Precarious Socioeconomic Conditions Research Articles

Opportunities of integrated care to improve equity for adults with complex needs: a qualitative study of case management in primary care

BackgroundPeople living in precarious socio-economic conditions are at greater risk of developing mental and physical health disorders, and of having complex needs. This places them at risk of health inequity. Addressing social determinants of health (SDH) can contribute to reducing this inequity. Case management in primary care is an integrated care approach which could be an opportunity to better address SDH. The aim of this study is to better understand how case management in primary care may address the SDH of people with complex needs.MethodsA case management program (CMP) for people with complex needs was implemented in four urban primary care clinics. A qualitative study was conducted with semi-structured interviews and a focus group with key informants (n = 24). An inductive thematic analysis was carried out to identify emerging themes.ResultsPrimary care case managers were well-positioned to provide a holistic evaluation of the person’s situation, to develop trust with them, and to act as their advocates. These actions helped case managers to better address individuals’ unmet social needs (e.g., poor housing, social isolation, difficulty affording transportation, food, medication, etc.). Creating partnerships with the community (e.g., streetworkers) improved the capacity in assisting people with housing relocation, access to transportation, and access to care. Assuming people provide their consent, involving a significant relative or member of their community in an individualized services plan could support people in addressing their social needs.ConclusionsCase management in primary care may better address SDH and improve health equity by developing a trusting relationship with people with complex needs, improving interdisciplinary and intersectoral collaboration and social support. Future research should explore ways to enhance partnerships between primary care and community organizations.

An Examination of the Ways in Which Transdisciplinary Research Could Be Used to Incentivize Local Communities to Combat the Illegal Wildlife Trade

The illegal wildlife trade (IWT) is currently one of the most critical conservation concerns, given its direct impact on biodiversity loss, endangering local ecosystems, and adding pressure to all species at a point when they face dangers like deforestation and mass extinctions. This industry also significantly impacts local communities, many of which are compelled to engage in it as a result of their precarious socioeconomic conditions. While effective countermeasures to this global issue have been identified, successful implementation of these countermeasures require diverse disciplines and collaborators. This paper argues that a transdisciplinary approach that converges knowledge and skills from social and socioecological fields of study is required to develop strategies that effectively incentivize communities to combat the IWT. This is true because A) at the social level, criminal justice is needed for the retraining and participation in law enforcement efforts to mitigate support for poaching; B) at the socio-ecological level, environmental economics and ecosystem management are needed for the validation of community assets and profitable management of local wildlife; and C) ecology and business administration are needed for the implementation of conservation initiatives like ecotourism. This paper not only presents the implementation of a transdisciplinary approach but also details the most important disciplines needed, provides a review of the correlation between this industry and the locals who live in close proximity to wildlife and conservation areas, and proposes workable recommendations to supporting initiatives that combat the IWT and serve as pillars for sustainable action. Without adopting and reinforcing the position argued for in this research, the IWT would continue to pose a threat to local ecosystems, populations, and economies. This is a major risk to global sustainability and will exacerbate the loss of biodiversity that is already recognized as an imminent threat by the United Nations Sustainable Development Goals.

Chagas disease is a low health priority among high-risk Latin American migrants in Geneva, a qualitative study

This qualitative study of the situation of Latin American migrants with Chagas Disease in Geneva analyses how precarious migration-related socioeconomic conditions determine health priorities and disease perception. The study was conducted between 2016 and 2019 and is based on survey data collected in three Chagas-related community events, as well as on open-ended interviews with Bolivian migrants. This research contributes to more appropriate development of public health policies for migrants, as well as to a more nuanced and culturally sensitive understanding of how precarity affects the delivery of, and access to, healthcare in Western Europe. The significance of this research is to highlight how perceptions of Chagas Disease provide a lens to better understand the links between precarity and health among Bolivian migrants.

Antigypsyism in Portugal: Expressions of Hate and Racism in Social Networks

Portuguese Roma/Ciganos face different forms of negative reactions; they are marginalized, live in precarious socio-economic conditions, and are the poorest in Portugal and in the European Union (EU), as shown by the reports of the European Agency for Fundamental Rights (FRA). Despite national and European strategies, these situations continue, with the proliferation of racist demonstrations and hate crimes, and the growth of extreme right-wing parties. In 2022, the publication of a report by the FRA, regarding the situation of Roma in 10 EU countries (including Portugal), revealed the impact of antigypsyism in the areas of employment, education, health, and housing; these data triggered hate speech on social networks, which happens whenever something about Ciganos is published. A content analysis of the news disseminated by the main Portuguese media (press, TV, Radio) and of the comments on this news was conducted, through qualitative methodology. The results reveal racist hegemonic perspectives towards Ciganos: they depend upon the minimum income, do not contribute economically to the state accounts, and boast luxury goods.

