Reduction Of Inequalities Research Articles

Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review

Background Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations. Objective This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations. Methods A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions. Results The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023. Conclusions This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries. International Registered Report Identifier (IRRID) DERR1-10.2196/50798

Multi-scale spatiotemporal trends and corresponding disparities of PM2.5 exposure in China

Despite the effectiveness of targeted measures to mitigate air pollution, China—a developing country with high PM2.5 concentration and dense population, faces a high risk of PM2.5-related mortality. However, existing studies on long-term PM2.5 exposure in China have not reached a consensus as to which year it peaked during the “initially pollution, then mitigation” process. Furthermore, analyses in these studies were rarely undertaken from multi-spatial scales. In this study, a piecewise linear regression model was employed to detect the turning point of population-weighted exposure (PWE) to PM2.5 for the period 2000–2020. Multi-scale spatiotemporal patterns of PM2.5 exposure were evaluated during upward and downward periods at the province, city and county levels, and their corresponding disparities were estimated using the Gini index. The results showed that 2013 was the breakpoint year for PM2.5 PWE across China from 2000 to 2020. Cities and counties where PM2.5 PWE displayed increasing trends during the mitigation stage (2013–2020) basically became the heaviest PM2.5 exposure regions in 2020. High PM2.5 exposure was observed in Beijing-Tianjin-Hebei, Central China, and the Tarim Basin in Xinjiang, whereas lower PM2.5 exposure regions were mainly concentrated in Hainan Province, the Hengduan Mountains, and northern Xinjiang. These cross-provincial patterns might have been overlooked when conducting macro-scale analyses. Province-level PM2.5 exposure inequality was less than the city- and county-levels estimations, and regional inequalities were high in eastern and western China. In this study, multi-scale PM2.5 exposure trends and their disparities over a prolonged period were investigated, and the findings provide a reference for pollution mitigation and regional inequality reduction.

Impact of interventions to reduce racial disparities in receipt of breast cancer guideline-concordant treatment: A statewide simulation analysis.

160 Background: Inequities in the receipt of guideline-concordant treatment contribute to worse survival in Black breast cancer (BCa) patients. Inequity reduction interventions (e.g., navigation, bias training, and real-time treatment tracking) may close such treatment gaps. However, evidence to date has been derived from small-scale interventional studies, and the potential impact of these interventions on population-level disparities is unclear. The aim of this study was to simulate the effect of implementing inequity reduction interventions on observed racial inequities in treatment and downstream outcomes after BC diagnosis. Methods: We used data from the North Carolina (NC) Cancer Information and Population Health Resource - which links multi-payer claims to state cancer registry data, for women diagnosed with BCa in 2004-2017 - to calculate Black/non-Black inequities in the receipt of chemotherapy (CTx) within 4 months for women ages <70 with hormone receptor-negative stage Ib-III BCa (n=2,223) and endocrine therapy (ET) within 12 months for stage I-III hormone receptor-positive BCa (n=16,220) in NC. Using effect estimates from trials of inequity-reducing interventions, we simulated the potential increase in the proportion of patients receiving CTx or ET if such interventions were implemented statewide. We estimated the effect of this potential increase in CTx and ET receipt on 10-year BCa mortality by building cohort-, race-, and treatment receipt-stratified simulation Markov models. We report confidence bounds representing 95% of simulation results. Results: Only 70.7% and 72.9% of Black patients in our cohorts received guideline-recommend ET and CTx, respectively, in 2004-2017 (versus 74.3 and 79.4% of non-Black patients, respectively; p<.005). Statewide implementation of inequity reduction interventions could increase ET and CTx receipt among Black patients to 84.3% (79.1-89.3%) and 86.8% (81.5-91.9%), respectively. This would be expected to reduce 10-year BCa mortality among Black patients from 14.2% to 13.6% (13.3-13.9%) in the ET cohort and from 29.4% to 28.7% (28.3-29.1%) in the CTx group. As a result, the racial mortality gap would decrease from 5.7 to 5.2 (4.9-5.5) from 7.0 to 6.6 (6.2-6.9) in the CTx cohorts, respectively. Conclusions: Implementation of interventions designed to reduce treatment inequities are likely to improve cancer care equity. However, increases intreatment receipt alone will not close the BCa mortality gap. Inequities at other points on the cancer continuum, such as in pre-diagnostic risk factors, screening, diagnostic work-up, and post-treatment factors, may explain residual gaps which will require more comprehensive interventions to achieve full equity in breast cancer outcomes.

