Inequalities In Access Research Articles

Perinatal and infant mental health care in Austria

Summary Purpose Perinatal mental illness (PMI) is one of the major health problems during pregnancy and one year after birth (the perinatal period), with robust evidence of its potentially detrimental effects on the parent’s and child’s health. Many countries have prioritised perinatal and infant mental health care (PIMHC). In Austria, it is currently unknown how many services are available in which region. The paper aims to map the current PIMHC landscape. Methods Using publicly accessible sources, such as health reports or organisation websites and supplementary information from experts, we collected data on eight characteristics of services to prevent, early identify, treat or support parents with a PMI. We extracted the information into tables, narratively summarised the results and presented a geographical visualisation of service availability. Results While there is currently no standardised nationwide systematic screening for PMI in place, there are a variety of services to support and treat parents with a PMI of different severity in Austria. However, there are large regional variations and gaps in care, particularly regarding specialised PIMHC and trained staff, leading to unequal access. PIMHC primarily addresses mothers and involves many, mostly public, providers and funding sources. Conclusion There is an urgent need to reduce the regional disparities regarding specialised PIMHC, ensuring adequate referrals and treatment and reducing inequalities in access to care. The results also call for a national strategy and defined political, administrative and service provider responsibilities based on international evidence-based recommendations. Investing in the training of staff and defined care pathways seems warranted.

STEAM en República Dominicana: retos presentes y oportunidades para el futuro

The STEAM approach (Science, Technology, Engineering, Arts, and Mathematics) has proven to be an innovative strategy for improving educational quality by fostering critical competencies such as creativity and problem-solving. In the Dominican Republic, its implementation has shown significant progress in specific contexts, although structural challenges limit its adoption at a national level. The purpose of this study was to analyze the current state of STEAM education in the country, identifying thematic gaps in the literature and proposing strategies to optimize its application. The research employed a qualitative approach based on a narrative literature review, gathering data from international and local sources and prioritizing studies that reflected the particularities of the Dominican context. The findings revealed successful cases, such as the Liceo Científico Dr. Miguel Canela Lázaro, where STEAM has enhanced academic performance and reduced learning gaps. However, limitations persist regarding teacher training, access to technological resources, and territorial inequality. It is concluded that the STEAM approach holds great potential to transform education in the country, provided that inclusive policies are implemented, teaching capacities are strengthened, and equity in access to resources is promoted.

Artificial intelligence in strengthening health services: a critical analysis of the literatura

Artificial intelligence (AI) is redefining healthcare services, offering innovative solutions that improve diagnostic accuracy, optimize resources, and personalize healthcare. This article analyzes the impact of AI on the healthcare sector through a semi-systematic review of the literature published between 2020 and 2024. Key trends are highlighted, such as the use of predictive algorithms in early diagnosis, the implementation of digital platforms for patient management, and the development of personalized therapies based on big data. Ethical challenges associated with the use of AI are also examined, such as data privacy, algorithm transparency, and equity in access to these technologies. The discussion addresses how interdisciplinary collaborations and professional training are essential to ensure effective and responsible adoption of AI in healthcare. Finally, the need to design inclusive and sustainable strategies that promote the use of AI as a complementary tool to human care is raised, contributing to a more efficient, equitable healthcare system focused on people's well-being. This analysis seeks to lay the groundwork for future research and applications in the field.

Addressing Healthcare Access Inequalities in South Africa: Evaluating Legislative and Human Rights Obligations and Proposing Strategies for Improvement

Addressing Healthcare Access Inequalities in South Africa: Evaluating Legislative and Human Rights Obligations and Proposing Strategies for Improvement

Overcoming Barriers to Inclusion: The Role of Financial Literacy and Digital Divide in Expanding Financial Access in Indonesia

This study explores the impact of financial literacy and the digital divide on financial inclusion in Indonesia using panel data from 35 provinces from 2015 to 2022. This study applies multiple linear regression and robust regression to ensure the consistency and validity of the estimation results. The analysis shows that improved financial literacy significantly contributes to expanding access to and use of formal financial services, especially in areas with limited infrastructure. On the other hand, the digital divide has been found to intensify access inequality, hindering the optimal use of digital financial services, especially in vulnerable communities and rural areas. These findings emphasize the importance of collaboration between the government, financial institutions, and technology providers when formulating integrated policies. Such policies should include inclusive financial literacy programs and digital infrastructure investments to encourage the adoption of digital services while reducing reliance on informal sources of financing. Thus, this research provides new insights for policymakers seeking to strengthen the inclusive financial system and ensure equitable access to financial services for all levels of society.

