Inequalities In Health Status Research Articles

Decomposing gender inequalities in self-assessed health status in Liberia

ABSTRACTBackground: Understanding the magnitude of inequalities and drivers for reducing gender-related health inequalities is crucial in developing countries. This is particularly the case for Liberia with its very high level of gender-related inequalities in health and health outcomes.Objective: This paper assesses the magnitude of gender health inequalities and the relative contribution of different factors to health inequality in Liberia.Methods: Data came from the Liberian Household Income Expenditure Survey 2014. A two stage sampling methodology was used and 4,104 households were randomly selected and interviewed. The main variable of interest is dichotomised, good versus poor self-assessed health. Gender-related health inequality is assessed using the Oaxaca–Blinder decomposition for non-linear models. The decomposition reveals the magnitude of inequality and contributions of different factors.Results: We found large gender disparities (0.054, p < 0.01) characterised by women disadvantages in health status. In addition, the gender health disparities are mostly pronounced in rural areas. About 54% of the gender inequalities in health status were explained by the differences in endowments. Equalizing access to information, wealth and utilization of mosquito nets would reduce the gender gaps by 44, 5 and 4%, respectively.Conclusions: Addressing gender health inequalities inter alia requires access to health information (i.e. electronic and print media), gender responsive interventions that improve wealth in key sectors (i.e. education, employment, social protection, housing, and other appropriate infrastructure). In addition, the government, private sector and civil society should ensure that the health sector provides access to quality mosquito nets and improved health services including preventive care in order to reduce disease burden.

The Impact of Age on Income-Related Health Status Inequalities from Birth to Adolescence: A Systematic Review with Cross-Country Comparisons

To examine the effect of age on associations between household income and overall health from birth to adolescence, and whether age patterns vary by country. It is uncertain whether income-related health inequalities remain stable, widen, or narrow as children age, which impacts optimal timing of equity-focused interventions. Systematic review (CRD42016038583) of MEDLINE, Embase, PsycINFO, CINAHL, SocINDEX (full-text), and EconLit (full-text) to April 2017. We included observational studies and trials in children and adolescents (0-18 years of age), examining age differences in associations between income and overall health (self-rated, clinician-rated, proxy-rated). One reviewer extracted data; 2 evaluated risk of bias. Thirty-eight articles containing 43 studies (30 cross-sectional, 13 cohort) were identified, from high-income (n = 39) and middle-income (n = 4) countries. In the US (n = 21), positive income-health associations emerged in early childhood, and these inequalities typically widened progressively into adolescence. Relative to 0- to 3-year-olds, ratios of income-health coefficients ranged from 1.10-3.71 for 4-8 years of age, 1.26-3.86 for 9-12 years of age, 1.36-6.71 for 13-17 years. In the United Kingdom and Ireland (n = 8), inequalities emerged in early-to-mid childhood, but age patterns were less consistent. In other high-income countries (Australia, Canada, France, Germany, Japan, Republic of Korea), inequalities mostly persisted or widened with age. In middle-income countries, inequalities appeared to narrow (Indonesia n = 2) or persist (Brazil n = 2) with age. Limitations are unclear/high risk of bias and dataset overlap for some studies. In many countries, income-related health status inequalities persist or widen as children age. Interventions that improve health equity early in the life-course are needed.

Inequalities in health status depending on socio-economic situation in the European countries

Inequalities in health status depending on socio-economic situation in the European countries