Santé publique France's cross-sectoral response to the climate and environmental changes

Abstract Heat is one of the most rapidly changing climate-related health issues. The Intergovernmental Panel on Climate Change (IPCC) considered that current existing and planned adaptation measures will not be sufficient to limit the health impacts of heat in Europe. The French heat wave alert system, set up in 2004, was one of the first and most innovative in the world thanks to a close collaboration between the French weather service Météo-France, the national public health agency and the ministry of health. It also benefits from a reactive syndromic surveillance based on emergency room visits and general practitioners emergency consultations. Yet, it is now challenged by the increase in frequency and intensity of heat waves due to climate change. The impacts of recent years show that short-term responses based on timely behavioural changes during heat waves are now insufficient. Structural adaptation measures are an asset, and should not only consider adaptation to heat, but also wider opportunities for mitigation and reduction of inequities, in order to promote robust healthy environments that protect against climate disruption. This presentation will share how Santé publique France is developing a set of interdisciplinary studies and an advocacy strategy to encourage stakeholders involved in urban planning and housing to better take into account the impact of heat in their projects.

‘Grunaus moves’ implementation as a best practice in tackling child obesity

Abstract Grunau moves targets children (4-12) and their environmental and living conditions and related actors, focus on deprived district (reduction of health inequalities). It aims at creating health promoting settings, environments to promote physical activity and healthy diet in children and families. This best practice confirmed differences in nutrition and opportunities for physical activity for children between advantaged and disadvantaged districts (health inequity).

Growth and inequality trade-offs to eradicate absolute poverty

The relationship between growth, inequality and poverty remains elusive, despite considerable scholarship. To what extent can governments rely on growth to eradicate poverty without reducing inequality? We derive a closed-form relationship between a minimum income threshold, changes in the Gini index of income inequality and average national income required to meet this target, independent of the form of income distribution. We develop a generalized form of redistribution and validate it against historical changes in inequality. We use this formulation to illustrate feasible growth-redistribution strategies to raise entire populations above the International Poverty Line ($1.90/day) by 2030, the Sustainable Development Goal 1, in two selective countries: India and Rwanda. We show that meeting this target would require unprecedented rates of both growth and inequality reduction in Rwanda. India could not eradicate acute poverty by 2030 with growth alone, but it could with only a modest reduction in inequality.

Frequency, inequalities and spatial distribution of oral health services utilization in Peruvian children under twelve years of age: a population-based comparative analysis of the years 2017 and 2021

BackgroundOral diseases pose a significant public health challenge among Peruvian children. However, oral health services utilization among them is marked by inequalities, which may have been exacerbated by the COVID-19 pandemic. The objective was to compare the frequency, inequalities, determinants of inequality, and spatial distribution in oral health services utilization in Peruvian children under 12 years of age in 2017 and 2021.MethodsComparative secondary data analysis from the Demographic and Family Health Survey (ENDES) for the years 2017 (38,787 minors) and 2021 (36,729 minors). Age-adjusted prevalence ratios (PR) with 95% confidence intervals (CI) were calculated to assess the change in oral health services utilization in the last 12 months between the years 2017 and 2021, stratifying by demographic and socioeconomic covariates. Inequality was assessed by decomposing the Erreygers Concentration Index (ECI) and calculating the percentage contribution to inequality of the independent variables. Spatial analysis was performed using spatial autocorrelation methods, Hot Spot Analysis, Cluster and Outlier analysis, Inverse Distance Weighting, ordinary Kriging, and Kulldorff analysis.ResultsThe probability of Peruvian children under 12 years of age using oral health services in the last 12 months was reduced by 45% in 2021 compared to 2017. The ECI identified a significant reduction in oral health services utilization inequalities at the national level (Diff: -0.0963; p < 0.001). The main contributor to inequality was higher tutor education level (55.2% in 2017 and 82.7% in 2021). In the comparison of spatial distribution, there was a greater dispersion of the conglomerates in which the use of oral health services is concentrated in 2021.ConclusionsThe frequency of oral health services utilization in the Peruvian children under 12 years of age was halved between 2017 and 2021. This problem is transversal to the entire population at the demographic and socioeconomic level. The key factor contributing to inequalities in the utilization of oral health services was the higher educational attainment of caregivers or guardians. Despite the improvement observed in inequalities and spatial distribution of the concentration of oral health services utilization, it is necessary to keep monitoring these patterns to guide decision-making.