Racism in Marketing Academia: A Necessary Discussion and Call for Action

The management academy as a whole, and more specifically the marketing academy, have recently recognized the importance of discussions of race and racial issues, which were discussed in a panel at EnAnpad 2021, the most prominent Brazilian management conference and the world's second. The Panel's proposal emerged from reading Francis’ provocative work, which establishes new relationships between structural racism and academic socialization, in which the mechanisms of social exclusion are present. As a result of the Panel’s debate, this paper presents three perspectives on the racialized reality in which we live. The first indicates how much racism conveniently insists on naturalizing privileges mistakenly treated as individual merits for specific groups. The second perspective reminds us how the racialized gaze forces subjugated groups to react, fight, and establish political and legal means. Finally, the third perspective explores a racial landscape, forcing us to ask ourselves how long academics and practitioners in Brazil and abroad will take to recognize ourselves as part of the problem. As a result, we advocate that educational institutions are fundamental to the path of change. Additionally, we propose a non-exhaustive critical agenda for social transformation.

Long lasting anti-IgG chikungunya seropositivity in the Mayotte population will not be enough to prevent future outbreaks: A seroprevalence study, 2019.

Chikungunya is an arboviral disease causing arthralgia which may develop into a debilitating chronic arthritis. In Mayotte, a French overseas department in the Indian Ocean, a chikungunya outbreak was reported in 2006, affecting a third of the population. We aimed at assessing the chikungunya seroprevalence in this population, after over a decade from that epidemic. A multi-stage cross sectional household-based study exploring socio-demographic factors, and knowledge and attitude towards mosquito-borne disease prevention was carried out in 2019. Blood samples from participants aged 15-69 years were taken for chikungunya IgG serological testing. We analyzed associations between chikungunya serological status and selected factors using Poisson regression models, and estimated weighted and adjusted prevalence ratios (w/a PR). The weighted seroprevalence of chikungunya was 34.75% (n = 2853). Seropositivity for IgG anti-chikungunya virus was found associated with living in Mamoudzou (w/a PR = 1.49, 95%CI: 1.21-1.83) and North (w/a PR = 1.41, 95%CI: 1.08-1.84) sectors, being born in the Comoros islands (w/a PR = 1.30, 95%CI: 1.03-1.61), being a student or unpaid trainee (w/a PR = 1.35, 95%CI: 1.01-1.81), living in precarious housing (w/a PR = 1.30, 95%CI: 1.02-1.67), accessing water streams for bathing (w/a PR = 1.72, 95%CI: 1.1-2.7) and knowing that malaria is a mosquito-borne disease (w/a PR = 1.42, 95%CI: 1.21-1.83). Seropositivity was found inversely associated with high education level (w/a PR = 0.50, 95%CI: 0.29-0.86) and living in households with access to running water and toilets (w/a PR = 0.64, 95%CI: 0.51-0.80) (n = 1438). Our results indicate a long-lasting immunity from chikungunya exposure. However, the current population seroprevalence is not enough to protect from future outbreaks. Individuals naïve to chikungunya and living in precarious socio-economic conditions are likely to be at high risk of infection in future outbreaks. To prevent and prepare for future chikungunya epidemics, it is essential to address socio-economic inequalities as a priority, and to strengthen chikungunya surveillance in Mayotte.

PROBLEMÁTICA AMBIENTAL Y MIGRACIÓN EN EL SISTEMA LAGUNAR DE ALVARADO, VERACRUZ, MÉXICO

<p><strong>Background</strong>. The fishing problem in the Lagunar de Alvarado System (LAS), taking into account environmental or socioeconomic aspects, has been analyzed by various authors, but few have addressed the relationship between environmental problems as perceived by fishermen, and migration. <strong>Objective</strong>. To identify the migration phenomenon in three zones of the LAS and its relationship with environmental problems perceived by fishermen. <strong>Methodology</strong>. Information was compiled from a survey applied to 32 Family Fishing Units. To quantify the environmental problem perceived and relate it to migration, three indicators were used: Pollution Perceived by fishermen, State of Perceived Health of the Fishery Resource and State of Perceived Health of the Environment. <strong>Results.</strong> The wetland areas have more precarious socioeconomic conditions than the area that borders the mainland, while migration and perceived environmental problems vary in each zone. <strong>Implications</strong>. Because the causes of migration are multiple, environmental deterioration has an impact on this phenomenon but does not explain it by itself. Therefore, more comprehensive analyses are required. <strong>Conclusions</strong>. There is insufficient evidence to affirm that the environmental deterioration identified by fishermen is an important motivation for migration.</p>

