Health Inequalities Research Articles

Using artificial intelligence to address mental health inequalities: co-creating machine learning algorithms with key stakeholders and citizen engagement

Purpose Artificial intelligence (AI) is poised to reshape mental health practices, policies and research in the coming decade. Simultaneously, mental health inequalities persist globally, imposing considerable costs on individuals, communities and economies. This study aims to investigate the impact of AI technologies on future citizenship for individuals with mental health challenges (MHCs). Design/methodology/approach This research used a community-based participatory approach, engaging peer researchers to explore the perspectives of adults with MHCs from a peer-led mental health organisation. This study evaluated potential threats and opportunities presented by AI technologies for future citizenship through a co-created film, depicting a news broadcast set in 2042. Data were gathered via semi-structured interviews and focus groups and were analysed using a reflexive thematic approach. Findings The analysis identified four key themes: Who holds the power? The divide, What it means to be human, and Having a voice. The findings indicate that adults with living experiences of MHCs are eager to influence the development of AI technologies that affect their lives. Participants emphasised the importance of activism and co-production while expressing concerns about further marginalisation. Originality/value This study provides new insights into the intersection of AI, technology and citizenship, highlighting the critical need for inclusive practices in technological advancement. By incorporating the perspectives of individuals with living experiences, this study advocates for participatory approaches in shaping AI technologies in mental health. This includes the co-creation of machine learning algorithms and fostering citizen engagement to ensure that advancements are equitable and empowering for people with MHCs.

The Role of Health Systems in Cross-Sector Collaboration in Addressing Social Determinants of Health and Promoting Health and Well-Being.

The articles featured underscore the critical role of trust, strategic planning, and cross-sector partnerships in addressing health inequities, while emphasizing the need for further research on sustainable and cost-effective collaboration models. Tocco and colleagues from Northwell Health describe the formation of the Health Equity Taskforce (HET), initially aimed at equitable COVID-19 vaccine distribution on Long Island. The HET has since expanded to address broader health disparities, focusing on community involvement, strategic partnerships, and sustainability. Nemiroff and colleagues discuss collaborations with community partners and payors to address social determinants of health in underserved populations, highlighting opportunities that can facilitate collaborations such as the New York State's Medicaid 1115 Demonstration Waiver.

Appalachia - Bridging the Opioid Epidemic Amid the Fentanyl Crisis.

Although the opioid epidemic and fentanyl crisis are nationwide problems of immense proportions, calming the storm raging across the isolating geo-economic framework of Appalachia demonstrates the need for courageous, culturally effective programs that have the power to address and overcome the grave situation of addiction in this region. In the Appalachian region, unjust social structures are embedded in the communities' socio-economic conditions. As this reality poses even greater barriers to addressing the opioid epidemic in these communities, the restoration of social relationships within a community becomes vital to the development of a broader approach to social functioning and human flourishing. Faith traditions and faith communities can play an important role in helping to establish and support such social cohesion through attention to the individual, social, and spiritual needs of the community. This essay explores the complex problem of the opioid epidemic compounded by the fentanyl crisis. It considers the importance of public health research within the regional geo-economic framework of Appalachia to (a) inform policies that improve health inequities and promote social cohesion, (b) develop social solutions with a spiritual dimension, and (c) reveal remedies capable of informing moral norms in support of building a more just society. Reflecting on the virtue of solidarity, this essay also highlights the witness of the Catholic Church's response to the suffering experienced within the communities and the societies within the Appalachian mountains. While there may be considerable interest in viewing this article as a research document, foundationally, this essay utilizes a literary narrative approach through a Catholic lens to inform ethical deliberations, reasoning, and practice while supporting ethical reflection and consideration of the responses raised. Further, the reader is strongly encouraged to reference the comprehensive footnote system provided for extension and verification of the data presented.

