Q. Workshop: Covid-19 and pandemic measures: reducing or reproducing social and health inequities among migrants?

Abstract The Covid-19 pandemic has exacerbated preexisting social and health inequalities across communities, states and regions; and it has entailed major disruptions in human mobilities. There is evidence that the Covid-19 pandemic has thus had particularly severe and unique impacts on migrants, their families, and communities. However, as yet, little is known about the magnitude of Covid-19 related health inequalities among different migrant categories, and, moreover, about the structures and mechanisms - including pandemic measures - that have generated these inequalities. This workshop will provide an up-to-date overview of the available evidence on Covid-19 related health inequalities and on the effects of pandemic measures among different migrant categories worldwide. It will then “zoom in” on particular categories of marginalized migrants to critically examine the role of pandemic measures in mitigating or reproducing social and health inequalities. To this end, we will deliver three short presentations: The first presentation comprises a meta-analysis and synthesis of the empirical evidence on inequalities in Covid-19 related health risks and impacts of lockdown measures among migrants, refugees and internally displaced persons globally. The second presentation will render the results of a systematic review of the unintended consequences of pandemic measures on refugees accommodated in camp-like settings worldwide. The third presentation will address the occupational health and safety of migrant workers employed in food supply chain industries in Germany, the Netherlands, and the USA. Both the presented studies and the workshop itself benefit from bringing together academic researchers, representatives of governmental agencies (such as the German public health agency, Robert Koch Institute), and representatives of local and international non-governmental organizations (such as the International Organization of Migration). This team diversity allows us to draw on different perspectives, resources, kinds of knowledge, and skill sets, including scientific rigor and a practice-oriented approach aiming at informing public health policymaking. Our workshop will provide a consolidated, evidence-informed picture of social and health inequalities related to the Covid-19 pandemic and pandemic measures faced by migrant populations. On this basis, we will discuss with workshop participants what lessons can be learned for future emergency preparedness. For instance, what were shortcomings in the inclusion and accommodation of different migrant populations in the response to the Covid-19 pandemic? What were good practices? What are barriers and facilitators to migrants’ inclusion and equitable social and health protection during crises? What are evidence gaps and future directions for research, advocacy and policymaking? Key messages • The Covid-19 pandemic has exacerbated and intersected with preexisting structural disadvantages among migrants, putting them at higher risk for multiple adverse outcomes. • We present consolidated evidence to inform future pandemic preparedness toward migrant-sensitive public health policies and the context-specific consideration of migrants’ health and social needs.

4.Q. Workshop: Inclusive and non-discriminatory language and health communication: state, needs, perspectives

Abstract Language has the potential to cause harm when used unreflectively, e.g. the inaccurate and derogatory/stigmatising term ‘illegal migrant’, the terms ‘second (or third) generation migrant’ emphasising recency or lack of belonging, crude and imprecise descriptive labels such as ‘Blacks’ or ‘Asians’, historic terms such as ‘Oriental’ or ‘Easterner’, and other similar terms impliying second-class or outsider status, such as ‘alien’ or ‘foreigner’ (or indeed, ‘native’ when used to indicate a ‘first nation’ or autochthonous group lacking in status). This applies to everyday life, health care and research. In public health (e.g. in publications and study materials) and in policy and medical guidelines, there is a particular need for risk awareness of the potential for discrimination and stigmatisation through the language and terminology used. The issue has been discussed since the late 1980s and was identified as a clear challenge during the recent COVID-19 pandemic in light of the social and ethnic disparities of risks, incidence and vaccination uptake that were communicated in research, policies and interventions. However, there are only few guidelines or materials to support the responsible use of language. Moreover, reflection on language is often not considered as important as other aspects of public health research and practice. Yet it seems to be a basic requirement for ensuring responsible communication of policies and research results and within the research process itself. After all, classification and accuracy of decriptive terms and analysis categories are quality standards in public health research. In the workshop we will take stock of what has been achieved so far in the field of anti-discriminatory communication and language and what challenges were faced in terms of communicating evidence and policies in relation to the COVID-19 pandemic. This will be followed by a presentation of a specific example from the National Public Health Institute in Germany, which has developed a guideline on anti-discriminatory language. The important perspective of community/NGOs will be also included as a presentation. Building on the work of the last decades, the EUPHA conference offers a great opportunity to bring together perspectives and experiences from different researchers, institutions and countries. The workshop takes up the theme at a time when public health research on migrants and refugees is on the rise due to global crises including climate change and war, migratory movements, and the need for awareness and discourse on anti-discrimination and anti-racism within the modern globalised world. As a global public health community, we have a responsibility to shape the public discourse. It is in our hands to continue the discussion and to raise awareness for continuous (self-) reflection, responsible communication and appropriate terminology within the public health community. Key messages • The workshop aims to contribute to increased awareness for responsible and discrimination-sensitive language and terminology within the public health community. • The global public health community has a responsibility to represent the population in its diversity. Reflective, accurate and responsible discrimination-sensitive communication are essential.