A qualitative analysis of postpartum contraceptive choice

ABSTRACTBackground: The World Health Organization recommends a minimum 24-month birth-to-pregnancy interval to improve maternal and child health. Postpartum contraception is a mechanism to achieve optimal birth spacing and prevent unintended pregnancy, which may reduce health disparities and inequalities in health status among new mothers and their children. This study investigated women’s communication channel preferences, as well as patient engagement and shared decision making about contraceptive method choice and use in the postpartum period.Method: Researchers conducted six focus groups with 47 women receiving postpartum care at an outpatient clinic. A semi-structured focus group protocol was created and tested. A constant comparative approach provided an inductive method of analysis. HyperRESEARCH 3.5.2 qualitative data analysis software facilitated coding based on the health belief model.Results: Participants included women 18–39 years of age with an average of 1.7 children. The majority of participants utilized Medicaid (53%) and self-identified as Black (49%) or White (43%). Participants discussed interpersonal, mass media, and new media channels featuring messages about contraception, including long-acting reversible contraception (LARC). These women negotiated complex social norms, including preferring the Internet as a primary source of information and avoiding mass media. Participants balanced messages from social networks, including physician counseling and the power of personal experiences of friends and family in contraceptive decision making.Conclusions: This study demonstrated women perceive the voices of lay experts online as the most influential source of information and prefer to receive contraceptive information online and in-person during the prenatal and postpartum period.

Regional differences in the health status of Chinese residents: 2003–2013

Health inequality is an increasing concern worldwide. Using the coefficient of variation, Theil index, exploratory spatial data analysis, and spatial panel econometric model, we examined the regional inequality, spatio-temporal dynamic patterns, and key factors in the health status of Chinese residents from 2003 to 2013. We found that China’s residential health index (RHI) decreased from 0.404 to 0.295 in 2003–2013 at an annual rate of 2.698%. Spatially, resident health status, based on the RHI, has improved faster in the western region than in the eastern and central regions. Inequality in resident health status continued to increase between 2003 and 2013; inequality between regions decreased, but health status inequality expanded within regions. Furthermore, disparities in health status grew faster in western regions than in the eastern and central regions. The spatial distribution of resident health status formed a “T-shaped” pattern across China, decreasing from east to center then to the west with a symmetric decrease north and south. Using the change in Moran’s I from 2003 to 2008 and 2013, we found that the distribution of resident health status across China has narrowed. All the hot spots and cold spots have decreased, but they are also stable. Resident health status formed a stable cold spot in the western regions, while the east coastal area formed a stable hot spot. Selected explanatory variables have significant direct impacts on resident health status in China: increasing per capita GDP, per capita spending on health, and urbanization, and improving environmental quality all lead to better resident health status. Finally, we highlight the need for additional research on regional inequality of resident health status across multiple time, spatial, and factor domains.

Socioeconomic inequalities and non-communicable diseases in Serbia: National health survey

Background/Aim. Non-communicable diseases (NCDs) are a major public health challenge worldwide. Although they are preventable, NCDs are the major global causes of morbidity and mortality, absenteeism, disability and premature death. The aim of this study was to examine socioeconomic inequalities in the prevalence of non-communicable diseases in Serbia. Methods. Data from the 2013 National Health Survey of the population of Serbia was used in this study. There were 13,765 adults interviewed, aged ? 20 years. We used multivariate logistic regression analyses with demographic and socioeconomic determinants of health as independent variables and prevalence of non-communicable diseases as a dependent variable. The minimum level of significance was p &lt; 0.05. Results. Hypertension was the most prevalent NCDs (36.1%). The prevalence of multimorbidity was 47.1%. Multivariate logistic regression analysis showed that gender, age, place of residence, employment status and education were associated with the presence of NCDs. The odds ratio (OR) for age was 1.074 [95% confidence interval (CI) : 1.070?1.077). Women were at a higher risk of NCDs by 58.9% when compared to men (OR = 1.589; 95% 95% CI : 1.467?1.726). Respondents who lived in the rural areas were at a higher risk for NCDs by 14.1% compared to those who lived in urban areas (OR = 1.141; 95% CI : 1.047? 1.244). Odds ratio for unemployment was 1.227 (95% CI: 1.118?1.346). Respondents with primary education were at a higher risk for chronic diseases by 47.1% (OR = 1.471; 95% CI : 1.281?1.687) while those with secondary school were at a higher risk by 27.7% (OR = 1.277; 95% CI : 1.142?1.428) compared to respondents who had higher education. When it comes to Wealth Index, univariate logistic regression analysis showed that respondents who belonged to the poor and middle classes were at a higher risk for NCDs (OR = 2.031; 95% CI : 1.819?2.267; OR = 1.473; 95% CI : 1.343? 1.615) compared to respondents who belonged to the rich class. Multivariate logistic regression analysis did not show statistically significant correlations between the Wealth index and NCDs. Conclusion. Socioeconomic inequalities in health status are the major challenge and should be a target of national health policy in Serbia, not only because they represent social injustice but also because solving the health problems of underprivileged groups of the population can influence improvement of health status of the population as a whole.