Can a smoking cessation app benefit individuals in disadvantaged areas? A qualitative study on motivation, barriers, and perceptions of a digital app in stockholm, sweden

ObjectiveIn Sweden, the prevalence of daily smoking has decreased substantially over the past few decades. However, a socioeconomic divide is evident, contributing to health inequities. The current study focuses on the needs, facilitators, and barriers in relation to quitting smoking among individuals in disadvantaged areas and explores their perception of digital tools for smoking cessation. MethodSemi-structured interviews were conducted with 30 participants in Stockholm County between 2022 and 2023. Participants were recruited through health care centres, dental clinics, and civil society actors. A thematic analysis was performed. ResultsTwo cross-cutting main themes were identified; 1) Motivational factors and barriers in smoking cessation, including the subthemes “health, concern for loved ones and economic aspects” and “emotional, environmental, and cultural barriers” and 2) Benefits and limitations of a digital tool for smoking cessation, including the subthemes”important/relevant features in a digital app” and “limitations of digital support”. ConclusionsThe results reveal that most participants want to quit smoking but perceive it as difficult. The study highlights the importance of addressing social disparities in smoking and the need for accessible smoking cessation support. While mobile apps are viewed as promising for smoking cessation by some of the participants, scepticism exists among others. Moving forward, personalized approaches that integrate digital tools with traditional methods for smoking cessation can be important to reduce smoking prevalence. Ensuring accessibility of effective smoking cessation support for all is a key public health interest.

Commentary on “Racial and ethnic diversity in academic nursing leadership: A cross-sectional analysis” by Travers and colleagues (2024)

The purpose of this commentary is to highlight key points made by Travers and colleagues (2024) in their study entitled, “Racial and ethnic diversity in academic nursing leadership: A cross-sectional analysis” and provide additional recommendations for future research and policy related to diversity in academic nursing leadership. While there is a significant underrepresentation of racial and ethnic minoritized populations in academic leadership in nursing, the level of underrepresentation and contributors to underrepresentation are not the same across racial and ethnic minoritized populations. As we design strategies to promote diversity in academic nursing it is important to benchmark efforts to ensure representation from groups who experience the most significant health inequities, create tailored strategies that consider the unique historical and contemporary barriers to leadership in academic nursing across and within minoritized groups, and build upon evidence-based strategies, especially the important role that minority serving institutions have played.

Modeling the Population Equity of Alzheimer Disease Treatments in the US

The arrival of new medications for Alzheimer disease (AD) has prompted efforts to measure their value using conventional cost-effectiveness analyses; however, these analyses focus on how much health improvement new medications generate per dollar spent. As AD disproportionately affects older adults, women, racial and ethnic minority individuals, and individuals with lower socioeconomic and educational levels, it is critical to also examine the health equity outcomes of treatment. To estimate the health equity impact of a hypothetical disease-modifying treatment for early AD in the US and to examine targeted policies to mitigate health care disparities. This economic evaluation, which used a distributional cost-effectiveness analysis, was conducted from June 16, 2022, to January 11, 2024. The study included subgroups defined by race and ethnicity and by social vulnerability quintiles in the US. A hypothetical disease-modifying treatment compared with best supportive care. The main outcomes were population-level quality-adjusted life-years (QALYs), lifetime costs, and net health benefits. The social welfare impact and change in health inequality were estimated using the Atkinson index. The distributional cost-effectiveness analysis simulated 316 037 100 individuals from the US population, including 25 subgroups defined by 5 categories of race and ethnicity and population quintiles of social vulnerability, with the fifth quintile representing the most socially vulnerable group. At an opportunity cost benchmark of $150 000 per QALY, treatment was associated with improved population health, adding 28 197 QALYs per year to the US population. Accounting for health inequality preferences (using an aversion level of 11, based on an Atkinson inequality aversion parameter that can range from 0 to infinity, with higher values assigning greater weight to health gains that accrue to the population with the lowest lifetime quality-adjusted life expectancy), treatment was associated with a 0.009% reduction in existing population health inequalities annually. Scenario analyses examining earlier and expanded treatment access suggested a population health improvement of up to 221 358 QALYs. The findings of this economic evaluation suggest that treatment for AD could improve population health and health equity. Policies to enable earlier diagnosis and treatment initiation, as well as expanded access to treatment, may further improve treatment and health equity impacts.