Harnessing deliberative regulation to address inequities in accessing healthcare services in England.

System-level decisions around the commissioning and provision of healthcare services in England have contributed to barriers in accessing the National Health Service. In this article, we ask how to better regulate resource allocation to ensure greater equity in access to healthcare services. First, we focus on the Health and Care Act 2022, which, drawing on principles of deliberative regulation to address health inequalities, initiates a shift away from previous regulatory approaches towards a collaborative decision-making model. We then shed light on the systemic factors creating and maintaining access barriers by considering shortcomings in previous regulatory approaches. With these in mind, we consider whether deliberative regulation-providing communities with resources to create normative solutions to intrinsic issues-could help address these systemic challenges. To assess the potential of laws or policies to achieve greater equity in healthcare, we also introduce an evaluative framework based on deliberative principles. We apply this framework to a case study of an Integrated Care System to gauge the extent to which the Health and Care Act 2022 has indeed been effectively adopting a deliberative approach by intentionally engaging marginalized communities in decision-making and devising accountability mechanisms for the allocation of healthcare resources.

Cognitive impairment in older people accessing public mental health services across Australia and New Zealand: Implications for clinical practice, workforce development and service provision.

Assessment and management of older people with cognitive impairment, especially those associated with psychiatric symptoms; are recognised as core capabilities of old age psychiatrists. Bi-national collections of HoNOS65+/HoNOS reveal that over 40% of older people entering public mental health services across Australia and New Zealand have a clinically significant rating on the HoNOS65+/HoNOS cognitive problem scale, with rates increasing with age, and significant regional variability. The high rates of cognitive impairment in these data reinforce the need for all mental health clinicians working with older people to have the capability to assess people with cognitive impairment. Once cognitive impairment is identified, clinicians must be equipped to incorporate the implications into individualised management plans, appropriate referral pathways and community support services. Such skills cannot be the sole responsibility of old age psychiatrists or aged care psychiatry services given the significant number of older people seen by adult mental health services. Regional variability in rates of cognitive impairment raises significant questions regarding variation in service eligibility criteria, equity of access to appropriate mental health care and the availability of a workforce and clinical environments that can meet the needs of older people with cognitive impairment. Finally, psychiatry trainees must learn about working with older people with various degrees of cognitive impairment as part of providing high-quality psychiatric care for an ageing population.

Assessing Urban Park Accessibility and Equity Using Open-Source Data in Jiujiang, China

Urban parks have become more important in residents’ daily lives owing to both rapid urbanization and increasing environmental pressures. Globally, there is growing concern regarding equitable access to urban parks, particularly in densely populated countries such as China. This study focuses on the accessibility and equity of urban parks in Jiujiang using walking route data obtained from an open-source platform through an application programming interface to assess park accessibility. We explored the equity of park accessibility from three perspectives: spatial, opportunity, and group equity. The results indicated that urban parks in central Jiujiang have significantly better accessibility than those in suburban areas. Less than half of the study area was covered within a 1500 m walking distance. There is a large service blind catchment in park accessibility. Similarly, disparities in the equity of park accessibility were observed. The Penpu sub-district has the best accessibility; in contrast, the Qili Lake sub-district benefits from less than 10% of park accessibility. Wealthier communities benefit more from park accessibility than disadvantaged communities. Our study aims to provide strategies for urban planning for policymakers. Strategies such as increasing park entrances, opening gated communities, and creating shared green spaces may help ensure environmental equity.

