Minimize Health Inequalities Research Articles

The development of a quality-assured action model for municipal health promotion

Abstract Background The creation of health-promoting living environments is a key strategy in order to minimise health inequalities, which have been increasing recently. Health promotion in municipalities offers many approaches in this context and is gaining importance on an international level. To structure the process of municipal health promotion, the aim of this research was to create a basis for action and to define requirements in the process. Methods A systematic literature research on models, approaches and tasks for health promotion in municipal settings was conducted in five databases such as Web of Science and EBSCOhost, and was supplemented by a manual search. All hits were filtered using inclusion and exclusion criteria. The design and presentation of the results were prepared based on the method of the Integrative Review. Results 262 publications were screened, sixteen of which were considered for analysis. On this basis, an action model for municipal health promotion was developed. It consists of four phases: Network Planning and Modification, Municipal Profiling, Municipal Strategy Development, Implementation and Evaluation. Other important identified aspects during the process are participation, project and network management, communication, evaluation and quality assurance. Conclusions The action model structures tasks and requirements in the process of municipal health promotion. The evidence also shows the importance of central coordination in municipal health promotion, which can be structured by the action model. The created model provides a new framework for a quality-assured and sustainable process and for a central coordinated municipal health promotion. Key messages Municipal health promotion should increasingly be established. Thereby, the adherence to a systematic, quality-assured process is important.

The effects of a preschool-based intervention for Early Childhood Education and Care teachers in promoting healthy eating and physical activity in young children: A cluster randomised controlled trial.

The need for excess weight gain prevention in disadvantaged young children is widely recognised. Early Childhood Education and Care teachers are potential key actors in early interventions to prevent overweight and obesity. This study examines the effects of a preschool-based intervention for teachers in promoting healthy eating and physical activity in young children. A cluster randomised controlled trial was conducted at 41 preschools in a deprived area of Amsterdam, The Netherlands. The intervention consisted of 2 programmes that were applied in succession: A Healthy Start and PLAYgrounds for TODdlers. The study period was 9 months. Primary outcomes were assessed via questionnaires and included teachers’ knowledge, attitude, food/activity-related practices, and level of confidence in promoting healthy behaviours. Secondary outcomes in this study were teachers’ and children’s BMI (z-score), body composition, dietary intake and physical activity level. Intention-to-treat analyses were performed using linear mixed models. In total, 115 teachers and 249 children (mean age 3.0 (0.2) years) were included. A positive effect on teachers’ knowledge about the Dutch dietary guidelines was found after the programme A Healthy Start (difference = 1.38; 1-sided 95% CL = 0.29; p = 0.02). This effect was not sustained at 9 months (difference = 0.34; 1-sided 95% CL = -0.76; p = 0.31). The overall intervention had a positive effect on 3 of the 5 attitude statements regarding a healthy lifestyle (difference ranged from 0.34 to 0.55) and on the practice scale Activity-related-Modelling (difference = 0.16; 1-sided 95% CL = 0.06; p = 0.01). No intervention effects were observed on food-related practice scales and the level of confidence in promoting healthy behaviours. At this stage, no effects were seen on teachers’ and children’s BMI (z-score). This study contributes to the professional development of Early Childhood Education and Care teachers and addresses the call for interventions to prevent overweight/obesity and to minimise health inequalities in young children.

Exploring how urban nature is associated with human wellbeing in a neotropical city

Human population growth and urbanisation are putting pressure on urban green and blue spaces worldwide. These spaces provide habitat for biodiversity and, as evidence from the Global North shows, can provide health and wellbeing benefits to urban dwellers. Nonetheless, there is a paucity of evidence regarding the wellbeing benefits associated with urban green and blue spaces from the Global South, where the fastest rates of population growth and urban expansion are occurring. Here, we examine green and blue spaces in Georgetown, Guyana, exploring whether frequency and duration of use is (1) associated with nature-relatedness, safety concerns, and sociodemographic characteristics, (2) associated with specific visit motivations (e.g. physical, cognitive, social), and (3) associated with wellbeing (positive and negative experiential, evaluative, eudaimonic, and mental wellbeing). Participants (n = 512) were more likely to visit green and blue spaces if they had higher nature-relatedness, no safety concerns, aged <35 years, and educated above secondary level. Visit frequency was not related to wellbeing. Visit duration did not differentiate according to visit motivations. Visits to green and blue spaces of more than 25 min were associated with increased positive experiential wellbeing. No comparable patterns were found for the other wellbeing dimensions. These findings can inform public health campaigns targeted at specific sociodemographic groups. Moreover, decision-makers could minimise health inequalities by incorporating new green and blue spaces into future development plans (including the provision of backyards), and enhancing existing spaces (e.g. reducing people’s safety concerns). These measures will help maximise wellbeing across all sectors of society.

