Inequalities In Provision Research Articles

In Desperate Need: Public Sanitation in Contemporary London

AbstractThere has been a collapse in the number of public toilets in UK cities. Austerity cuts, a lack of legal requirements, and a failure to prioritise sanitation has led to significant health and equality impacts. Research on public toilets in the Global North focuses on their historical production, contemporary design, or on the experience of particular social groups, with less work bringing governance and social experience together. We argue for a focus on the “ungoverning” of sanitation, on how residents “learn” sanitation in the city, and on the need for radical transformation in sanitation approaches and delivery. Drawing on research in London, we set out the challenges for public toilet provision and make a case for a sanitation revolution in British cities. We focus on the experience of delivery drivers and residents with health concerns in order to illustrate the inequalities in provision and their consequences.

Equity in Public Facilities Provision in an Urban Area: A Spatial Analysis of Rajshahi City Corporation

In the Rajshahi City Corporation (RCC)area, spatial sizeis not proportionate to the placement of public facilities due to rapid urbanization and population growth. This raises the question ofwhat is the level of equity present inthe provision of public facilities in the city corporation area. For this research, primary schools, high schools, colleges, health facilities, and markets were selected from the available types of public facilities.Location Quotient (LQ) method and Gini Coefficientwere used to analyze locational concentration and spatial disparity in the provision of public facilities in 30 wards of Rajshahi City Corporation (RCC). Service area analysiswas done to show how much of the city corporation area falls under afavorable distance from the public facilities.The number of the wards having LQ value > 1 range from 9 – 15 based on different public facilities; showing locational concentration is present for all public facilities. The Gini coefficient (GC) values range from 0.41 to 0.67, showing a high level of spatial inequity. The service area analysis also shows the service area of the public facilities fail to cover all of the wards.In the future, inequity in provision of public facilities can compound with the increase in population and urban sprawl if not met with regulatory and inclusive planning policies.

Kidney Beam-A Cost-Effective Digital Intervention to Improve Mental Health

BackgroundThere is inequity in provision of physical rehabilitation services for people living with chronic kidney disease (CKD). The Kidney BEAM trial evaluated the clinical value and cost effectiveness of a physical activity digital health intervention in CKD. MethodsIn a single-blind, 11 centre, randomised controlled trial, 340 adult participants with CKD were randomly assigned to either the Kidney BEAM physical activity digital health intervention or a waitlist control. This study assesses the difference in the Kidney Disease Quality of Life Short Form 1.3 Mental Component Summary (KDQoL-SF1.3 MCS) between intervention and control groups at 6 months, and cost-effectiveness of the intervention. ResultsAt 6 months there was a significant difference in mean adjusted change in KDQoL MCS score between Kidney BEAM and waitlist control (intention-to-treat adjusted mean: 5.9 {95% confidence interval: 4.4 to 7.5} arbitrary units, p<0.0001), and a 93% and 98% chance of the intervention being cost-effective at a willingness to pay threshold of £20,000 and £30,000 per quality-adjusted life year gained. ConclusionThe Kidney BEAM physical activity digital health intervention is a clinically valuable and cost-effective means to improve mental health related quality of life in people with CKD (trial registration no. NCT04872933).

Unequal geographies of gender-affirming care: A comparative typology of trans-specific healthcare systems across Europe

RationaleGender-affirming healthcare can carry significant benefits for trans people. However, there are substantial geographical inequalities in the provision of and access to trans-specific healthcare across Europe. Comparative healthcare systems research has typically focused on universal services, neglecting provision which serves specific groups within populations (e.g., trans people). ObjectiveThis study aimed to develop a comparative typology of trans-specific healthcare systems across 28 European countries (the EU 27 plus the UK), and to examine country-level correlates which may influence or be influenced by these systems. MethodsUsing hierarchical and k-means cluster analysis, countries were classified into four types based on measures of trans-specific healthcare provision, regulation and access. Possible country-level correlates (including socio-political climate, medical outcomes, and the general healthcare system) were investigated. Results and discussionThe cluster analysis identified four clusters of trans-specific healthcare systems in Europe, characterized as: 1) Centralized conservative (highly centralized, extensive range of treatments, few trans-specific government policies); 2) Centralized reformist (highly centralized, extensive range of treatments, multiple trans-specific government policies); 3) Decentralized marketized (highly decentralized, moderate range of treatments, few trans-specific government policies); 4) Underdeveloped (highly decentralized, limited range of treatments, few or no trans-specific government policies). We found statistically significant differences between the clusters in rates of: public support for trans people; gender identity concealment; treatment access; overall health expenditure; gender inequality. ConclusionsThe study develops a novel typology of trans-specific healthcare systems in Europe. It also identifies a range of potential drivers and outcomes of geographical divergences and inequalities in trans-specific healthcare provision. Building on this typology, future comparative research should aim to link the structure of healthcare systems to outcomes for trans people. Comparative healthcare systems research must account for the distinctive forms taken by services and systems that provide healthcare to specific groups within populations.