Uncomfortable curricula? A survey of academic practices and attitudes to delivering Indigenous content in health professional degrees

ABSTRACTUnacceptable inequity in health status between Indigenous and non-Indigenous Australians remains despite much work in the area. The imperative for graduating health professionals capable and ready to work with urban and rural Indigenous communities has led to a focus on curriculum development, but less focus has thus far been applied to academic staff capability to deliver the content. We surveyed academic staff at a large multi-campus Australian university on their practices and attitudes towards teaching Indigenous content in health professional programs. Indigenous and non-Indigenous academic staff were surveyed online about whether Indigenous content was included in the curricula they taught; whether they felt confident and capable of delivering curricula related to Indigenous issues; what challenges they found in including Indigenous content; and what, if any, supports and resources they felt were needed. Sixty-three per cent of respondents said that they included Indigenous content in their curricula, but 43% said that they did not access Indigenous resources; 60% reported feeling awkward, unsure or avoided teaching Indigenous content; most (74%) were comfortable teaching discipline-specific content to Indigenous students but only 26% felt comfortable teaching Indigenous content to Indigenous students. The findings reflect a level of discomfort experienced by some academic staff when teaching Indigenous content in health professional degrees. Reasons for this include being worried they would make mistakes, not knowing what to teach and finding it ‘too hard’. We suggest that three levels of action are required within universities to address this discomfort in academic staff: (i) provide a rationale (‘why’ teach Indigenous content); (ii) develop a plan (‘where’ and ‘what’ Indigenous content to teach) and (iii) develop capability in academic staff regarding ‘how’ to teach Indigenous content.

Despairing about Health Disparities

AbstractI have never doubted that the problem of inequalities in health status and access to needed care is a difficult ethical and political challenge. After reading the essays in Understanding Health Inequalities and Justice: New Conversations across the Disciplines, edited by Mara Buchbinder, Michele Rivkin‐Fish, and Rebecca Walker, I concluded that despair was the only suitable response in the face of daunting ethical and political complexity.The editors of this volume have three questions in mind that they asked contributors to address. (1) How do scholars from various disciplines approach relations between health inequalities and ideals of justice? Social scientists want to offer empirical descriptions of inequalities in health status across a range of social groups, but there are numerous ways of offering such descriptions. Are they all “correct”? Philosophers and medical ethicists want to make normative judgments regarding which inequalities matter, ethically speaking. So (2) do we need to know when considerations of justice are relevant to assessing health inequalities and which considerations of justice are most relevant in specific contexts? Ultimately, (3) the question is which of these scholarly approaches is most useful for improving health policy.

Inequalities in the utilization of health care services in a transition European country: results from the national population health survey.

To examine demographic, socio-economic, and health status inequalities in the utilization of health care services (UHCS) in the Republic of Srpska (RS), Bosnia and Herzegovina. Data were retrieved from the 2010 National Health Survey for the RS adult population (n=4128). A complex sample design was taken into account for statistical analysis. As compared to men, a higher percentage of women visited a family physician (FP), urgent care department, dentist and private doctor. Higher educated women and those worse-off (OR 1.17) more frequently visited FP. Hospitalization (OR 4.56 for males; OR 9.17 for females), visit to urgent care department (OR 3.19 for males; OR 2.42 for females) and visits to FP in females (OR 1.46) were associated with poor self-perceived health. No inequalities by wealth index were found for the utilization of FP, hospitalization, urgent care and dentist among persons with poor self-perceived health status. The present study confirmed demographic, socio-economic and health status inequalities in the UHCS in RS. These findings have significant implications for health policy makers that seek to provide equal care for all people living in RS.