MICROBIAL THREATS TO PUBLIC HEALTH: EMERGING INFECTIOUS DISEASES AND THE ROLE OF PHARMACOLOGY- NARRATIVE REVIEW

Background: Emerging infectious diseases (EIDs) continue to pose significant threats to global public health, driven by environmental disruption, globalization, and the growing challenge of antimicrobial resistance (AMR). The integration of pharmacology and public health strategies is critical in addressing these threats. Objectives: This review explores the drivers of EIDs, the role of pharmacology in combating them, and the integration of innovations like vaccines and diagnostics into global health frameworks. It also identifies key gaps in knowledge and highlights potential future directions. Methods: A thematic analysis of recent literature was conducted, focusing on key findings related to pathogen evolution, the development of vaccines and therapeutics, and public health preparedness. Results: The review identifies zoonotic spillovers, climate change, and AMR as central drivers of EIDs. Advances such as mRNA vaccines and genomic technologies have significantly enhanced disease prevention and management. However, inequities in access to healthcare innovations and gaps in pathogen surveillance remain major challenges. AI-driven tools and one-health approaches are highlighted as emerging trends with transformative potential. Conclusions: Addressing EIDs requires interdisciplinary strategies that combine pharmacological innovations, public health measures, and global collaboration. Future research should focus on equitable access, advanced surveillance systems, and sustainable antimicrobial solutions to bridge existing gaps and improve global preparedness.

Exploring the role of digital infrastructure in school accreditation across types and geographies

This study examines the role of digital infrastructure in shaping school accreditation outcomes across public and private institutions in urban and suburban settings in Indonesia. Utilizing a quantitative correlational approach, data from 643 schools, including information on digital infrastructure, school types, geographical location, and accreditation scores, were analyzed. The results revealed a moderate positive correlation between digital infrastructure availability and accreditation outcomes, with public schools and urban schools generally outperforming their counterparts in suburban areas. Public schools benefited from superior access to digital tools, such as high-speed internet and smart classrooms, due to government funding, while private schools often faced resource limitations. Geographical disparities were also evident, with urban schools achieving higher digital readiness and better accreditation scores compared to suburban schools. These findings highlight systemic inequities in digital access that influence accreditation outcomes, emphasizing the need for targeted policies to bridge the digital divide. Interventions should prioritize under-resourced private schools and suburban areas to promote equitable educational opportunities and improve accreditation standards. This research contributes to the broader discourse on education equity and provides actionable insights for policymakers and educators aiming to enhance digital infrastructure in diverse educational contexts.

Community readiness to address disparities in access to cancer, palliative and end-of-life care for ethnic minorities

Abstract Background Inequalities in cancer, palliative, and end-of-life care services remain a significant challenge, particularly for ethnic minorities who face systemic barriers such as limited awareness, cultural stigmas, and language differences. These disparities hinder equitable access to essential services and contribute to poorer health outcomes for affected communities. Addressing these challenges requires targeted, culturally sensitive initiatives that promote both awareness and uptake of care. Community readiness is a critical factor in the success of such interventions, as it reflects the willingness and capacity of a community to engage with and support change. Methods A mixed-methods approach was used, combining individual interviews and two focus groups with key informants (N = 14). This study, conducted in the ethnically and geographically diverse region of Bedfordshire, Luton, and Milton Keynes in southeast England, aimed to assess community readiness to embrace initiatives designed to reduce health inequalities in cancer, palliative, and end-of-life care. The key informants, including faith leaders and professional stakeholders, rated community readiness on five anchored scales: Knowledge of efforts, Leadership, Knowledge of the issue, Community Climate, and Resources. The focus groups facilitated a discussion of the ratings, providing deeper insights into community dynamics and barriers. Results Overall, the community was identified as being at the pre-planning stage of readiness to address disparities in cancer, palliative, and end-of-life care for ethnic minorities. Quantitatively, faith and religious leaders assessed readiness at the vague awareness stage (mean: 3.88), while professional stakeholders rated it at the pre-planning stage (mean: 4.87). Qualitative findings highlighted limited community knowledge, passive leadership with potential for ‘community champions’ to foster openness, a positive climate influenced by younger generations, widespread misconceptions, language barriers, and resource constraints affecting service accessibility. Conclusions The Community Readiness Model provides an insight into the community’s position regarding disparities in access to cancer, palliative and end-of-life services. In order to ensure that continuing efforts are successful in addressing existing inequalities rather than exacerbating them, this study emphasises how critical it is to evaluate the readiness of the community in order to avoid widening inequalities in access and use of services.