How the Struggle for Public Health in the Jim Crow South Reflected and Reinforced Systemic Racial Health Inequality

Abstract The twenty-first century COVID-19 epidemic revealed a U.S. public health system that countenanced health inequities and a U.S. public that resisted disease containment policies. This crisis, however, was only the most recent chapter in a longer struggle in the United States to institutionalize public health. We focus on two early twentieth-century public health campaigns in the American South, the unhealthiest U.S. region at the time. Black southerners—denied basic health, political, economic, and social rights under a rising Jim Crow regime—self-organized health services networks, including through the Tuskegee Woman’s Club, the Negro Organization Society of Virginia, and the Moveable School (1890s–1915). Around the same time, a philanthropic project, the Rockefeller Sanitary Commission (RSC, 1909–1914), seeded state-level public health agencies in eleven southern states, thereby installing public health in a top-down manner. We use archival data sources to explore key similarities and differences in the public health concerns and coalition-building approaches of each campaign and southern resistance to their efforts. We find Black-led campaigns often blurred the color line to form coalitions that provided services to the underserved while tackling environmental health risks at the community level. In contrast, RSC affiliates in southern states, as directed by RSC administrators, provided health services as short-term public dispensaries. Services reached Black and White communities willing to participate but in a manner that did not overtly challenge Jim Crow-era practices. Southern resistance to public health expansion persisted under each approach. The legacies of these struggles remain; the political-economic and ideological forces that limited public health expansion while marginalizing Black community health efforts reverberate in public health inequities today.

General practice should tackle healthcare inequalities but not health inequalities.

General practice should tackle healthcare inequalities but not health inequalities.

Burden and causes of anemia in Vietnam: insights from the global burden of disease data

BackgroundAnemia is a significant global health issue, impacting 1.92 billion people and ranking as a leading cause of disability. It is marked by low hemoglobin levels, which hinder oxygen delivery to vital organs and result from causes such as nutritional deficiencies and chronic diseases. Despite some progress, anemia remains a major concern in Southeast Asia, including Vietnam. Although the country has reduced its anemia rates, the progress is insufficient to achieve the WHO’s 2030 targets for anemia reduction among women of reproductive age. This study explores anemia trends and socio-economic determinants in Vietnam, with a focus on age and gender differences, to inform targeted interventions and policy development.MethodsThis study used the Global Burden of Diseases, Injuries, and Risk Factors (GBD) dataset to explore the burden of anemia and its causes in Vietnam from 1990 to 2021. The GBD study provides data on anemia prevalence and years lived with disability (YLD) by age, sex, and 37 causes across 204 countries and territories. Further, this study employed a regression model to examine how the anemia burden (i.e., prevalence rate and YLD rate) relates to socio-economic factors such as the Human Development Index (HDI), gender disparities in human development achievement, and gender-based inequalities in reproductive health, empowerment, and economic status in Vietnam over this period.ResultsIn 1990, there were 16.30 million anemia cases in Vietnam, decreasing slightly to 16.05 million by 2021. Male prevalence dropped from 34.90 to 26.58%, while female prevalence increased from 65.10 to 73.42%. Iron deficiency was the main cause, affecting 68.35% of cases in 1990 and 68.84% in 2021, with 24.96% in males and 75.04% in females in 2021. While anemia has decreased among infants, young children, and adolescents due to improved healthcare, it has increased among middle-aged and older adults, especially females. Regression analysis shows that higher human development and gender equality reduce anemia prevalence and disability, whereas gender inequality worsens the issue.ConclusionsThe study underscores that anemia remains a major health concern in Vietnam, marked by significant gender and age disparities. Despite a decrease in overall anemia rates and the effectiveness of specific interventions like iron-folic acid supplementation, females, particularly those of reproductive age and older adults, continue to face higher rates. Socio-economic improvements, including higher income and better human development, are linked to lower anemia rates, though the impact differs by gender. The persistent gender disparity and the shift in burden to older adults highlight the need for more comprehensive, gender-sensitive interventions. Future efforts should integrate nutritional support with broader socio-economic enhancements to effectively address anemia and improve public health in Vietnam.

공서비스 공급 관점에서 살펴본 비의료 건강관리서비스 인증 시범사업과 의료민영화 논쟁

In June 2022, the Ministry of Health and Welfare introduced a pilot program for the certification of non-medical health management services. This initiative, however, faced opposition due to concerns about potential healthcare privatization. This study aimed to examine whether the certification pilot program promotes healthcare privatization by utilizing a classification framework for public service provision. Contrary to initial concerns, it appears that the government sought to ensure publicness by acting as an intermediary between service beneficiaries and private providers, thereby incorporating the efficiency and accessibility of the private sector into the system. To address the potential exacerbation of health inequalities through technological monopolies and large-scale capital investment, continuous discussion and consensus among various social stakeholders surrounding this system will be necessary.