Cancer among Indigenous Communities: Disparities &amp; Challenges

Given the history of racism and systemic oppression of Indigenous communities, examining and addressing health inequities in in Indigenous continues to be relevant and important. An increasing number of healthcare problems are emerging from Indigenous communities.1,2 Canadian First Nations women and men have lower life expectancies and increasing rates of chronic conditions, such as diabetes, cardiovascular diseases, heart disease, and obesity.1 Some evidence suggests that the burden of cancer is lower among Indigenous communities than the overall population.3 However, there is much data indicating that this rate in increasing and that members of Indigenous communities have increased mortality rates when compared to non-Indigenous groups for cancers of the cervix, breast, gallbladder, lip and oropharynx, liver, lung, prostate and stomach.4,5 This paper discusses cancer incidence, risk factors, screening, and detection of cancers among Indigenous communities. This is followed by a discussion of potential interventions that may reduce the burden-related morbidity and mortality of cancer on these communities. Indigenous communities continue to experience unique barriers to accessing appropriate cancer care and preventive services and steps to minimize health inequalities should be taken.

Ethical principles and a practical approach to support policy making through the next phases of the COVID-19 pandemic and beyond

There is an urgent need for an ethical framework to help us address the local and national challenges that we face as clinicians during the COVID-19 pandemic. We propose four key commitments from which a practical and consistent ethical approach can be derived. These commitments are to articulate the needs, rights and interests of the different stakeholders affected by any policy; to be accountable and transparent, recognising that people are autonomous individuals with values and concerns of their own; to consider the impact of our actions on the sustainability of the NHS, infrastructure, service demands and staff welfare; and to treat everybody equitably, with all deserving of consideration and care. Implementing these commitments will require a number of specific actions. We must put in place frameworks enabling clear advocacy for each competing objective; communicate policy and practice effectively to the public; promote integration of decision-making among social, primary, secondary and tertiary care and reduce or stop unnecessary or inefficient interventions; minimise health inequalities; and build spare capacity into the system.In this article, we expand on these actions, and note the legal context in which this would be delivered.

Impact of socioeconomic- and lifestyle-related risk factors on poor mental health conditions: A nationwide longitudinal 5-wave panel study in Japan.

The association of socioeconomic status and lifestyle behaviours on mental health appears well-established in the literature, as several studies report that better socioeconomic status such as higher levels of disposable income and employment as well as practising healthy lifestyles can enhance mental well-being. However, the reliance on cross-sectional correlations and lack of adequate statistical controls are possible limitations. This study aims to add the evidence of longitudinal association to the literature by using Japanese representative longitudinal household panel data. We employed panel data analytical techniques such as the random-effects conditional logistic regression (RE-CLR) and the fixed-effects conditional logistic regression (FE-CLR) models with possible time variant confounders being controlled. Our sample was comprised of 14,717 observations of 3,501 individuals aged 22-59 years for five waves of the Japanese Household Panel Survey. We confirmed many of the factors associated with mental health reported in existing studies by analysing cross-sectional data. These significant associations are also longitudinal (within) associations estimated by the FE-CLR models. Such factors include unemployment, low household income, short nightly sleeping duration, and lack of exercise. However, we also found that several factors such as disposable income, living alone, and drinking habits are not significantly associated with mental health in the FE-CRL models. The results imply the reverse causality that poor mental health conditions cause lower disposal income, possibly due to the inability to exhibit higher productivity, but an increase in disposal income would not necessarily improve mental health conditions. In this case, aggressive policy interventions to increase the disposal income of people of lower socioeconomic backgrounds would not necessarily be effective to minimize health inequalities.