A casemix classification for those receiving specialist palliative care during their last year of life across England: the C-CHANGE research programme

A casemix classification for those receiving specialist palliative care during their last year of life across England: the C-CHANGE research programme

Shoulder replacement surgery’s rising demand, inequality of provision, and variation in outcomes: cohort study using Hospital Episode Statistics for England

BackgroundThe aim of this study was to forecast future patient demand for shoulder replacement surgery in England and investigate any geographic and socioeconomic inequalities in service provision and patient outcomes.MethodsFor this cohort study, all elective shoulder replacements carried out by NHS hospitals and NHS-funded care in England from 1999 to 2020 were identified using Hospital Episode Statistics data. Eligible patients were aged 18 years and older. Shoulder replacements for malignancy or acute trauma were excluded. Population estimates and projections were obtained from the Office for National Statistics. Standardised incidence rates and the risks of serious adverse events (SAEs) and revision surgery were calculated and stratified by geographical region, socioeconomic deprivation, sex, and age band. Hospital costs for each admission were calculated using Healthcare Resource Group codes and NHS Reference Costs based on the National Reimbursement System. Projected rates and hospital costs were predicted until the year 2050 for two scenarios of future growth.ResultsA total of 77,613 elective primary and 5847 revision shoulder replacements were available for analysis. Between 1999 and 2020, the standardised incidence of primary shoulder replacements in England quadrupled from 2.6 to 10.4 per 100,000 population, increasing predominantly in patients aged over 65 years. As many as 1 in 6 patients needed to travel to a different region for their surgery indicating inequality of service provision. A temporal increase in SAEs was observed: the 30-day risk increased from 1.3 to 4.8% and the 90-day risk increased from 2.4 to 6.0%. Patients from the more deprived socioeconomic groups appeared to have a higher risk of SAEs and revision surgery. Shoulder replacements are forecast to increase by up to 234% by 2050 in England, reaching 20,912 procedures per year with an associated annual cost to hospitals of £235 million.ConclusionsThis study reports a rising incidence of shoulder replacements, regional disparities in service provision, and an overall increasing risk of SAEs, especially in more deprived socioeconomic groups. These findings highlight the need for better healthcare planning to match local population demand, while more research is needed to understand and prevent the increase observed in SAEs.

Addressing the Inequality of Disasters: The Role of Faith-based Organizations in Disaster Response and Recovery

Disasters have a significant global impact every year and disproportionally effect vulnerable populations. Disaster response efforts are often inequitable leaving already vulnerable populations at risk. These inequities in disaster response represent a social justice concern for congregations and congregational social workers and must be considered in future disaster recovery efforts. As churches and faith organizations provide essential disaster response and recovery services, this article outlines a model for increased inequity in provision of disaster response and recovery efforts. A case illustration using the COVID-19 pandemic is provided for further exploration of the equitable disaster response model in the context of congregations and congregational social work.

Low Vision Services Provision throughout NHS Trusts in the UK.