Gender-specific personal values and life priorities: Insights from the Bedouin minority in Israel

Abstract Introduction Personal values play a crucial role in shaping health behaviors and decision-making. The study aimed to explore the values and priorities of the Bedouin minority in Israel using the Portrait Values Questionnaire (PVQ-21). While the PVQ-21 is widely used, few studies have examined its use among minority populations in Israel. Methods A cross-sectional survey was conducted among 331 Bedouin participants in Southern Israel. Participants completed the PVQ-21 questionnaire, which measures four key values related to self-transcendence (universalism and benevolence), self-enhancement (achievement and power), openness to change (self-direction, stimulation and hedonism), and conservation (security, conformity and tradition). Results The overall PVQ-21 score was significantly higher (p < 0.001) among Bedouin males (6.40±0.67) than females (5.92±0.89). Gender differences were significantly higher among men in self-transcendence (7.02±0.9 vs. 6.02± 1.21, respectively) and conservation (7.04±0.73 vs. 6.11±1.07, respectively), but not in self-enhancement and openness to change. Specifically, significant differences (p < 0.05) in conservation values were observed between residents of recognized towns and residents of newly recognized/unrecognized villages (6.66±1.07 vs. 6.42±0.95, respectively). Religiosity, marital status, and education were significantly associated with self-transcendence and conservation values. Conclusions This study provides valuable insights into the personal values and priorities of the Bedouin minority in Israel. The results suggest that Bedouin women prioritize values related to benevolence and conservation, which may reflect the traditional gender roles and expectations within Bedouin society. Recognizing the cultural context and unique value orientations within minority populations is essential for developing effective and inclusive health promotion strategies that can contribute to reducing health disparities and improving overall well-being. Key messages • Gender differences in personal values among Bedouin minority in Israel highlight the importance of understanding cultural context. • Recognizing the value priorities of minority populations is crucial for developing effective and inclusive health promotion strategies that address health disparities.

Do the future health professionals feel prepared to care for the increasingly diverse population?

Abstract Background Migrant and ethnic minority populations in Europe are growing, leading to a demand for health systems and health educations to accommodate the growing diversity. However, many medical educations in Europe, including Denmark, have not yet incorporated diversity competence training into their curriculum. The aim of the study is to investigate whether Danish medical students feel adequately prepared to provide care and address the needs of the increasingly diverse population. Methods An online survey was conducted by email to 5234 students in four medical Master programs in Denmark or were undergoing clinical internship. Reminders were distributed by email, shared in Facebook groups and were presented during lectures where cards with QR codes for the survey were distributed. Data collection took place during spring 2023. The survey questions were adapted from the validated Recidency Training In Cross-Cultural Care questionnaire (University of Boston and Harvard University), with adjustments from the University of Hawaii. Results Across universities 64% - 80% of the participating medical students and young physicians reported that they felt very or somewhat unprepared when it comes to care for patients who are new immigrants. Additionally, 57%-83% of the participants felt very or somewhat unprepared in providing care for patients with a distrust of the Danish health care system. In total, 31% reported feeling helpless at times or often in the last year when providing care to patients from a culture different from their own. Conclusions Our findings indicate that many Danish medical students and young physicians feel challenged and unprepared when it comes to providing care to migrants and ethnic minority patients. The variation between universities may reflect differences in curriculum and patient composition. Key messages • The increasing diversity of European populations is a challenge to the medical profession and not yet sufficiently reflected in Danish medical training. • Medical schools need to ensure development and integration of diversity competence training in the medical programs in order to support inclusive health care services.