The Born in Bradford COVID-19 Research Study: Protocol for an adaptive mixed methods research study to gather actionable intelligence on the impact of COVID-19 on health inequalities amongst families living in Bradford

The UK COVID-19 lockdown has included restricting social movement and interaction to slow the spread of disease and reduce demand on NHS acute services. It is likely that the impacts of restrictions will hit the least advantaged disproportionately and will worsen existing structural inequalities amongst deprived and ethnic minority groups. The aim of this study is to deliver rapid intelligence to enable an effective COVID-19 response, including co-production of interventions, that address key issues in the City of Bradford, UK, and nationally. In the longer term we aim to understand the impacts of the response on health trajectories and inequalities in these. In this paper we describe our approach and protocol. We plan an adaptive longitudinal mixed methods approach embedded with Born in Bradford (BiB) birth cohorts which have rich existing data (including questionnaire, routine health and biobank). All work packages (WP) interact and are ongoing. WP1 uses co-production and engagement methods with communities, decision-makers and researchers to continuously set (changing) research priorities and will, longer-term, co-produce interventions to aid the City’s recovery. In WP2 repeated quantitative surveys will be administered during lockdown (April-June 2020), with three repeat surveys until 12 months post-lockdown with an ethnically diverse pool of BiB participants (parents, children aged 9-13 years, pregnant women: total sample pool N=7,652, N=5,154, N=1,800). A range of health, social, economic and education outcomes will be assessed. In WP3 priority topics identified in WP1 and WP2 will be explored qualitatively. Initial priority topics include children’s mental wellbeing, health beliefs and the peri/post-natal period. Feedback loops will ensure findings are fed directly to decision-makers and communities (via WP1) to enable co-production of acceptable interventions and identify future priority topic areas. Findings will be used to aid development of local and national policy to support recovery from the pandemic and minimise health inequalities.

Strengthening Child-centred Health Systems response: what happens with migrant children?

Abstract Migrant children are especially vulnerable to the challenges experienced during the migratory process and its integration in the host country, even more, if they are unaccompanied. Child-centred Health Systems responses are needed, for that reason, the Erasmsus+ project EUVETCARE aims to strengthen the capacity of the professionals and systems to meet the specific needs of this population. A qualitative study allowed a needs assessment of the health and social care professionals in 5 EU countries (Cyprus, Germany, Greece, Italy and Spain). A total of 15 focus groups were carried out (99 participants). Focus groups discussions were transcribed verbatim in local languages and transcripts were analyzed using thematic analysis. Moreover, a literature review informed about the current learning opportunities for professionals in the European context regarding migrant children. Focus groups discussions highlighted some general needs for all professionals such as communicative skills with migrant children and their families as well as cultural competence to deal with these cases. Moreover, participants stressed the need to deal with this population with low levels of health literacy too. Finally, strategies to provide integrated care and meet the major needs of these children were needed. Unaccompanied minors were highlighted as a vulnerable group by participants. In addition, the literature review revealed some gaps in the learning guidelines offer across Europe. Future training for professionals should stress the specific gaps in order to don't replicate existing materials. Furthermore, professionals' voices should be taken into account in the design of these new training to directly answer to their professional needs. Additionally, the needs of migrant children have to be differentiated and appropriated culturally-competent care delivered in order to minimize health inequalities for this group. Key messages Training of healthcare professionals should target culturally-competent case management strategies for minor migrants. The delivery of health care for minor migrants requires major intensity from the health care services.

Promoting physical activity-related health competences in people with intellectual disability

Abstract Background Physical inactivity is a global health problem. Physically active people show lower rates of chronic diseases or mortality. People with intellectual disabilities (PWID), a vulnerable group for health problems, have significantly lower levels of physical activity (PA) than general population. Due to reduced cognitive abilities, communicative and literacy skills, PWID have less access to health programs. Target-group-oriented interventions are rare. Methods Methodological triangulation to survey PA-related health competences in all 3 subcategories: 3 participating observations and 24 interviews with PWID (inclusion criteria for both: mild or moderate ID); staff online survey (n = 67), all in an integration assistance institution. Participatory approach: 2 expert groups with PWID advise researchers e.g. validating results. Results As expected, movement abilities and body awareness various highly from general population. An effect knowledge is widely spread (PA = health), but execution knowledge of PA is only marginally available e.g. not knowing how to increase PA healthy. Control competences as results from interview and observations: intrinsic motivation is highly present (unlike results from staff survey), but volition - self-efficacy and bring into action - is very poor, self-management and a lack of ideas are identified as a major problem. Low expectation of self-efficacy proved to be the biggest obstacles for PA, but caregiver are an own health resource. Expert groups confirm important of PWID perspectives on living environment. Conclusions To promote a PA lifestyle, health education with a focus on promoting self-efficacy orientated to the living environment (incl. caregiver) regarding own perspectives and health resources is needed. In this way, a vulnerable group for health problems can be empowered. Results indicate a successful approach to promote PA-related health competences in PWID to minimize health inequalities in relation to general population. Key messages Health inequalities among people with intellectual disability through promoting a PA lifestyle can be minimized. Intervention for people with intellectual disabilities must take into account the perspectives and the resources of the users.