The aim of this study was to understand the picture of low vision service provision within NHS Trusts in the United Kingdom, for children and adults. A survey was distributed to all members of the British and Irish Orthoptic Society (BIOS) and to all Eye Clinic Liaison Officers (ECLOs) through the Royal National Institute for the Blind (RNIB). The survey was also directly emailed to Orthoptic contacts of all 238 Trusts/Health Boards, which covered the four nations of the United Kingdom. The survey asked whether their Trust had a clinical low vision service, which professions were involved in leading and working within it, where it was based, and whether provision was offered to children, adults, or both. In the United Kingdom (UK), 117 out of 238 (49%) Trusts responded. Of these responders, 94% had a level of Trust-delivered low vision service provision; 90% had services for adults; 83% had services for children; and 79% had services for both adults and children. Service accessibility for patients of all ages had regional and national variation. Significant variation was found in low vision service provision throughout the UK, with some regions having no NHS-delivered provision for either children, adults, or both. This calls for further research to gain a more comprehensive understanding of low vision service provision and remove inequalities in provision, access and resourcing, aiming to ensure equitable access for all.

Spirometry services in England post-pandemic and the potential role of AI support software: a qualitative study of challenges and opportunities.

Spirometry services to diagnose and monitor lung disease in primary care were identified as a priority in the NHS Long Term Plan, and are restarting post-COVID-19 pandemic in England; however, evidence regarding best practice is limited. To explore perspectives on spirometry provision in primary care, and the potential for artificial intelligence (AI) decision support software to aid quality and interpretation. Semi-structured interviews with stakeholders in spirometry services across England. Participants were recruited by snowball sampling. Interviews explored the pre- pandemic delivery of spirometry, restarting of services, and perceptions of the role of AI. Transcripts were analysed thematically. In total, 28 participants (mean years' clinical experience = 21.6 [standard deviation 9.4, range 3-40]) were interviewed between April and June 2022. Participants included clinicians (n = 25) and commissioners (n = 3); eight held regional and/or national respiratory network advisory roles. Four themes were identified: 1) historical challenges in provision of spirometry services; 2) inequity in post- pandemic spirometry provision and challenges to restarting spirometry in primary care; 3) future delivery closer to patients' homes by appropriately trained staff; and 4) the potential for AI to have supportive roles in spirometry. Stakeholders highlighted historic challenges and the damaging effects of the pandemic contributing to inequity in provision of spirometry, which must be addressed. Overall, stakeholders were positive about the potential of AI to support clinicians in quality assessment and interpretation of spirometry. However, it was evident that validation of the software must be sufficiently robust for clinicians and healthcare commissioners to have trust in the process.

Third sector provision of dementia support in the community: results from a scoping exercise of charity involvement in the UK

Third sector dementia support is characterised by wide variation and a heavy reliance on volunteer engagement. While there has been a growth in the reach and diversity of different schemes, their short-term funding results in a loss of networks, collaborations and local knowledge. This practice paper reflects on strengthening community-based dementia support and care via public and third sector partnerships. National and local data sources could help charities and commissioners begin to identify inequalities of provision.

Inequalities in provision of hip and knee replacement surgery for osteoarthritis by age, sex, and social deprivation in England between 2007-2017: A population-based cohort study of the National Joint Registry.

While the United Kingdom National Health Service aimed to reduce social inequalities in the provision of joint replacement, it is unclear whether these gaps have reduced. We describe secular trends in the provision of primary hip and knee replacement surgery between social deprivation groups. We used the National Joint Registry to identify all hip and knee replacements performed for osteoarthritis from 2007 to 2017 in England. The Index of Multiple Deprivation (IMD) 2015 was used to identify the relative level of deprivation of the patient living area. Multilevel negative binomial regression models were used to model the differences in rates of joint replacement. Choropleth maps of hip and knee replacement provision were produced to identify the geographical variation in provision by Clinical Commissioning Groups (CCGs). A total of 675,342 primary hip and 834,146 primary knee replacements were studied. The mean age was 70 years old (standard deviation: 9) with 60% and 56% of women undergoing hip and knee replacements, respectively. The overall rate of hip replacement increased from 27 to 36 per 10,000 person-years and knee replacement from 33 to 46. Inequalities of provision between the most (reference) and least affluent areas have remained constant for both joints (hip: rate ratio (RR) = 0.58, 95% confidence interval [0.56, 0.60] in 2007, RR = 0.59 [0.58, 0.61] in 2017; knee: RR = 0.82 [0.80, 0.85] in 2007, RR = 0.81 [0.80, 0.83] in 2017). For hip replacement, CCGs with the highest concentration of deprived areas had lower overall provision rates, and CCGs with very few deprived areas had higher provision rates. There was no clear pattern of provision inequalities between CCGs and deprivation concentration for knee replacement. Study limitations include the lack of publicly available information to explore these inequalities beyond age, sex, and geographical area. Information on clinical need for surgery or patient willingness to access care were unavailable. In this study, we found that there were inequalities, which remained constant over time, especially in the provision of hip replacement, by degree of social deprivation. Providers of healthcare need to take action to reduce this unwarranted variation in provision of surgery.