“Economic migrants will anyway be deported soon”. Negotiating access and deservingness of refugees

Abstract Background Conflicting rationales permeate the European discourse on refugee migration: inclusiveness and human rights clash with xenophobia and aims to protect territory and wealth. Against this backdrop, health care access for newly arrived refugees in many European countries is restricted. The legal frame in Germany allows for extended restrictions as well as inclusive health care. While vague legal formulations create uncertainties regarding entitlements, they allow for discretionary decisions by a plethora of health care and government actors. Methods An ethnographic field study in two German refugee outpatient clinics including participant observation and interviews with 29 members of health care, administrative, social work and interpreting staff was conducted. By means of a qualitative content analysis we explored prioritisation criteria and negotiations about service provision to refugees by street-level decision-makers. Results Medical decision makers adopted government criteria to increase the chances of success of requests for reimbursement. We could identify various non-medical criteria, like asylum status and logistics impacting on access to care. Political and societal discourses seeped into discussions on granting or denying medical services: Medical and government decision-makers reflected on prospects of staying associated with the countries of origin of asylum seekers and illegitimate motives for flight, such as poverty, while negotiating what services should be provided to whom. Conclusions The vagueness of legal concepts allows for the implementation of restrictions based on non-medical grounds in practice, that would contradict international conventions if included in the legal norm unambiguously. In the face of contradictory imperatives, the state has chosen to leave policymaking to practitioners. They are in danger of being instrumentalized as agents of migration control, exclusion and deterrence, which raises practical and ethical questions. Key messages • Legal uncertainty leads to inconsistent medical care practices, that can exacerbate health inequities. • Health professionals have to be made aware of their responsibility as gate keepers to the medical system for refugees, so they cannot be politically instrumentalized as agents of migration control.

Health and Well-Being in Higher Education: Student Perception of an Australian University

The health and well-being of university students is a priority agenda, given the need to advance health in the university system and the United Nations Sustainability Development Goal regarding quality and inclusive education. However, current literature lacks adequate insights regarding health and well-being considerations. This study investigated students’ perceptions concerning how university students experience health and well-being. The study is underpinned using the biopsychosocial model of health and was conducted via a cross-sectional student survey with quantitative and open-ended questions at an Australian university in 2021. A hierarchical regression model with 625 respondents indicated health and well-being are significantly influenced by mental (t-value = 15.7, p < 0.001), physical (t-value = 9.48, p < 0.001), university learning (t-value = 5.16, p < 0.001), and economic (t-value = 4.78, p < 0.001) domains regardless of the demographic and study characteristics of students. Students’ perception of their health and well-being varied according to student age, the college of study, and whether they were an international student. Both the quantitative and qualitative findings supported that the mental, physical, university learning, and economic domains of students’ health and well-being are interdependent. There is a case for a proactive, continuous, inclusive, and holistic health and well-being approach to support student success in higher education.

Association Between Temporary Employment and Gradient Health Outcomes Among Chinese Workers.

Temporary workers' health problems in China have raised concerns recently. This study aimed to assess the relationship between temporary employment and three health outcomes with gradient severity and explore mediating mechanisms. Data was obtained from a national cross-sectional survey (China General Social Survey 2018). Compared with regular workers, temporary workers reported more frequent mood disorders (β = 0.197) and disturbance of daily activities (β = 0.132), however, there was no significant difference in serious health risks (inpatient treatment) between temporary and regular workers. Income poverty, subjective social status, and family relative socioeconomic status were significant mediators. The results suggest that temporary workers have higher general health risks, and economic deprivation is the main mechanism. Therefore, Chinese policymakers should provide more inclusive preventive health services beyond the existing health care system focused on critical illness to reduce the general health risks of grassroots workers.

Conflict and antagonism within global psychiatry: A discourse analysis of organisational responses to the UN reports on rights-based approaches in mental health.