A National Study on Psychological Violence in Brazil: Differences by Sex and Skin Color.

Violence is a global public health problem that affects especially the most vulnerable people. The aim was to analyze the prevalence of psychological violence in the Brazilian population and inequalities according to sex and skin color. This was a cross-sectional study in which the database of the National Health Survey 2019 was used. Psychological violence was considered present when an individual answered yes to at least one of the five variables investigated: In the last 12 months, has anyone (a) offended you, humiliated you, or ridiculed you in front of other people?; (b) yelled at you or called you names?; (c) used social media or cell phones to threaten, offend, curse, or expose your images without your consent?; (d) threatened to hurt you or hurt someone important to you?; and (e) destroyed something of yours on purpose? The independent variable was skin color. The crude prevalence ratio (PR) was determined by Poisson regression. All analyses were stratified by sex. Of the 88,531 respondents, 41,662 were males and 46,869 were females. The prevalence of the presence of psychological violence was 19% in women and 15.6% in men. Men and women with black/brown/yellow/indigenous skin color were 20% and 15% more likely to suffer one or more items of psychological violence, respectively, than men and women with white skin color (PR = 1.20; 95% CI [1.11, 1.30] and PR = 1.15; 95% CI [1.08, 1.23]). Psychological violence occurred predominantly against females and individuals with black/brown/yellow/indigenous skin color. There were notable inequalities in the exposure to this type of violence that need to be considered when making plans to address this problem. The findings emphasize the relevance of constantly reviewing political and social constructions to promote a reduction of inequalities.

Inequality: the scourge of the twenty-first century

ABSTRACT Rising inequality is a ubiquitous problem, encompassing every geographical region and nation in the world. Inequality can be contended to have replaced unemployment as our most vital economic issue. After nearly six decades of declining inequality from the time of the First World War, the process has reversed itself with a vengeance, and we may be about to surpass the very high levels of inequality that prevailed in 1914. The causes are multifarious, including accelerating globalisation, plutocratic politics, excessive emphasis on ‘meritocratic’ pay, declining public expenditure, and social protection combined with the high rates of return on ‘capital’ compared to the overall economy’s growth rate. Inequality between nation-states may be declining because of the rise of China, but within countries, inequalities are increasing everywhere. Excessive inequality prevents social mobility and contains the seeds of social conflict and even civil wars. Most crucially, excessive and rising inequality makes democratic politics and governance unsustainable. High inequality may be a causal factor behind the decline of democracy and the rise of autocracy and populism that we are witnessing globally. In the ultimate analysis, the reduction of inequality necessitates wealth taxes.

Trend of sociodemographic and economic inequalities in the use of maternal health services in Lao People’s Democratic Republic from 2006 to 2017: MICS data analysis.

BackgroundMaternal mortalities remain high in the Lao People’s Democratic Republic (Lao PDR). Since 2012, to improve access to maternal health services for all women, the country implemented several policies and strategies including user fee removal interventions for childbirth-related care. However, it remains unclear whether inequalities in access to services have reduced in the post-2012 period compared to pre-2012. Our study compared the change in sociodemographic and economic inequalities in access to maternal health services between 2006 to 2011–12 and 2011–12 to 2017.MethodsWe used the three most recent Lao Social Indicator Survey datasets conducted in 2006, 2011–12, and 2017 for this analysis. We assessed wealth, area of residence, ethnicity, educational attainment, and women’s age-related inequalities in the use of at least one antenatal care (ANC) visit with skilled personnel, institutional delivery, and at least one facility-based postnatal care (PNC) visit by mothers. The magnitude of inequalities was measured using concentration curves, concentration indices (CIX), and equiplots.ResultsThe coverage of at least one ANC with skilled personnel increased the most between 2012 and 2017, by 37.1% in Hmong minority ethnic group women, 36.1% in women living in rural areas, 31.1%, and 28.4 in the poorest and poor, respectively. In the same period, institutional deliveries increased the most among women in the middle quintiles by 32.8%, the poor by 29.3%, and Hmong women by 30.2%. The most significant reduction in inequalities was related to area of residence between 2006 and 2012 while it was based on wealth quintiles in the period 2011–12 to 2017. Finally, in 2017, wealth-related inequalities in institutional delivery remained high, with a CIX of 0.193 which was the highest of all CIX values.ConclusionThere was a significant decline in inequalities based on the area of residence in the use of maternal health services between 2006 and 2011–12 while between 2011–12 and 2017, the largest decrease was based on wealth quintiles. Policies and strategies implemented since 2011–12 might have been successful in improving access to maternal health services in Lao PDR. Meanwhile, more attention should be given to improving the uptake of facility-based PNC visits.