Caste, Wealth and Regional Inequalities in Health Status of Women and Children in India

Since time unmemorable, the caste system has been prevalent in Indian society. It has deeply developed roots in human minds, which leads to income inequality in the country. In the era of globalization and privatization, inequalities have extended to a large extent, which in turn has serious consequences for women and children’s health. In this article, an attempt has been made to understand the Caste, Income and Regional inequalities as determinants of health of women and children. For this study, the data are derived from the National Family Health Survey III conducted during 2005–2006. Bivariate and regression analysis has been done to understand the likelihood of health status of women and child in different categories. The results show that the scheduled tribes and schedule castes having poor wealth quintile and northern Indian women and children are at a greater disadvantage in all indicators of women and child health as compared to other groups.

Exploring the high-resolution mapping of gender-disaggregated development indicators.

Improved understanding of geographical variation and inequity in health status, wealth and access to resources within countries is increasingly being recognized as central to meeting development goals. Development and health indicators assessed at national or subnational scale can often conceal important inequities, with the rural poor often least well represented. The ability to target limited resources is fundamental, especially in an international context where funding for health and development comes under pressure. This has recently prompted the exploration of the potential of spatial interpolation methods based on geolocated clusters from national household survey data for the high-resolution mapping of features such as population age structures, vaccination coverage and access to sanitation. It remains unclear, however, how predictable these different factors are across different settings, variables and between demographic groups. Here we test the accuracy of spatial interpolation methods in producing gender-disaggregated high-resolution maps of the rates of literacy, stunting and the use of modern contraceptive methods from a combination of geolocated demographic and health surveys cluster data and geospatial covariates. Bayesian geostatistical and machine learning modelling methods were tested across four low-income countries and varying gridded environmental and socio-economic covariate datasets to build 1×1 km spatial resolution maps with uncertainty estimates. Results show the potential of the approach in producing high-resolution maps of key gender-disaggregated socio-economic indicators, with explained variance through cross-validation being as high as 74–75% for female literacy in Nigeria and Kenya, and in the 50–70% range for many other variables. However, substantial variations by both country and variable were seen, with many variables showing poor mapping accuracies in the range of 2–30% explained variance using both geostatistical and machine learning approaches. The analyses offer a robust basis for the construction of timely maps with levels of detail that support geographically stratified decision-making and the monitoring of progress towards development goals. However, the great variability in results between countries and variables highlights the challenges in applying these interpolation methods universally across multiple countries, and the importance of validation and quantifying uncertainty if this is undertaken.

Do healthcare tax credits help poor-health individuals on low incomes?

In several countries, personal income tax permits tax credits for out-of-pocket healthcare expenditure. Tax credits benefit taxpayers at all income levels by reducing their net tax liability and modify the price of out-of-pocket expenditure. To the extent that consumer demand is price elastic, they may influence the amount of eligible healthcare expenditure for which taxpayers may claim a credit. These effects influence, in turn, income distributions and taxpayers' health status and therefore income-related inequality in health. Redistributive consequences of tax credits have been widely investigated. However, little is known about the ability of tax credits to alleviate health inequality. In this paper, we study the potential effects that tax credits for health expenses may have on income-related inequality in health status with reference to the Italian institutional setting. The analysis is performed using a tax-benefit microsimulation model that reproduces the personal income tax and incorporates taxpayers' behavioral responses to changes in tax credit rate. Our results suggest that the current healthcare tax credit design tends to favor the richest part of the population.