Outreach as a Topical Direction of Approaching Library Services to Consumers

The aim of the article is to outline the state of outreach issues in Ukrainian librarianship, to reveal the guidelines of the international library community regarding outreach activity, to clarify paradigmatic relations between terms “outreach” and “non-stationary library service” for exchanging knowledge in the process of professional communication. Research methods. General scientific methods of cognition (analysis, synthesis, abstraction), semantic analysis, comparative analysis are used to compare the essence of terms; terminological analysis, method of content analysis are applied in the study of texts and documents. The scientific novelty of this research grounds on the fact that the contexts of outreach activity as a communicative, informative and educational activity direction of libraries in ensuring the citizens’ barrier-free access to information resources by means of non-stationary library services are outlined, and the relevance of this tendency in current conditions of Ukraine is substantiated. Main conclusions. In the information space of Ukraine, there are obvious contradictions between requirements for the general availability of information for the country’s citizens and objective/subjective factors that cause the presence of various barriers and determine the information inequality of access to information resources, the main of which are military operations and a decrease of the society’s interest to reading. In these conditions, non- stationary library service is updated as one of directions of informative and educational, as well as communicative activity of public libraries. Used in foreign librarian scientific discourse and practice activity, the term “outreach (outreach activity)”, is synonymous with the term from Ukrainian library science and practice “non-stationary library service”, and essentially characterises the informative and educational function of libraries in conditions of approaching library services to the population’s place of work, study, recreation or residence. International library institutions, library associations of foreign countries actively support outreach activity, offering recommendations for mobile library function and manuals for mobile service personnel, presenting it as as an integral and vital part of library practice in providing access to information and studying resources throughout life for all communities. Projects and practices of outreach activity in Ukraine appear as one of the relevant function forms in current conditions, and require positioning in the library science through the prism of comprehensive studying the communication strategies of libraries.

Inequity in access to liver transplant care: Time to make the invisible visible.

Inequity in access to liver transplant care: Time to make the invisible visible.

Integrated, Scaffolded, and Mandatory Community and Shelter Medicine Curriculum: Best Practices for Transformational Learning on Access to Veterinary Care.

Within veterinary medical education, there is increasing focus on equity and cultural competency/humility, especially within service learning in community and shelter medicine. This article reviews the current literature and draws from the experience of the Ontario Veterinary College Community Healthcare Partnership Program's development of a community and shelter medicine curriculum. We propose that to graduate veterinarians with the knowledge and skills to address inequities in access to veterinary care, a best practice is to integrate mandatory in-class and experiential learning activities, scaffolded across the curriculum. This is a best practice as it creates the best chance for transformational learning for students and is part of our responsibility to the communities we partner with to move toward cultural safety. This Best Practice report addresses the following questions: 1. What foundation of knowledge in community and shelter medicine is needed? (Five curricular pillars: animal welfare, vulnerable animals, spectrum of care, well-being, and cultural humility). 2. How should programs be structured? (Mandatory, integrated, and scaffolded curriculum). 3. What are the pedagogical goals? (Transformational learning). It is our hope that this synthesis is of value to other veterinary colleges seeking to develop programs and/or curricula in community and shelter medicine to address barriers to veterinary care access.

Left out in the cold - inequity in infectious disease control due to cold chain disparity.

Vaccines and diagnostic tools stand out as among the most influential advancements in public health, credited with averting an estimated 6 million deaths annually and substantially alleviating the burden of infectious disease. Despite this progress, the global imperative to prevent, detect, and combat infectious disease persists. Regrettably, hundreds of thousands of lives are still lost due to inadequate access to vaccines and diagnostics. A critical obstacle in accessibility lies in the requirement of reliable cold chain for their transportation and storage, a resource that remains inadequate in many regions, particularly in the developing world. Various factors, including socio-economic disparities, biological complexities, and manufacturing processes, exert significant influence on the availability and integrity of vaccines and diagnostic materials. This review aims to explore the multifaceted issue of inequality in access to disease control tools, examining the vulnerabilities of vaccines and diagnostics while also investigating recent advancements that offer promising solutions to improve thermal stability.

"Sometimes I just wanna be outside": A qualitative analysis of experiences with accessing community greenspace among people living with chronic mobility disability.