How Financial Development and Regional Integration Promotes Inclusive Growth? Evidence from BRI Countries?

This research examines the role of financial development and regional integration to attain inclusive growth in selected BRI countries from 2000 to 2020. Existing studies for BRI focused on economic growth, infrastructure development and environmental sustainability. A few studies indicated pro-poor growth, but no empirical study was found regarding inclusive growth. Economic growth is inclusive in a sense to promote employment level, reduction in poverty and inequality along with increased accessibility and social security. To incorporate these factors, this study calculates a detailed inclusive growth index incorporating its four dimensions using principal component analysis (PCA) and applies Pooled OLS and two stages least squares (2SLS) to overcome the endogeneity problem. The results shows that FD, TO and FDI are significant in explaining inclusive growth in selected countries. Moreover, four pillars of inclusive growth are individually analyzed to attain clearer results. These findings indicate that regional integration along with FD, TO and FDI increases economic growth with employment level, reduces poverty and inequality and increases accessibility with social protection. Therefore, the study recommends that outward FDI flow from China towards BRI emerging countries is crucial for employment generation with reduced poverty and inequality and improves accessibility and social security. Domestically, Host countries must stabilize their economies politically, socially, and culturally to attain maximum gain from this FDI inflow for sustainability.

Improved human greenspace exposure equality during 21st century urbanization

Greenspace plays a crucial role in urban ecosystems and has been recognized as a key factor in promoting sustainable and healthy city development. Recent studies have revealed a growing concern about urban greenspace exposure inequality; however, the extent to which urbanization affects human exposure to greenspace and associated inequalities over time remains unclear. Here, we incorporate a Landsat-based 30-meter time-series greenspace mapping and a population-weighted exposure framework to quantify the changes in human exposure to greenspace and associated equality (rather than equity) for 1028 global cities from 2000 to 2018. Results show a substantial increase in physical greenspace coverage and an improvement in human exposure to urban greenspace, leading to a reduction in greenspace exposure inequality over the past two decades. Nevertheless, we observe a contrast in the rate of reduction in greenspace exposure inequality between cities in the Global South and North, with a faster rate of reduction in the Global South, nearly four times that of the Global North. These findings provide valuable insights into the impact of urbanization on urban nature and environmental inequality change and can help inform future city greening efforts.

Social–Emotional Skills in Five-to-Six-Year-Olds in Social Hotspots in Germany: Individual Trajectories in a Prospective Cohort

AbstractSocial–emotional skills as valid predictors for subsequent school success should be promoted in early childhood. Preschools are a relevant setting to reach children from families with low socioeconomic status. The federal state law for children´s day-care and preschools in the state of Mecklenburg-Western Pomerania offers preschools in difficult social areas financial support for the individual targeted promotion. Prospective longitudinal observational data of a cohort: annual application of Dortmund Developmental Screening for Preschools domains “social competence” and “social interaction” over two years of 5-to-6-year-olds. Calculation of prevalence rate ratios and ratios of rate of improvements are divided by rate of deteriorations after one year. The proportion of children with inconclusive findings in “social competence” decreases. &gt; 50% have no finding after one year. In “social interaction,” the proportion of children with inconclusive findings increases. Both domains detected more improvements than deteriorations for all children after one year. The indicated improvement of developmental risks is possibly associated with a reduction of social inequalities and tend to improve equal opportunities for all children at school start. Nevertheless, results of some children are deteriorating. More effective promotion of social–emotional skills is needed also for children without developmental risks—especially for children with internalizing problems. Trial registration: German Clinical Trials Register, ID: DRKS00015134, Registered on 29 October 2018, retrospectively registered.

Maternal capital predicts investment in infant growth and development through lactation.