Analysis of Inequality in Healthcare Utilization among Pregnant Women in Nigeria: Concentration Index Approach

Social inequalities in health care are considered to arise from social and economic determinants outside the health care services. There is an increasing interest in the role of the health care system. It is generally assumed that socioeconomic gradients in access to health care are very high, but only recently has this been subject to critical review. This study adopts health concentration index as a measure of inequalities in health status among pregnant women in Nigeria. The study observes that socioeconomic inequalities in healthcare utilization in Nigeria can be attributed to the high level of poverty in the country, as a major barrier that discourages household from gaining access to health care services. For healthcare utilization among pregnant women in Nigeria to be effective, the study suggests for interventions in order to promote maternal health care service utilization among pregnant women in Nigeria.

Maternal Deaths Databases Analysis: Ecuador 2003-2013.

Background: Maternal mortality ratio in Ecuador is the only millennium goal on which national agencies are still making strong efforts to reach 2015 target. The purpose of the study was to process national maternal death databases to identify a specific association pattern of variable included in the death certificate.Design and methods: The study processed mortality databases published yearly by the National Census and Statistics Institute (INEC). Data analysed were exclusively maternal deaths. Data corresponds to the 2003-2013 period, accessible through INEC’s website. Comparisons are based on number of deaths and use an ecological approach for geographical coincidences.Results: The study identified variable association into the maternal mortality national databases showing that to die at home or in a different place than a hospital is closely related to women’s socioeconomic characteristics; there was an association with the absence of a public health facility. Also, to die in a different place than the usual residence could mean that women and families are searching for or were referred to a higher level of attention when they face complications.Conclusions: Ecuadorian maternal deaths showed Patterns of inequity in health status, health care provision and health risks. A predominant factor seems unclear to explain the variable association found processing national databases; perhaps every pattern of health systems development played a role in maternal mortality or factors different from those registered by the statistics system may remain hidden. Some random influences might not be even considered in an explanatory model yet.Significance for public healthGeneral agreement on maternal mortality reduction suggests that to reach the millennium target a health system must to be able to provide essential, and emergency obstetric care in a well allocate, geographic, ethnic, and socioeconomic distribution of resources. Patterns of inequity in health status, health care provision, and health risks are demonstrable in Ecuadorian maternal deaths, but at levels below of those three decades ago. However, a predominant factor seems unclear to explain the variable association found processing national databases. It could mean that every pattern of health systems development played a role in maternal mortality, but also that factors different than those registered by the statistics system may remain hidden and that some random influences are not even considered in an explanatory model yet. To use maternal mortality to assess health system development might contribute to a general improvement in system performance.

Sisters Saving Lives: Instituting a Protocol to Address Breast Cancer Disparities.

Caucasian women have a higher incidence of breast cancer compared to African American women; however, African American women are more likely to die from the disease than their Caucasian counterparts. Many efforts have been made to address this disparity, but it still exists. Data have shown factors contributing to this disparity, such as inequalities in health status, environment, access and use of care, socioeconomic status, knowledge, and cultural beliefs. Train-the-trainer programs have been widely used to address breast cancer disparities. The aims of this article are to (a) identify and describe breast cancer disparities in an urban setting, (b) describe the Sisters Saving Lives program as an evidence-based intervention to address breast cancer disparities, (c) describe how self-efficacy theory was used to guide and evaluate the development of this pilot project, (d) identify key stakeholders involved, and (e) summarize outcomes observed. Self-efficacy theory served as a guide to the development of the train-the-trainer program to help address breast cancer disparities among African American women residing in Chicago. Training African American breast cancer survivors to deliver a culturally competent message on breast health education to African American women who do not have a breast cancer diagnosis raised awareness of the disease and potentially can address breast cancer disparities among African American women residing in Chicago.

Uterine transplantation is not a good use of limited resources: FOR: Uterine transplantation is not a good use of limited resources-a case of distributive justice and burden of disease.