Exposure to nature is associated with better mental health in the general population, but prior evidence suggests that people living with severe, chronic mobility impairment from paralysis due to spinal cord injury (SCI) may not experience similar benefits. Since many people living with SCI use wheelchairs and other medical devices for mobility, further exploration of how people living with mobility disability experience greenspace is needed to achieve equity in access to all public places. We assessed experiences with accessing greenspace reported in a sample of people living with chronic SCI and the meanings they ascribe to these experiences for their health and quality of life. A thematic content analysis of the qualitative interview data from a mixed-methods study of community activity patterns among adults with SCI was conducted. Three major themes emerged: important accessibility features, strategies used to enable access, and psychosocial consequences of greenspace accessibility. These results suggest that people living with chronic mobility impairment have unmet needs for outdoor recreation that can be addressed through urban planning approaches that prioritize input from people with lived disability experience and universal design for creating equitable greenspace access, as well as ongoing policy work that aims to expand access to assistive technology needed for outdoor community activities.

Inequities in Access to Mental Health Services Among Asian American, Native Hawaiian, and Pacific Islander Medicaid Enrollees.

Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) people are often aggregated into a monolithic group, but when they are disaggregated into ethnic groups (e.g., Chinese), inequities can be identified. Using a representative sample of adult Medicaid enrollees (N=55,215), the authors assessed inequities in self-reported access to mental or behavioral health services between non-Hispanic AA and NHPI Medicaid enrollees and non-Hispanic White Medicaid enrollees, both by racial group and across 10 disaggregated ethnic groups. AA and NHPI enrollees, by race and all 10 ethnicities, reported significantly worse mental health care access than did White enrollees. The magnitude of disparities also differed between ethnic groups, ranging from -14.6 percentage points for Native Hawaiian enrollees to -43.6 percentage points for Vietnamese enrollees.

Immediate Postintervention Outcomes from a Randomized Trial that Sought to Enhance Access to Live Donor Kidney Transplant for Black and African Americans.

Eliminating racial inequities in access to kidney transplantation requires multilevel interventions that target both patients and health systems. The aim of this study was to determine whether adding culturally sensitive, web-based patient education to a transplant center-level intervention was associated with increased knowledge, motivation to pursue living donor kidney transplant, and confidence in the behavioral skills to discuss living donation among Black/African American patients with end-stage kidney disease. A total of 411 transplant candidates were randomized to intervention (N = 222) or control groups (N = 189) and completed measures at baseline and immediate follow-up during the transplant evaluation visit. Results indicated no significant change in knowledge across time or study condition. At immediate follow-up, participants of both study conditions exhibited a significantly higher motivation to pursue living donation (t = 3.066, P < .01) versus at baseline. Both study conditions demonstrated increased confidence in the behavioral skills to discuss living donation over time (t = 3.580, P < .001). Process evaluation findings demonstrated limited engagement with the online video content across both conditions. Results suggest that the intervention did not perform better than control but raised important considerations for the delivery of transplant education targeting Black/African American patients in a busy clinical setting.

From Clinician to Commissioner

The need to develop a workforce who can deliver on the purpose of enhancing equity of access to primary care has been identified by one of the 31 Primary Health Networks (PHN) established by the Australian Government in 2015. Over almost a decade, Hunter New England and Central Coast PHN has been undertaking assessments of its organisational capability to commission primary care services for the local community. The outcome of these assessments and of a training needs analysis for team members engaged in commissioning has lead to the development of a training program which is growing in sophistication. This has lead to the development of a Primary Care Commissioning Development Centre, which coordinates education and training for PHN teams, service providers and primary care clinicians in many aspects of the commissioning of primary care.

Mitigation of AI adoption bias through an improved autonomous AI system for diabetic retinal disease

Where adopted, Autonomous artificial Intelligence (AI) for Diabetic Retinal Disease (DRD) resolves longstanding racial, ethnic, and socioeconomic disparities, but AI adoption bias persists. This preregistered trial determined sensitivity and specificity of a previously FDA authorized AI, improved to compensate for lower contrast and smaller imaged area of a widely adopted, lower cost, handheld fundus camera (RetinaVue700, Baxter Healthcare, Deerfield, IL) to identify DRD in participants with diabetes without known DRD, in primary care. In 626 participants (1252 eyes) 50.8% male, 45.7% Hispanic, 17.3% Black, DRD prevalence was 29.0%, all prespecified non-inferiority endpoints were met and no racial, ethnic or sex bias was identified, against a Wisconsin Reading Center level I prognostic standard using widefield stereoscopic photography and macular Optical Coherence Tomography. Results suggest this improved autonomous AI system can mitigate AI adoption bias, while preserving safety and efficacy, potentially contributing to rapid scaling of health access equity. ClinicalTrials.gov NCT05808699 (3/29/2023).