Maternal capital (MC) is a broad term from evolutionary biology, referring to any aspects of maternal phenotype that represent resources available for investment in offspring. We investigated MC in breastfeeding mothers of late preterm and early term infants, examining its relationship with infant and breastfeeding outcomes. We also determined whether MC modified the effect of the relaxation intervention on these outcomes. The data was collected as part of a randomized controlled trial investigating breastfeeding relaxation in 72 mothers of late preterm and early term infants. Indicators of MC (socioeconomic, social, somatic, reproductive, psychological, and cognitive) were collected at baseline at 2-3 weeks post-delivery. Principal Component Analysis was conducted for the MC measures and two components were identified: 1."Subjective" maternal capital which included stress and depression scores, and 2."Objective" maternal capital which included height, infant birth weight, and verbal memory. Univariate linear regression was conducted to assess the relationship between objective and subjective MC (predictors) and infant growth, infant behavior, maternal behavior, and infant feeding variables (outcomes) at 6-8 weeks. The interaction of MC and intervention assignment with outcomes was assessed. Higher objective MC was significantly associated with higher infant weight (0.43; 95%CI 0.21,0.66) and length z-scores (0.47; 95%CI 0.19,0.76), shorter duration of crying (-17.5; 95%CI -33.2,-1.9), and lower food (-0.28; 95%CI -0.48,-0.08) and satiety responsiveness (-0.17; 95%CI -0.31,-0.02) at 6-8 weeks. It was also associated with greater maternal responsiveness to infant cues (-0.05, 95%CI -0.09,-0.02 for non-responsiveness). Greater subjective maternal capital was significantly associated with higher breastfeeding frequency (2.3; 95%CI 0.8,3.8) and infant appetite (0.30; 95%CI 0.07,0.54). There was a significant interaction between the intervention assignment and objective MC for infant length, with trends for infant weight and crying, which indicated that the intervention had greater effects among mothers with lower capital. Higher MC was associated with better infant growth and shorter crying duration. This was possibly mediated through more frequent breastfeeding and prompt responsiveness to infant cues, reflecting greater maternal investment. The findings also suggest that a relaxation intervention was most effective among those with low MC, suggesting some reduction in social inequalities in health.

Non-linear dynamics in finance–inequality nexus: time series evidence from the Indian economy

PurposeThe principal aim of this study is to examine the relationship between financial development and income inequality in India using the financial Kuznets curve (FKC) hypothesis.Design/methodology/approachThis study uses the autoregressive distributed lag (ARDL) model and the Toda–-Yamamoto causality test to investigate the long-run and short-run relationship and causality between financial development and income inequality. In addition, this study employs a principal component analysis (PCA) to construct a comprehensive financial development index.FindingsThe study found a long-run relationship between financial development and income inequality in India for the period under consideration. Trade is found to improve the income distribution, while inflation worsens income distribution. Moreover, the empirical results revealed a feedback causality between financial development and income inequality. The study results confirm an inverted U-shaped relationship between financial sector development indicators and income inequality, thus validating the FKC hypothesis for the Indian economy.Research limitations/implicationsThe study draws attention of the government and policymakers, urging them to focus on building a strong financial sector by improving its efficiency. This, in turn, will lead to enhanced financial stability and a reduction in income inequality. They should prioritise the development of high-quality and sustainable financial products and services to ensure the robust growth of the financial sector.Originality/valueTo the best of our knowledge, this study is the latest of its kind to empirically test the financial development on income inequality and the FKC hypothesis simultaneously for the Indian economy using financial proxy variables from financial institutions (FIs) and financial markets (FMs) for the measurement of financial depth.

Does reducing income inequality promote the decoupling of economic growth from carbon footprint?

Mitigating climate change, improving economic growth, and reducing income inequality are three of Sustainable Development Goals (17 SDGs). It has been well understood that economic growth has a significant impact on carbon footprint, but it remains unclear whether this impact will be mitigated or intensified by reducing income inequality. By applying the Multi-Regional Input-Output model, this study assesses the consumption-based carbon footprints of 43 major economies over the period 1995–2019 and conducts the corresponding empirical analysis. Through examining the moderating effect of income inequality (Gini coefficient) on the relationship between economic growth (GDP per capita) and consumption-based carbon footprint (CO2 per capita), we demonstrate that a lower Gini coefficient – a more equitable distribution of income − could significantly promote the decoupling of economic growth from carbon footprint. The results also show a heterogeneous moderating effect of income inequality – reducing income inequality in rich countries helps decouple economic growth from carbon footprint more than in poor countries. This study contributes to a better understanding of the synergy among economic growth (SDG 8), income inequality reduction (SDG 10), and carbon mitigation (SDG 13). Given that reducing income inequality in the context of economic growth can have significant benefits for carbon mitigation, we would suggest that income inequality reduction should be incorporated into climate action, particularly in rich countries.