Some like it hot? Unequal provision of tree shading in Australian subtropical suburbs

ABSTRACT This pilot study, set in Brisbane, Australia, provides answers to the following research questions: (1) Is there inter- or intra-suburb inequality in street tree provision, in particular along routes that lead to public transport stops? (2) Are further investments in street trees justifiable on heatwave harm reduction alone? The pilot targets three suburbs away from the urban core, which have different socio-economic levels. The ‘number of street trees per kilometre’ is used as a foundational measure and a labour-intensive (but quite granular and accurate) data collection method is adopted. Our findings point toward inequality in the provision of street trees, especially in the lower income suburb. In the two wealthier suburbs too, street trees are not regarded as a pedestrian transport infrastructure asset. At the same time, our threshold analysis shows that street tree planting is justifiable on heatwave harm reduction alone. In the future, a study of all Brisbane streets would provide more conclusive answers.

Analysis of maternal mortality in Jammu and Kashmir: A retrospective study based on review of field data

Background: The inequities in provision of essential maternal healthcare have led to significant difference in maternal mortality globally. Having area specific data of maternal deaths are an important prerequisite for strengthening of reproductive and maternal health services. Aims and Objectives: The present study was conducted to estimate maternal mortality ratio (MMR) for J&amp;K and describe the epidemiological characteristics of maternal deaths. Materials and Methods: Data regarding maternal deaths and live birth from April 2020 to March 2021 were collected. Data for maternal deaths were analyzed with respect to epidemiological parameters. MMR and lifetime risk were calculated using standard formulas. Results: A total of 91 maternal deaths were reported in the same period. It translated to an MMR of 46 for J&amp;K. The mean age at death was 28.6 years ± 5.57. Primigravidae constituted 41.8% of deaths and most deaths (72.5%) had happened in post-natal period. Most of the deaths (78/91) had happened at tertiary level healthcare facilities with two facilities (LD Hospital, Srinagar &amp; SMGS Hospital Jammu) reporting (52/91) of the deaths. Deaths during transit contributed to 5% of total deaths. Eclampsia and post-partum hemorrhage were the most common causes of death and contributed to around 50% of deaths. Conclusion: The maternal mortality rate was estimated to be 46 with wide inter district variations. PPH and Eclampsia were the most common causes with most deaths happening within tertiary care hospitals.

Towards an Understanding of Population Health Data in a Single NHS Trust during COVID-19.

The objective of this study was to determine the further care needs of people discharged from the hospital following a COVID-19 illness from April–September 2020. Methods: In partnership with an NHS trust in the UK, data analysis was undertaken by linking data from the Trust, to facilitated a triage process. The intention was to provide information in a format that enabled an examination of the population data and highlight any inequality in provision. Data were mapped onto the indices of multiple deprivation, and a range of text and graphical methods were used to represent the population data to the hospital leadership. The visual representation of the demographics and deprivation of people discharged during a critical period of the pandemic was intended to support planning for community services. The results demonstrated that just under half of those discharged were from the poorest fifth of the English population and that just under half were aged 75 or older. This reflected the disproportional effect of COVID-19 on those who were poorer, older or had pre-existing multiple morbidities. Referral to community or outpatient services was informed by the analysis, and further understanding of the diversity of the population health was established in the Trust. Conclusion: By identifying the population and mapping to the IMD, it was possible to show that over half of discharged patients were from deprived communities, and there was significant organisational learning bout using data to identify inequalities.. The challenge of planning services that target underserved communities remains an important issue following the pandemic, and lessons learnt from one health system are being shared.