The Born in Bradford COVID-19 Research Study: Protocol for an adaptive mixed methods research study to gather actionable intelligence on the impact of COVID-19 on health inequalities amongst families living in Bradford.

The UK COVID-19 lockdown has included restricting social movement and interaction to slow the spread of disease and reduce demand on NHS acute services. It is likely that the impacts of restrictions will hit the least advantaged disproportionately and will worsen existing structural inequalities amongst deprived and ethnic minority groups. The aim of this study is to deliver rapid intelligence to enable an effective COVID-19 response, including co-production of interventions, that address key issues in the City of Bradford, UK, and nationally. In the longer term we aim to understand the impacts of the response on health trajectories and inequalities in these. In this paper we describe our approach and protocol. We plan an adaptive longitudinal mixed methods approach embedded with Born in Bradford (BiB) birth cohorts which have rich existing data (including questionnaire, routine health and biobank). All work packages (WP) interact and are ongoing. WP1 uses co-production and engagement methods with communities, decision-makers and researchers to continuously set (changing) research priorities and will, longer-term, co-produce interventions to aid the City's recovery. In WP2 repeated quantitative surveys will be administered during lockdown (April-June 2020), with three repeat surveys until 12 months post-lockdown with an ethnically diverse pool of BiB participants (parents, children aged 9-13 years, pregnant women: total sample pool N=7,652, N=5,154, N=1,800). A range of health, social, economic and education outcomes will be assessed. In WP3 priority topics identified in WP1 and WP2 will be explored qualitatively. Initial priority topics include children's mental wellbeing, health beliefs and the peri/post-natal period. Feedback loops will ensure findings are fed directly to decision-makers and communities (via WP1) to enable co-production of acceptable interventions and identify future priority topic areas. Findings will be used to aid development of local and national policy to support recovery from the pandemic and minimise health inequalities.

Clinical Practice of Adalimumab and Infliximab Biosimilar Treatment in Adult Patients With Crohn's Disease.

The introduction of tumor necrosis factor (TNF) inhibitors has significantly changed the treatment landscape in Crohn’s disease (CD). The overall therapeutic achievements with TNF inhibitors such as infliximab, adalimumab, and certolizumab pegol paved the way to push the boundaries of treatment goals beyond symptomatic relief and toward cessation of objective signs of inflammation, including endoscopic remission. Even though these agents are widely used for the treatment of moderate to severe CD, heterogeneity still exists in translating evidence-based guidelines on the use of anti-TNF agents into actual treatment algorithms in CD. This might be due to several reasons including disparities in health expenditure policies; lack of harmonization between countries; and variations in assessment of disease severity, use of disease monitoring tools, or application of treatment targets by physicians. With the advent of biosimilars, patent-free versions of reference biologics are now available to minimize health inequalities in drug availability. In this context, this article aims to provide practical clinical guidance for the use of infliximab and adalimumab biosimilars in patients with moderate to severe CD by outlining different clinical scenarios that patients may encounter during their treatment journey.

Competency Driven Approach in Advancing Reforms Agenda: Reinventing India’s Public Health Education

Today public health professionals face new and demanding challenges to improve health of the population and minimize health inequalities. The world suffers from the unappeasable tide of triple burden of disease, the threat of new pandemics, the environmental risks and weak health systems that impose severe burden on health services, systems and society, locally and globally. Disease knows no border; the developed and developing worlds are united by one scourge - the shortage of a public health workforce[1]. Recent public health events have emphasized the need to strengthen and develop the public health workforce. National Health Policy – 2017 by Ministry of Health and Family Welfare, Government of India, recognizes the need to revise health professional education keeping in view the changing needs, technology and the newer emerging disease trends[2]. Improvements in public health can only be realized through the development of a workforce that understands that “working differently means leading and learning differently”[3]. Competency based education (CBE) has witnessed a growing interest over the years in the field of especially for experiential learning and as a means for optimizing the preparation of health professionals[4, 5, 6].