Co-designing postpartum contraceptive services with and for immigrant women in Sweden: lessons learned from the IMPROVE-it project

Background and aimImmigrant women in many high-income countries including Sweden, report unmet need of sexual and reproductive health and rights, and face worse pregnancy outcomes and higher risk of unintended pregnancies. Postpartum contraceptive services are often inadequate to meet their needs. Co-design has shown to reduce health inequities, yet little is known about using this method for postpartum contraceptive service development and even less in collaborating with immigrant populations. The aim of this paper is to describe the co-design process and the strategies that were developed to help develop tailored and acceptable postpartum contraceptive services for immigrant women in Sweden.MethodsThe paper describes a co-design process that took place during 2022–2023, including the cyclical digital consultations with Arabic and Somali speaking immigrant women, midwives and researchers, as well as the outputs from the process. The theoretical framework for the co-design process was the ‘Double Diamond’ Design Process Model. Data analysis included qualitative content analysis.ResultsThe co-design process led to the joint development of intervention materials and strategies to improve postpartum contraceptive services. Specifically, the process revealed ideas on how to improve contraceptive counseling within three pre-identified areas of change: improve physical access to contraceptive services; improved communication strategies using visual aids and information charts; and empowerment strategies that focus on reflective practice without assumptions about what a group of women might expect. We found that participants contributed actively to the process with ideas and suggestions, and that the co-design process facilitated positive reflections on ongoing counseling practices.ConclusionThe co-design process resulted in the successful and participative development of innovative tools and activities to improve contraceptive counseling services. This approach is original because it involves both immigrant women, often left behind, and midwives delivering the services. Whilst this interplay allowed for careful refinement of services and tools by using an iterative process, it also facilitated reflective midwifery practice.

Development of Undergraduate Competencies in Caring for People Experiencing Homelessness.

Nurses play a critical role in reducing health inequities in people experiencing homelessness (PEH), a key social determinant of health. Health disparities specific to PEH are exacerbated by numerous factors, including bias, stigma, and a lack of nursing competency in caring for PEH. The purpose of this study was to validate registered nurse key competencies; associated knowledge, skills, and attitudes; and concepts, content, and learning activities to serve as an educational framework in providing care for PEH. Twenty-four nursing experts on the care of PEH rated draft competency and subcompetency statements for relevance and clarity, proposed revisions and missing competencies, and identified essential and useful content, concepts, and learning activities. Four key competencies, 38 subcompetencies, and associated concepts, content, and learning activities were validated by the experts. This framework can be used to guide curricular development across nursing programs to advance health equity for PEH.

Empowering Global Health Systems to Protect, Promote and Support Optimal Breastfeeding.

Breastfeeding is a critical public health strategy for optimal child development and maternal health across the life course. The 2021 Global Burden of Diseases, Injuries and Risk Factors Study reveals that, despite reductions in mortality and disability-adjusted life years (DALYs) attributed to suboptimal breastfeeding practices-namely, non-exclusive breastfeeding during the first 6 months or early discontinuation within the first 2 years-low- and middle-income countries (LMICs) continue to bear a staggering 50-fold higher burden compared to high-income nations. This inequity signals a pressing global health priority. Hence, we propose to address these challenges by first, expanding the Baby-Friendly Hospital Initiative (BFHI) reach through community-driven efforts such as the Baby-Friendly Community Initiative (BFCI) to enhance breastfeeding support in both clinical and community settings; second, embedding breastfeeding counselling within national health and social protection programmes to fill in gaps in culturally competent care, drawing on large scale breastfeeding peer counselling programme experiences like the one being implemented by the US Supplemental Nutrition Program for Women, Infants and Children (WIC); third, improving maternity leave policies and workplace accommodations for breastfeeding women and fourth, stringent regulation of exploitative commercial milk formula (CMF) marketing to combat misinformation and reduce health inequities. Governments must implement strong, evidence-driven policies-such as strict monitoring and regulation of product labelling and digital media marketing-to establish safeguards against the powerful influence of the CMF industry. Collectively, these strategies will enhance breastfeeding outcomes, reduce health disparities and drive progress across countries towards meeting the UN Sustainable Development Goals.