Towards an understanding of inequalities in accessing residential and nursing home provision: The role of geographical approaches.

Suggestions of the existence of so-called 'social care deserts' in England in the years leading up to the COVID-19 pandemic drew attention to the potential impact of geographical inequalities on the availability of residential, nursing and domiciliary care. To date, much of this analysis has been conducted at spatially aggregated scales such as that of local authorities or postcode sector. Hidden within such aggregate-level analysis however are geographical differences in the local provision of care services. In this paper, we draw attention to geographical modelling techniques that can be used to examine local trends in the supply of social care services in relation to potential demand. These spatial models can be used to examine variations in the number of facilities (or choice) within reasonable drive times/distances. Drawing on a national database of residential and nursing care beds in Wales for March 2020, we illustrate the potential of such techniques to provide an insight into current patterns in access to care homes, and to monitor future changes in the fall-out from the effects of the COVID-19 pandemic on the care home sector. The concentration of care home sites in metropolitan areas and in the heavily populated post-industrial valleys in the south-east is identified, but significant demand present in these areas ameliorates scores towards mid-range ratios. We conclude by suggesting that the types of techniques used in this study enable disparities in provision within localised areas to be better explored, thereby helping planners and policy makers to address potential inequalities in provision.

РЕФОРМИРОВАНИЕ ЗДРАВООХРАНЕНИЯ И ГОСУДАРСТВЕННАЯ РЕГИОНАЛЬНАЯ ПОЛИТИКА США

One of the reasons of social contradictions aggravation in modern USA is inequality of provision of the population with medical benefits, which actualizes the research of reforms and directions of regional policy, carried out by the state in the sphere of health care. The purpose of the research consists in revealing the tendency of formation of inequality in provision of the population of the USA with medical services, developed as a consequence of socio-economic and political processes in American society, expressed in permanent reforming of national health care and state regulation of regional problems. On the basis of the evolutional-genetic approach to the subject of research and the use of methods of statistical and economic analysis, as well as abstract-logical methods of processing of the theoretical material the results were obtained, that reflect the dynamics of the studied inequality and the factors determining it during 1951—2020 years were revealed. A number of conclusions reflecting the spatial-temporal and socio-structural nature of inequality in the provision of medical benefits to the US population, determined by the economic and political cyclism of the development of American society in the period under study, are made. The consequence of cyclicity is the inconsistency of reforming and using various types of state regional policy in the regulation of healthcare, depending on conjunctural factors.

The Lived Experience of Inequalities in the Provision of Treatment for Hepatitis C.

The issues of health, illness, stigma and inequalities in healthcare provision, areas that in my role as a social researcher were already of interest and concern, shifted to a different perspective when I was diagnosed with hepatitis C. From this altered position, my body and lifeworld were a nexus point for a range of ongoing challenges around staying as well as possible, and the struggle to get my healthcare needs met. There is a gap between the support provided for some ill and disabled people, and the help that they actually require. This is particularly so for conditions that are not well understood, that have a low public profile, limited funding, and/or are in some way stigmatised due to perceived differences to social norms. Hepatitis C is one such condition, it is a viral disease that is transmitted through blood-to-blood contact and it causes ongoing damage to the liver. Because of the systemic nature of the disease, individuals may struggle to cope with the demands of work and daily living, and their lifeworld and opportunities are frequently limited. It can be challenging for the patient to advocate for themselves due to low energy levels, self-blame for getting ill, and the stigma associated with the condition. The first generation of effective anti-viral drugs emerged from clinical trials in 2013, but in the United Kingdom context, access was only possible for those with advanced liver disease. Therefore, many patients felt compelled to purchase the anti-virals through Buyers Clubs, whereby generic versions of the drugs are imported for personal use at a fraction of the market cost. In this article I draw on my own lived experience of joining a Buyers Club as an example of how risks and benefits are weighed, and to explain the contexts in which decisions are shaped and made.