Between 2017 and 2020, the UN Special Rapporteur (SR) Dainius Puras published three reports that called for significant changes to organisation, funding and service provision in mental health care in ways that emphasise inclusive, rights-oriented, democratic and sustainable community health services. This article aims to examine formal organisational responses to the UN mental health reports and consider the underlying arguments that either support or delegitimise the SR stance on the need for a paradigmatic shift towards a human rights-based approach to mental health. By combining several different search strategies to identify organisational responses across the web, a total of 13 organisational responses were included in the analysis. Given the political nature of the responses, concepts from discourse theory were used to analyse the responses. The analysis showed how the responses articulated two binary positions and contesting articulations of good mental health care, which formed a backdrop for rejecting the SR reports in defence of psychiatry. The discussion elucidates how the responses tend to resemble previous ways in which critique has been dealt with mainly by 'biological psychiatry', but that the counter-critical nature of the medical and psychiatric organisational responses remains in contrast to the broader reception within the UN community.

Developing inclusive digital health diagnostic for schistosomiasis: a need for guidance via target product profiles

IntroductionThe INSPIRED project aims to develop inclusive Digital Optical Diagnostic Devices (DODDs) for schistosomiasis, to support disease management by enabling rapid diagnostic results, to improve efficient data management to guide decision-making and to provide healthcare workers with critical health information to facilitate follow-up action. Due to the non-availability of Target Product Profiles (TPPs) for guiding the development of digital diagnostics for schistosomiasis, we explored existing diagnostic TPPs.MethodsUsing a curated open access database (Notion database), we studied a selection of TPPs for diagnosing infectious diseases, focusing on specifications related to digital health products for Neglected Tropical Diseases (NTDs).ResultsEighteen TPPs originating from 12 documents, covering 13 specific diseases, were selected and their characteristics were labeled and entered into the database. Further exploration of the database revealed several gaps, including a lack of stakeholder input, sustainability, and TPP availability. Other significant gaps related to digital health platform interconnectivity and data stewardship specifically in relation to digital diagnostics, including DODDs.DiscussionThese findings reflect two possible scenarios: (1) there is currently no need for digital diagnostic devices for schistosomiasis and, by extension for other NTDs; or (2) those needs are not yet covered by TPPs. Therefore, we recommend that digital health diagnostics are included in the use cases for schistosomiasis control and elimination, at least in the ideal/desirable scenario, as this will guide research and incentivize investment in digital health diagnostics for schistosomiasis.

Small numbers, big impact: making a utilitarian case for the contribution of inclusion health to population health in England

Inclusion health groups make up a small proportion of the general population, so despite the extreme social exclusion and poor health outcomes that these groups experience, they are often overlooked...

Context, health and migration: a systematic review of natural experiments

Migration health research pays little attention to the places into which people migrate. Studies on health effects of contextual factors are often limited because of the ability of individuals to self-select their environment, but natural experiments may allow for the causal effect of contexts to be examined. The objective was to synthesise the evidence on contextual health effects from natural experiments among migrant groups. We performed a systematic review of natural experiments among migrant populations in PubMed/MEDLINE, The Cochrane Library, Web of Science, CINAHL and Google Scholar for literature published until 13 October 2022. 5870 articles were screened in duplicate using the following inclusion criteria: quantitative natural experiment design, migrant population, context factor as treatment variable and health or healthcare outcome variable. Synthesis without meta-analysis was performed following quality appraisal using the EPHPP tool for quantitative studies and data extraction (PROSPERO: CRD42020169236). The 46 included articles provide evidence for negative effects of neighbourhood disadvantage on physical health and mortality, while finding mixed effects on mental health. Articles comparing migrants with those that stayed behind demonstrate detrimental effects of migration and adverse post-migratory contexts on physical health and mortality, while demonstrating favourable effects for mental and child health. Natural experiments of policy environments indicate the negative impacts of restrictive migration and social policies on healthcare utilization, mental health and mortality, as well as the positive health effects when restrictions are lifted. Natural experiments complement observational studies and provide robust evidence to advocate for more inclusive migration, health and social policies as well as neighbourhood improvement programmes. In order to strengthen the methodological approach, future research utilising natural experiments should be more explicit in the mechanisms underlying the experiment and provide details on potential causal mechanisms for the observed effects. German Science Foundation (FOR: 2928/GZ: BO5233/1-1).