Ngā Kaupapa Wawata me Uara: a narrative review exploring Tiriti o Waitangi-centred population health programmes in Aotearoa New Zealand

Globally, Indigenous Peoples experience widespread health inequities. Treaties provide a potential framework to uphold Indigenous rights and progress health equity. Te Tiriti o Waitangi (Māori language version of the Treaty of Waitangi) established the relationship between Māori, the Indigenous people of Aotearoa (New Zealand), and the British Crown. Grounded in Kaupapa Māori theory, this literature review used an Indigeneity-Grounded Analysis (IGA) policy lens to identify four characteristics of Tiriti-centred population health programmes: whanaungatanga (relationships), pro-equity actions, Te Ao Māori (Māori worldviews), and accountability. Although the evidence-base is emergent, a rights-based approach identifies the centrality of Indigenous self-determination, structural and system transformation, and freedom from discrimination. Indigenous knowledge provides the foundation for treaty-centered policy supportive of Indigenous rights and health equity.

Transactional experiences of discrimination, depressive symptoms, and ethnoracial socialization in Mexican-origin families.

Racial-ethnic discrimination is a prevalent stressor for Mexican-origin individuals that potentiates health inequities in depressive symptoms. However, existing research has primarily focused on individual-level associations between discrimination and depressive symptoms, neglecting the interdependent nature within family systems. Little is known about how one family member's discriminatory experiences relate to the depressive symptoms of others. Although ethnoracial socialization may disrupt the link from discrimination to depressive symptoms, how different ethnoracial socialization practices operate and influence parents themselves have not been examined. This study examines the associations among discriminatory experiences, depressive symptoms, and ethnoracial socialization among 604 Mexican-origin adolescents and their parents from low-income families. The findings revealed intraindividual and interindividual discrimination-depressive symptoms associations. Parental ethnoracial socialization's role in the link varied over time, individuals, and practices. Mental health research and services should consider shared and nonshared experiences among family members and adopt personalized approaches to support different family members. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Food Insecurity Is Common in Patients with Inflammatory Bowel Disease and Is Associated with Increased Ultra-Processed Food Intake.

Food insecurity (FI) is defined as the lack of consistent access to enough food for an active and healthy life. FI affects over 30 million Americans and is associated with poor clinical outcomes and impaired quality of life and drives significant health inequities. Despite the rising prevalence of FI and the federal focus on improving access to healthy food, there is a paucity of research on FI in patients with inflammatory bowel disease (IBD). Therefore, the goal of this study was to define FI in a cohort of IBD patients and determine whether FI was associated with changes in dietary patterns, including specifically an increase in ultra-processed food (UPF) consumption in this high-risk patient population. This was a single-center, retrospective cohort study of patients with a diagnosis of IBD who were 18 years of age or older and who were seen in a nutrition focused clinic. Patients were screened for FI using the Hunger Vital Sign™, a 2-question validated FI screening tool and underwent a 24-h dietary recall. The degree of food processing was assessed using the NOVA Food Classification System. Among 128 patients with IBD, we observed that FI is increasingly prevalent, with 45% of patients reporting difficulty with sufficient grocery access at least "sometimes" in the last 12 months and 10% reporting decreased food access "often" in the prior year. In addition, the patients at high-risk for FI were significantly more likely to eat NOVA 4 UPFs (54% vs. 27%, p = 0.001) and were significantly less likely to eat NOVA 1 unprocessed foods (32% vs. 61%, p = 0.001) as compared to those not at risk for FI. Finally, only a small percentage of those at highest risk for FI were enrolled in a federal food assistance program for grocery support. The prevalence of FI is increasing in patients with IBD and is associated with reduced dietary quality.

Unmasking population undercounts, health inequities, and health service access barriers across Indigenous populations in urban Ontario.