Accessibility barriers to primary care in a Pernambuco, Brazil, settlement via the perspective of peasants, health professionals, and management

We are unable to deny the iniquities which are directly involved in the ways of being born, living, falling ill, and dying of the rural population. To analyze these people's accessibility to health care, we considered four barriers pertinent to accessibility to primary care: geography, organization, finance, and information. This study stresses the accessibility barriers to primary care which the population of a Pernambuco, Brazil, settlement faces from the perspective of settlers, professionals, and management. This is a descriptive, cross-sectional, qualitative, single-case research conducted in a Pernambuco agrarian reform settlement and in the family health unit responsible for caring for this territory. We interviewed a primary care municipal management representative and conducted two focus groups, one with settlers and another with the healthcare providers of the family health team. To analyze data, the Discourse of the Collective Subject method was used. Geographical accessibility barriers showed a distance between unity and settlement without guaranteeing transportation; organizational ones showed high user demand and precarious physical structure; financial ones, threats of new financing and precarious socioeconomic conditions of this population; and information ones revealed the scarcity of continuing education and the prejudice associated with communication gaps between professionals and settlers. In view of the numerous accessibility barriers and their consequences for the studied population, we must improve primary care adequacy to expand access to the evinced health needs.

Understanding Social and Environmental Hazards in Urban Areas: An Analysis from Barranquilla, Colombia

The present research aims to understand the challenges faced by a Colombian city in the context of multidimensional risk scenarios, given the existing demographic and socio-economic conditions and local perspectives and perceptions regarding socio-environmental risks. The research was undertaken in the city of Barranquilla, northern Colombia. A survey was designed to analyze (1) the general socio-economic and vulnerability conditions of a communities’ sample, (2) information related to hazards and disaster risk in their neighbourhoods, and (3) information on actions to mitigate risk. Three hundred and ninety-one people were surveyed. Likert scale and Pearson's Chi-square test and descriptive, inferential statistical methods, regression models, and the Mann–Whitney U test were used to process the results. Respondents lived, in general, under precarious socio-economic conditions (such as low income or lack of infrastructure and others). Given socio-environmental constraints, the research revealed that hazards such as urban stream flooding and robbery were the most negatively associated with the respondent’s quality of life. Regarding the actions to avoid losses, 84% of respondents had not implemented any preventive action. Respondents also have low awareness of the need to implement risk prevention actions. Social risks and the configuration of anthropic hazards stand out as principal centres for concern.

Breastfeeding experiences of Latina migrants living in Spain: a qualitative descriptive study

BackgroundThe migratory flows in Spain have changed due to the arrival of a diverse migrant population. Among the new migrants the Latino collective predominate with more than half being women of childbearing age. There are no previous studies exploring breastfeeding experiences of migrants in a country where their mother tongue is spoken. This study aimed to explore Latina migrants’ breastfeeding experiences in a Spanish-speaking country.MethodsA descriptive qualitative study was carried out in the main province in southern Andalusia between November 2019 and June 2020. The study used intentional sampling. The study participants were contacted by video calls and data were collected through a semi-structured in-depth interview (n = 19). The interviews were transcribed and analysed by thematic analysis.ResultsThe nineteen participants were aged between 22 and 43 years old and came from six different countries in Latin America. The two main categories that emerged were breastfeeding facilitators and barriers, divided into ten interrelated sub-categories: working conditions; precarious socioeconomic conditions; lack of support (health professionals, family and society); physiological changes, pain and fatigue; ignorance and wrong beliefs; support networks (partner, health professionals and family); host country versus home country; religious practices/worship; appropriate attitude, knowledge and experience; and breastfeeding support groups. Most of the study participants stated that their breastfeeding experiences were influenced by barriers such as work and by facilitators such as peer support.ConclusionsMore support from caregivers and more sensitivity to cultural diversity were demanded by the women and well-trained professionals are needed to enable breastfeeding for a longer time. This paper provides caregivers, such as nurses, more knowledge about the care demanded by migrant women to ensure a longer breastfeeding experience.

La pandemia de covid-19 en municipios afromexicanos de la costa guerrerense y oaxaqueña

The covid-19 pandemic has transformed people’s lives globally but has particularities specific to each context. This article analyzes some of its effects in five Afro-Mexican municipalities on the coast of Guerrero and Oaxaca. Using official health data and interviews conducted by local researchers, we developed a collaborative study about the situation of infections in the region, the service networks available for their care, and the perception of risk by the population. The results show the uncertainty regarding the virus and –even though the prevalence of infections is apparently low– the pandemic has exposed the precarious socioeconomic and health infrastructure conditions and the structural vulnerabilities in a región with high rates of marginalization. It is an exploratory study that analyzes the first months of the pandemic but contributes to its understanding in rural contexts and among the Afro-Mexican population.