Workshop: MigHealthCare - strengthening Community Based Care to minimize health inequalities

Abstract Over the past few years, a large number of refugees, migrants and asylum seekers have reached the south-eastern points of entry of the EU, challenging health and social systems of bordering countries with a spillover effect to the rest of the EU. Refugees, asylum seekers and migrants are at higher risk of poverty and social exclusion compared to the local populations, while the different vulnerable groups face diverse barriers when accessing health services. In many cases they do not receive appropriate health and social care that best meets their needs. Furthermore, in the EU MS, different practices apply to health and social care delivery for migrants/refugees. Research has shown the importance of community-based models to improve health care access of vulnerable migrants and refugees. Such models include elements of good communication, cultural awareness, sensitivity and respect for the diverse cultural and ethnic backgrounds by community health care staff as well health education and primary healthcare services. Mig-HealthCare - strengthening Community Based Care to minimize health inequalities and improve the integration of vulnerable migrants and refugees into local communities, is a 3-year project, launched in 2017, with the financial support of the European Commission. It is implemented by a consortium of 14 partners among them universities, national authorities and NGOs from ten countries across Europe (Greece, France, Malta, Germany, Austria, Italy, Cyprus, Spain, Sweden and Bulgaria). The overall objective of Mig-HealthCare is to improve health care access for vulnerable migrants and refugees, support their inclusion and participation in European communities and reduce health inequalities. The project’s specific objectives are: Describe the current physical and mental health profile of vulnerable migrants and refugees including needs, expectations and capacities of service providers.Develop a roadmap and toolbox for the implementation of community based care models, following an assessment of existing health services and best practices.Train community service providers on appropriate delivery of health care models for vulnerable migrants and refugees.Pilot test and evaluate community based care models which emphasize prevention, physical and mental health promotion and integration. The project results are presented on behalf of the Mig-HealthCare consortium. Key messages The overall objective of Mig-HealthCare is to improve health care access for vulnerable migrants and refugees. The Mig-HealthCare project focuses on developing a roadmap to facilitate the effective implementation of community care models.

A preschool-based intervention for Early Childhood Education and Care (ECEC) teachers in promoting healthy eating and physical activity in toddlers: study protocol of the cluster randomized controlled trial PreSchool@HealthyWeight

BackgroundInterventions to prevent overweight and obesity in toddlers are needed to minimize health inequalities, especially in migration and lower socio-economic groups. Preschools are identified as important environments for interventions to prevent overweight and obesity. Early Childhood Education and Care (ECEC) teachers in preschools are potential key actors in promoting healthy eating and physical activity. This paper describes the research design of a Dutch preschool-based intervention for ECEC teachers in promoting healthy eating and physical activity in toddlers.MethodsPreSchool@HealthyWeight concerns a cluster randomized controlled trial on preschools in Amsterdam Nieuw-West, Netherlands. This city district is characterised by inhabitants with a migration background and low socio-economic status. Forty-one preschools, with 115 ECEC teachers and 249 toddlers/parents, were randomly allocated to an intervention or control group. An intervention for teachers will be carried out on intervention locations and consists of modified versions of 2 existing programs: ‘A Healthy Start’ and ‘PLAYgrounds’. In ‘A Healthy Start’, ECEC teachers learn to provide a healthy and active environment for toddlers. The ‘PLAYgrounds for Toddlers’ program, coaches ECEC teachers to stimulate physical activity in the playgrounds of preschools. PreSchool@HealthyWeight aims to evaluate the effectiveness of the intervention after 9 months. Primary outcomes are the teachers’ knowledge, attitude and practices concerning healthy eating and physical activity, and consequently the level of confidence of ECEC teachers in promoting healthy eating and physical activity in toddlers. Secondary outcomes include the Body Mass Index, body composition, dietary intake and physical activity level of teachers and toddlers. In addition, the activating role of ECEC teachers and the physical activity of toddlers on the playgrounds will be evaluated. Lastly, the knowledge, attitude and practices of parents concerning healthy eating and physical activity will be assessed.DiscussionIt is hypothesized that this preschool-based intervention for ECEC teachers improves the knowledge, attitude and practices regarding healthy eating and physical activity, and consequently the level of confidence of ECEC teachers in promoting healthy eating and physical activity of toddlers. The intervention addresses the call for early intervention to prevent overweight and obesity and to minimize health inequalities.Trial registrationNetherlands Trial Register (NTR): NL5850. Date registered: August 26, 2016.