Our Health Counts (OHC) methods are designed to address gaps in urban-based Indigenous health information. In partnership with local Indigenous health service providers, we have successfully implemented OHC in six Ontario cities. The aim of this study is to summarize findings regarding Indigenous population undercount, health inequities, and health service access barriers across study sites. We estimated Indigenous population size using OHC census participation survey responses and a multiplier approach. Health inequities between Indigenous populations and overall populations in each city were examined using respondent-driven sampling (RDS), adjusted OHC survey results, and existing public data. Measures included health status outcomes; determinants of health; barriers to health service access, including discrimination by health service providers; and unmet health needs. Indigenous social networks were strong and extensive, and the urban populations demonstrate resilience and cultural continuity across multiple measures. Self-reported rates of census participation for Indigenous populations were markedly lower than those for the general population in each city, and OHC Indigenous population size estimates were consistently 2‒4 times higher than reported in the census. Indigenous to general population health inequities cut across measures of chronic disease, determinants of health, and unmet health needs. Indigenous populations experienced multiple barriers to health services access, including racial discrimination by health service providers. The Canadian census appears to markedly underestimate Indigenous population size in urban areas. Indigenous health inequities and service access barriers are striking and cross-cutting. Timely adaptation of health policies, services, and funding allocations in response to these findings is recommended.

Bridging the gap: how education transforms health outcomes and influences health inequality in rural China.

This study focuses on the impact of education on health and health inequalities in rural areas of China. Education significantly enhances economic status and health, driving economic growth and improving public health standards. Integral to the "Healthy China Strategy," it provides essential guidance for public policy and underscores the need for strategic human capital investments to achieve these goals. The study utilizes data from the China Family Panel Studies (CFPS) spanning 2010-2020 and employs the average educational level within counties as an instrumental variable. The causal impact of education on health and health inequalities is estimated using the two-stage least squares (2SLS) method. The findings reveal a significant positive correlation between enhancing education levels and health improvements. Specifically, after controlling for endogeneity, the duration of individual education significantly improves both subjective and objective health outcomes. It reduces health inequalities, with these effects being more pronounced among women and low-income groups. Mechanistically, education positively impacts health primarily by altering health behaviors and social network levels and reducing health inequalities through socio-economic factors. This paper provides important implications for public policy, suggesting that enhancing educational investments can drive economic development and improve population health standards.

A population-level framework to estimate unequal exposure to indoor heat and air pollution

As people in the UK spend 95% of their time indoors, buildings are an important modifier of exposure to both non-optimal temperatures and air pollution. High ambient temperature and high PM2.5 (particulate matter) concentrations often occur together in urban areas. Residential building types prone to overheating (e.g. purpose-built flats) are often also more common in urban areas. Together, this may lead to spatial and demographic inequalities in indoor exposure to heat and PM2.5 from outdoor sources. By combining building simulations (EnergyPlus), a spatially distributed description of the residential building stock—from publicly available Energy Performance Certificate (EPC) data, ambient temperature, PM2.5 data and area-level (40–250 households) socio-demographic data—we estimated these inequalities in exposure for the population of England and Wales. Maximum indoor temperature was higher in areas with larger ethnic minority and infant populations, and lower in areas with a higher proportion of people aged ≥ 65 years. Indoor concentrations of outdoor-source PM2.5 were higher in areas with larger ethnic minority and low-income populations. With rising inequality in England and Wales, housing and environmental conditions play an important role in contributing to health inequalities from social disadvantage. Policy relevance Differences in environmental exposures may partly explain inequalities in health outcomes. These differences are mediated by dwelling type and quality. Identifying the driving factors for differences in environmental exposures may allow for the development of interventions to address health inequalities more effectively. This study finds differences in indoor exposure across socio-demographic groups due to both location and housing. This could be of interest to national, regional and local authorities responsible for targeting building retrofit interventions across the housing stock.

Closing gaps in emergency care

Abstract: Current socio, political, and economic events may disproportionately affect those who are identified as vulnerable, as well as their presentation to Canadian emergency departments. The housing crisis, food instability, and concurrent issues with mental health and addictions are a harsh reality for many of these individuals. The emergency department may not be suited to complex health and social issues, but it provides an essential safety net for the vulnerable who cannot access care through traditional primary care routes. Alternative, patient-centered solutions to the problem are necessary, and advanced practice nurses can be the key to appropriately organizing and delivering integrated care innovative models. Raising awareness and influencing public policy to drive meaningful social change and address alarming health inequities is an important consideration for nurses working in emergency departments.