The debate surrounding uterine transplantation (UTx) is complex and multifaceted. Although its scientific merit has recently been put in the spotlight, the social, economic and ethical considerations implicated have been largely left out of the mainstream conversation. In its current state, a principlistic analysis of UTx reveals arguments in favour of the principles of autonomy and beneficence, but it remains largely equivocal with regards to the principle of justice (Lefkowitz et al. Transpl Int 2012; 25:439–47). Successful public healthcare systems aim to abide by the principle of distributive justice, where providers seek to allocate the scarce resources at their command (operating rooms, time of physicians and nurses, medical supplies) in a just way so as to most efficiently address the needs, health and welfare of individuals and groups within the population. The aim of such an approach is to ensure maximisation of quality-adjusted life-years (Skedgel et al. Med Decis Making 2015;35:94–105). In such considerations, ‘micro-allocation at the lower level’ (Breyer, F. Health care rationing and distributive justice. Rationality, Markets and Morals 2009;27:406), particularly among individuals with rare conditions, is not prioritised unless unjust burden exists, or the population-risk of not treating such individuals is disproportionate (e.g. epidemics and quarantines). Indeed, in the setting of limited resources, the needs of the people should guide the distribution of opportunities for wellbeing, including access to care and partitioning of goods and services. Relative to a number of life-threatening conditions for which there may not be treatment alternatives, the burden of disease of uterine factor infertility, the main indication for UTx, remains comparatively low. In addition, the cost of the procedure is disproportionate in comparison to the cost of its alternatives, namely surrogacy and adoption. Said cost includes four surgeries, anti-rejection regimens, at least one cycle of in vitro fertilisation, and close monitoring for at least a year after the transplant and throughout the pregnancies. Furthermore, as it stands today, the number-needed-to-treat to reach a live birth in UTx is unknown; however, in theory it is likely to be rather high because it must take into account the success of both the transplant itself and the ensuing in vitro fertilisation cycle. Hence, a cost-effectiveness analysis is necessary before allocating limited resources to this procedure. As it has been performed at an experimental stage, where it still remains, UTx programmes are better funded by grants from private research foundations and philanthropists [Brännström et al. Lancet 2015;385(9968):607–16]. Other ethical concerns that arise in the case of UTx, notably the principles of equity, inclusion and social solidarity, reveal tensions with the use of limited resources for like-procedures. A challenge exists in finding the right balance between the social responsibility of the state and the individual rights and responsibilities of citizens. Although each person should benefit from the same care, health equity is not the same as equality in health status. Inequalities in health status between individuals are inevitable consequences of genetic differences, gaps between social and economic circumstances or personal choice of lifestyle. Such individual decisions should not drive the unequal distribution of resources for expensive interventions like UTx. Although healthcare systems may no longer be exclusively concerned with the preservation of life but rather with remedying the malfunctions of the body and enhancing quality of life (Warnock. A question of life: The Warnock report on human fertilisation and embryology. Oxford: Blackwell, 1985), the use of limited resources should be morally prioritised into the research and treatment of life-threatening diseases. Indeed, in the presence of limited resources, the management of life-enhancing conditions, such as uterine factor infertility, need not be prioritised. None declared. Completed disclosure of interests form available to view online as supporting information.■ Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Why US Health Care Should Think Globally.

Why should health care systems in the United States engage with the world's poorest populations abroad while tremendous inequalities in health status and access are pervasive domestically? Traditionally, three arguments have bolstered global engagement: (1) a moral obligation to ensure opportunities to live, (2) a duty to protect against health threats, and (3) a desire to protect against economic downturns precipitated by health crises. We expand this conversation, arguing that US-based clinicians, organizational stewards, and researchers should engage with and learn from low-resource settings' systems and products that deliver high-quality, cost-effective, inclusive care in order to better respond to domestic inequities. Ultimately, connecting "local" and "global" efforts will benefit both populations and is not a sacrifice of one for the other.

Health inequalities in hypertension and diabetes management among the poor in urban areas: a population survey analysis in south Korea.