How culturally competent are hospitals in Israel?

BackgroundCultural competence (CC) in health systems is the ability to provide care to patients with different values, beliefs and behaviors, and to match the care to their social, cultural and linguistic needs. In 2011, the Director-General of Israel’s Ministry of Health issued a cultural competence directive to health care providers that sought to minimize health inequalities caused by cultural and linguistic gaps. This study assesses the status of organizational CC in Israeli general hospitals in the wake of the 2011 directive.MethodOrganizational CC was assessed using a 75-item structured questionnaire based on the 2011 directive and on international standards. Data were gathered via interviews conducted between December 2012 and February 2014. 35 of Israel’s 36 general hospitals participated in the study, for a response rate of 97%.A composite CC score was calculated for each hospital as the average of the 75 items in the questionnaire.ResultsThe average composite score of all the hospitals was low to moderate (2.3 on a scale of 0–4), the median score was 2.4, and the range of composite scores was large, 0.7–3.2. The interquartile range was [1.94, 2.57].Hospital CC is positively associated with non-private ownership status and location in the southern or central districts. Still, these differences are not statistically significant and immutable hospital characteristics such as ownership status and location account for only 21% of the inter-hospital variation in CC. This suggests that hospital leaders have significant discretion in the priority to be given to CC.Dimensions of CC with relatively low average scores include hospital connections with the community (1.28), staff training on CC (1.35), oral translation (i.e. interpreting) during treatment (1.62), and CC adaptation of human resources recruitment and evaluation (1.64). These areas appear to be particularly in need of improvement.ConclusionThe study findings suggest that hospitals and policy-makers can take significant steps to improve CC; these include setting more concrete and measurable implementation guidelines. We conclude with suggestions for policy and practices to improve cultural competence in the health system.

1.10-P15Health providers in France: how do they find a way to meet migrants' needs?

Background: The Mig-HealthCare project aims to strengthen a community based care model to minimise health inequalities and improve the integration of vulnerable migrants and refugees into local communities. The project is funded by the European Commission for three years and has been deployed in ten European Countries. Firstly, the health profile of vulnerable migrants is described, and then need for health services is defined. A roadmap for a community based care model and pilot health services are developed. We present findings from interviews and focus groups discussions (FGDs) with health providers in facilities receiving vulnerable migrants in France. Methods: As a pilot we interviewed four professionals in the field. From these preliminary results we developed a hypothesis that we tested in FGDs. We conducted three FGDs with health providers (doctors, nurses, social workers, cultural mediators) in different settings in France (Paris, Calais, Nantes) with both NGOs and hospital providers who receive migrant patients. We focused on needs, expectations and capacities of health services. We interviewed 21 health professionals in total and performed a qualitative content analysis. Results: Health providers explained the difficulty of providing care for migrants in the context of increasing patient numbers and decreasing funding. In order to develop a coherent route for migrant patients, they highlighted the support of a shared common culture based on protocols and shared values, and the importance of interinstitutional and interprofessional work. Moreover, professionals highlighted the interpersonal, informal and trusted links between health providers and other professionals that allow them to meet migrants’ needs. Conclusion: In a difficult context, professionals providing health services for migrants base their practices on the construction of trusted links and social networks. This however involves the continuous activation of networks, formal and informal. In order to meet migrants’ needs, health providers tend to base their practices on networking and trusted links.