Income Leakage Regional Effects: Supply and Demand Shocks during the Pandemic in Brazil and Chile

During the COVID-19 pandemic, regions were affected by a combination of economic crises: weak demand and constrained supply. Several studies have sought to analyse the heterogeneous effects of supply and demand shocks on the labour market, economic growth, and the environment. This study has a different focus, estimating both direct and indirect effects of demand and supply shocks adopted during the pandemic in Brazil and Chile. Afterwards, the paper compares the degree of regional absorption (leakage) of income resulting from each of these shocks, applying an interregional input–output model for each country. The results of this study show that income absorption by the poorest regions is relatively greater in the case of a supply shock. It can be said, therefore, that this type of shock improves the retention of income generated in the poorest regions, favouring the development of these localities and the reduction in regional inequalities. The main reason for this result is that supply policies have restricted essential sectors to a lesser extent, and these sectors are generally less concentrated in large urban centres in both Brazil and Chile. In other words, much of the interregional leakage is driven by the demand for non-essential products, mainly in the richest urban economy centres. Finally, the geographical dimension of regional inequalities leads to the economic benefit of prosperous areas in the country when shocks occur in vulnerable regions, highlighting the centre–periphery pattern in both countries.

Social disparities in cardiovascular mortality of patients with cancer in the USA between 1999 and 2019

BackgroundTemporal trends of the impact of social determinants on cardiovascular outcomes of cancer patients has not been previously studied. ObjectivesThis study examined social disparities in cardiovascular mortality of people with and without cancer in the US population between 1999 and 2019. MethodsPrimary cardiovascular deaths were identified from the Multiple Cause of Death database and grouped by cancer status. The cancer cohort was subcategorized into breast, lung, prostate, colorectal, and haematological. The number of cardiovascular deaths, crude cardiovascular mortality rate, cardiovascular age-adjusted mortality rate (AAMR), and percentage change in cardiovascular AAMR were calculated by cancer status and cancer type, and stratified by sex, race, ethnicity, and urban-rural setting. Results17.9 million cardiovascular deaths were analysed. Of these, 572,222 occurred in patients with a record of cancer. The cancer cohort were older and included more men and White racial groups. Regardless of cancer status, cardiovascular AAMR was higher in men, rural settings, and Black or African American races. Cardiovascular AAMR declined over time, with greater reduction in those with cancer (−51.6% vs −38.3%); the greatest reductions were in colorectal (−68.4%), prostate (−60.0%), and breast (−58.8%) cancers. Sex, race, and ethnic disparities reduced over time, with greater narrowing in the cancer cohort. There was increase in urban-rural disparities, which appeared greater in those with cancer. ConclusionsWhile most social disparities narrowed over time, urban-rural disparities widened, with greater increase in those with cancer. Healthcare plans should incorporate strategies for reduction of health inequalities and to promote equitable access to cardio-oncology services.

Politik- und Marktversagen erfordern Entgeltund Rentenkorrektur

Abstract Pension policy with regard to statutory pension insurance can be described as a failure, at least since the Riester pension. It does not secure the standard of living and many pensioners are poor despite their pensions. In addition to a reduction in benefit levels, unemployment and significant inequality in income distribution also contribute to these developments. The author calls for compensating for this market and political failure and for raising the pension back to its original level.

Transformations in the world of healthcare work: workers and future challenges.

This article addresses the world of healthcare work, especially in the Brazilian Unified Healthcare System (SUS) in the context of the COVID-19 pandemic in Brazil. This study used data from the following surveys: "Working conditions of health professionals in the context of COVID-19 in Brazil" and "The Invisible health workers: working conditions and mental health in the context of COVID-19 in Brazil". Data analysis proves that the pandemic highlighted existing structural problems within SUS, involving the issue of healthcare workforce (HWF) management, which can be interpreted as another reflection of the socioeconomic inequalities that already exist in the country. This article highlights: the reduced provision of permanent education, the regulation of hybrid care, precariousness, a lack of protection in the work environment, as well as fragile biosecurity leading to tragic rates of illness and death of health workers. Our study concludes by showing the importance of formulating public policies in the scope of education and work management in SUS that ensure the discussion on hybrid care as a new way of acting without losing quality, together with the need to review issues related to permanent education, protection, valuation, and reduction of inequalities pointed out among the professional contingents analyzed in this article.