BackgroundThis study investigated whether the prevalence, awareness, treatment, and control of hypertension and diabetes differed by residential areas. In addition, the rate of good hypertension or diabetes control was examined separately in men and women, and in urban and rural areas.MethodsThis study used Korea National Health and Nutrition Examination V (2010–2012) data, a nationwide cross-sectional survey of general South Korean population. Residential areas were categorized into urban and rural areas.To examine differences between the residential areas in terms of prevalence, awareness, treatment, and control of hypertension and diabetes we performed a multivariate logistic regression adjusting for age, body mass index, physical activity, alcohol use, smoking, marital status, monthly income, and educational level. To investigate control of hypertension or diabetes within each residential area, we performed a subgroup analysis in both urban and rural areas.ResultsThe prevalence of hypertension is higher among men in urban areas than among those in rural areas (OR = 0.80; 95 % CI = 0.67–0.96, reference group = urban areas). However, the subgroups did not differ in terms of diabetes prevalence, awareness, treatment, and control. Regardless of both sex and residential area, participants in good control of their hypertension and diabetes were younger. Inequality in good control of hypertension was observed in men who lived in urban (≤Elementary school, OR 0.74, 95 % CI 0.60–0.92) and rural areas (≤Elementary school, OR 0.67, 95 % CI 0.46–0.99). Inequality in health status was found in women who resided in urban areas (≤Elementary school, OR 0.53, 95 % CI 0.37–0.75). Good control of diabetes also showed inequalities in health status for both men (≤Elementary school, OR 0.61, 95 % CI 0.40–0.94; Middle/High school, OR 0.69, 95 % CI 0.49–0.96) and women in urban areas (≤1 million won, OR 0.56, 95 % CI 0.33–0.93) (Reference group = ‘≥College’ for education and ‘>3 million’ Korean won for income).ConclusionsAfter correction for individual socioeconomic status, differences by residential area were not observed. However, when the participants with good disease control were divided by region, inequality was confirmed in urban residents. Therefore, differentiated health policies to resolve individual and regional health inequalities are necessary.

The economic feasibility of price discounts to improve diet in Australian Aboriginal remote communities

Objective:To estimate the cost‐effectiveness of fiscal measures applied in remote community food stores for Aboriginal Australians. Methods:Six price discount strategies on fruit, vegetables, diet drinks and water were modelled. Baseline diet was measured as 12 months’ actual food sales data in three remote Aboriginal communities. Discount‐induced changes in food purchases were based on published price elasticity data while the weight of the daily diet was assumed constant. Dietary change was converted to change in sodium and energy intake, and body mass index (BMI) over a 12‐month period. Improved lifetime health outcomes, modelled for the remote population of Aboriginal and Torres Strait Islanders, were converted to disability adjusted life years (DALYs) saved using a proportional multistate lifetable model populated with diet‐related disease risks and Aboriginal and Torres Strait Islander rates of disease. Results:While dietary change was small, five of the six price discount strategies were estimated as cost‐effective, below a $50,000/DALY threshold. Conclusion:Stakeholders are committed to finding ways to reduce important inequalities in health status between Aboriginal and Torres Strait Islanders and non‐Indigenous Australians. Price discounts offer potential to improve Aboriginal and Torres Strait Islander health. Verification of these results by trial‐based research coupled with consideration of factors important to all stakeholders is needed.

Class, territory, and inequality: Explaining differences in the framing of health inequalities as a policy problem in Belgium and France

Inequalities in health status between social groups have been on the agenda as a problem for policymakers in France and Belgium in recent years. But the constitutive arguments that French and Belgian policy elites use to frame the problem of health inequalities in public discourse – arguments about what health inequalities are, where they come from, and how they might be corrected – differ in ways that run counter to expectations based on the geography and sociology of health inequalities in the two countries. Belgian national policy documents steer clear of discussing the very large regional inequalities in health, focusing instead on differences between groups defined by socioeconomic status. Meanwhile, French documents emphasize territorial inequalities over those linked to social class. Systematic content analysis of policy documents and interviews with over 50 health policy experts and actors in Belgium and France shed light on this puzzle. In both countries, political elites employ policy discourses about health inequalities that paper over the most salient and contentious political cleavages of the day. In doing so, they are constrained by historically rooted definitions of (in)equity, as well as nationally specific institutions of financing and redistribution.