Walk this way: Pedestrian accessibility and equity in Barranquilla and Soledad, Colombia

As a transport mode available to everyone and most abled-bodied urban residents, walking is, actually, the most equitable mode of transport. Walking brings several benefits to inhabitants among money savings and health improvement. Unfortunately, despite its benefits, walking is not a priority in the urban planning agenda of some cities, especially in the Global South. Walkability conditions in some areas of these cities are not particularly friendly for pedestrians, which discourage walking trips and promotes inequities across inhabitants. Evidence supporting inequalities in the provision of adequate conditions for the use of active transport in the Global South cities remain scarce. This paper aims to contribute to filling this gap by first proposing a framework to link pedestrian accessibility with walkability measures. Specifically, we use a macro-scale measure of pedestrian accessibility and a meso-scale measure of walkability to compare walking conditions on different zones in Barranquilla and Soledad, Colombia. After comparing both measures, we found that low-income zones have higher walkability indexes but present lower potential pedestrian accessibility. In contrast, the highest potential pedestrian accessibilities were located in high and medium-income zones, where people rely more on private transport modes. This imbalance regarding supply and demand conditions for walking trips suggest that unfortunately, zones with the highest potential of being walkable are the ones that face more barriers to walk. Then, adequate planning policies when implemented in the right locations could promote higher use of walking and have the potential to reduce current inequalities in pedestrian infrastructure provision.

Addressing the Covid-19 Burden on Medical Education and Training: The Role of Telemedicine and Tele-Education During and Beyond the Pandemic.

Medical students are the future of sustainable health systems that are severely under pressure during COVID-19. The disruption in medical education and training has adversely impacted traditional medical education and medical students and is likely to have long-term implications beyond COVID-19. In this article, we present a comprehensive analysis of the existing structural and systemic challenges applicable to medical students and teaching/training programs and the impact of COVID-19 on medical students and education. Use of technologies such as telemedicine or remote education platforms can minimize increased mental health risks to this population. An overview of challenges during and beyond the COVID-19 pandemic are also discussed, and targeted recommendations to address acute and systemic issues in medical education and training are presented. During the transition from conventional in-person or classroom teaching to tele-delivery of educational programs, medical students have to navigate various social, economic and cultural factors which interfere with their personal and academic lives. This is especially relevant for those from vulnerable, underprivileged or minority backgrounds. Students from vulnerable backgrounds are influenced by environmental factors such as unemployment of themselves and family members, lack of or inequity in provision and access to educational technologies and remote delivery-platforms, and increased levels of mental health stressors due to prolonged isolation and self-quarantine measures. Technologies for remote education and training delivery as well as sustenance and increased delivery of general well-being and mental health services to medical students, especially to those at high-risk, are pivotal to our response to COVID-19 and beyond.

Sustainability of transport system: Case study of Greater Mumbai

Sustainable transport is about taking holistic approach by considering economic, society and environment along with the mobility and accessibility requirement of people. In case of Greater Mumbai, there is presence of inequity in provision of transport infrastructure and service. The first part of paper arrives at sustainability indicator by means of compounded economic, social &amp; demographic, land use and transport access indicators. The second part of paper measures the extent of sustainability in various wards of Greater Mumbai. It was important to study the extent of sustainability by measuring the gap between sustainability &amp; HDI indicator and sustainability &amp; transport access indicator. In terms of transport access, the gap between transport access indicator and sustainability indicator is present in most of the wards of Greater Mumbai. The overall result proves that there is urgent need to address the provision of transport access in most of the wards of Greater Mumbai. Purpose: The main purpose of this paper is to arrive at sustainability indicator and to measures the extent of sustainability in various wards of Greater Mumbai in transport. Methodology: The paper arrives at sustainability indicator by developing compounded economic, social and demographic, land use and transport access indicators. In order to calculate economic, social &amp; demographic, land-use and transport access indicator considered normalized value of each indicators derived from maximum point normalization across all wards. Finally equal weighted average of all indicators was taken to calculate the overall sustainability indicator. To measure the extent of sustainability in various wards of Greater Mumbai was done by comparing aggregate sustainable indicator with HDI indicator and transport access indicator. Result: The overall result proves that there is urgent need to address the provision of transport access in most of the wards of Greater Mumbai. The theoretical contribution: This paper arrives at sustainability indicator by compiling economic, social and demographic, land use and transport access indicators. Practical implications: This paper calculates ward level sustainability in Greater Mumbai and identifies the need to make provision of different transport infrastructure.