The challenge of providing primary healthcare care to indigenous peoples in BrazilEl desafío de brindar atención primaria de salud a los pueblos indígenas en Brasil

RESUMONo Brasil, o direito à saúde pleiteado pelos povos indígenas dialoga com diferentes marcos regulatórios, incluindo a Declaração de Alma-Ata, a qual propõe e valoriza a atenção primária à saúde (APS) como promotora de maior acesso e forma de minimizar as desigualdades em saúde. No âmbito do Sistema Único de Saúde (SUS), o subsistema de atenção à saúde indígena (SASI) e a Política de Atenção à Saúde dos Povos Indígenas (PNASPI) foram criados como estratégia para garantir o acesso à saúde aos povos indígenas. A PNASPI prevê atenção diferenciada às populações indígenas com base na diversidade sociocultural e nas particularidades epidemiológicas e logísticas desses povos e focando no desenvolvimento da APS com garantia de integralidade da assistência. O presente artigo traz reflexões acerca da implementação da PNASPI, destacando os avanços e desafios apresentados durante esse percurso. Apesar dos crescentes recursos financeiros disponibilizados para implementar o subsistema de saúde indígena, as ações têm apresentado poucos resultados nos indicadores de saúde, que refletem desigualdades historicamente descritas entre esses povos e os demais segmentos. A participação social ainda se mantém frágil, e suas discussões refletem a insatisfação dos usuários. A descontinuidade do cuidado somada à carência e alta rotatividade de profissionais, assim como a necessidade de estabelecer diálogos interculturais que promovam a articulação com saberes tradicionais, são fatores que desafiam a efetividade da PNASPI. O cuidado ainda é centrado em práticas paliativas e emergenciais, geralmente baseado na remoção de pacientes, gerando altos custos. A superação desses desafios depende do fortalecimento da APS e de seu reconhecimento enquanto importante marco regulador do modelo organizacional da PNASPI.

Ensuring the universal adoption of health equity assessment toolkit to minimize health inequalities

Ensuring the universal adoption of health equity assessment toolkit to minimize health inequalities

Self-Rated Health Among Very Old People in European Countries: An Explorative Study in Latvia and Sweden.

Objectives: To explore and gain insight into factors related to self-rated health (SRH) among very old people in two European countries. Methods: The study was based on Latvian (n = 301) and Swedish (n = 397) data from the baseline of the Enabling Autonomy, Participation, and Well-Being in Old Age: The Home Environment as a Determinant for Healthy Ageing Survey Study. Besides descriptive statistics, ordinal regression analysis was used to analyze demographic, physical and mental health-related, functional and environmental factors related to SRH in each sample. Results: In both samples, participants with worse perceived physical mobility and more symptoms were significantly more likely to have worse SRH. There were more diverse results regarding other factors in terms of opposite relations to SRH, comparing the two samples. Discussion: Preventive measures and health care should focus on improving and supporting mobility and physical health among older people. Especially in countries with low scores on indicators of health such as Latvia, to minimize health inequalities. More attention should be paid to factors to improve the general health status of the population.

A scoping review on the experiences and preferences in accessing diabetes-related healthcare information and services by British Bangladeshis

Diabetes is a chronic condition requiring lifelong self-management. Patients are encouraged to access appropriate services to facilitate optimum management of diabetes. Although equitable access to healthcare in the United Kingdom is a legal right, not all groups and individuals in the community experience equity. Despite various equality laws and numerous efforts to minimise health inequalities related to access, particular community groups are more likely to experience inequitable access than others. The Bangladeshi community are one such community who experience some of the worst diabetes-related health outcomes in the United Kingdom. Little is known about their experiences and preferences in accessing diabetes healthcare information and services. Consequently, we undertook a scoping review of the literature by following the York Scoping Reviews Framework to identify the experiences and preferences of Bangladeshi patients and carers when gaining access to diabetes-related healthcare information and services. We identified eight articles and reported our results in relation to four domains of access: health service availability, health service utilisation, health service outcomes and the notion of equity. The review identified that language and literacy issues were the most common barriers hindering access to information and services. Patient knowledge regarding diabetes and its management was generally low, and friends and family were frequently being used as information sources and as informal interpreters. Additionally, there were feelings of isolation from mainstream information and services possibly resulting in the high prevalence of depression in the Bangladeshi community with women more affected than men. Social networks combined with religious and cultural beliefs as well as wider societal duties played a crucial role in accessing information and services for this population, and the identification of these issues merit further research and are possible avenues towards improved access to healthcare information and services for the Bangladeshi population.