Improving pathways to care through interventions cocreated with communities: a qualitative investigation of men’s barriers to tuberculosis care-seeking in an informal settlement in Blantyre, Malawi

IntroductionMen have a higher prevalence of undiagnosed tuberculosis (TB) than women and can spend up to a year longer contributing to ongoing transmission in the community before receiving treatment. Health...

COVID-19 and Immigrants’ Increased Exclusion: The Politics of Immigrant Integration in Chile and Peru

The COVID-19 pandemic has put into sharp relief the need for socio-economic integration of migrants, regardless of their migratory condition. In South America, more than five million Venezuelan citizens have been forced to migrate across the region in the past five years. Alongside other intra-regional migrants and refugees, many find themselves in precarious legal and socio-economic conditions, as the surge in numbers has led to xenophobic backlashes in some of the main receiving countries, including Chile and Peru. In this paper, we explore in how far the COVID-19 crisis has offered stakeholders an opportunity to politically reframe migration and facilitate immigrant integration or, rather, further propelled xenophobic sentiments and the socio-economic and legal exclusion of immigrants.

Integrative review on the incidence of HIV infection and its socio-spatial determinants.

to identify the socio-spatial determinants associated with the incidence of infection by the human immunodeficiency virus (HIV) described in national and international literature. integrative literature review that included original articles indexed in the LILACS, PUBMED, CINAHL, and Scopus databases, from 2015 to 2019. The synthesis of the articles was done in a descriptive manner in two categories according to the type of approach. 13 articles were selected, with a predominance of ecological studies. Regions with deficient access to health services, high population density, higher rates of poverty, intense migratory flow, border areas, as well as precarious socioeconomic conditions, and risk behaviors are associated with higher rates of infection. the influence of regional inequalities on the incidence of HIV infection is revealed, confirming the relevance of spatial analysis techniques for mapping the distribution of diseases and identifying risk areas.

Precarity at the Margins of Malaria Control in the Chittagong Hill Tracts in Bangladesh: A Mixed-Methods Study.

Bangladesh has achieved significant progress towards malaria elimination, although health service delivery for malaria remains challenging in remote forested areas such as the Chittagong Hill Tracts (CHT). The aim of this study was to investigate perceptions of malaria and its treatment among the local population to inform contextualized strategies for rolling out radical cure for P. vivax in Bangladesh. The study comprised two sequential strands whereby the preliminary results of a qualitative strand informed the development of a structured survey questionnaire used in the quantitative strand. Results show that ethnic minority populations in the CHT live in precarious socio-economic conditions which increase their exposure to infectious diseases, and that febrile patients often self-treat, including home remedies and pharmaceuticals, before attending a healthcare facility. Perceived low quality of care and lack of communication between Bengali health providers and ethnic minority patients also affects access to public healthcare. Malaria is viewed as a condition that affects vulnerable people weakened by agricultural work and taking away blood is perceived to increase such vulnerability. Healthcare providers that initiate and sustain a dialogue about these issues with ethnic minority patients may foster the trust that is needed for local malaria elimination efforts.

Importance of health education actions to improve quality of life of vulnerable populations

Abstract Introduction Health Education (HE), which is an integral part of Brazilian basic health care policy, reflects on the actions of a specific service or area. In regions where access to health care is precarious and poor socioeconomic conditions predominates, HE is fundamental for the comprehension of the health-illness process which aims at promoting a better quality of life. This study aims to assess through experiment the viability and adhesion of HE actions conducted in indigenous and Riverside communities in the Brazilian Amazon region. Methodology This study aims at reporting field trips during health expeditions between July and August 2019 in communities of the state of Pará, Brazil. The HE was composed by seven students and professors. Throughout patient's medical care, the team selected individuals to participate in different group dynamics at common spaces in the community area. The topics covered had been pre-screened based on epidemiological surveys conducted in previous expeditions. Visual and ludic resources were adapted to match local reality. Results 2860 medical and dental care consultations were given. The adherence to the dynamics in was significant and covered the majority of them. The topics approached by the HE team were breast-feeding, family-planning, non-transmissible chronic diseases, healthy eating habits, hygiene, and awareness for natural resources. It has been observed that culture was a determinant factor for small a number of individuals in the comprehension of actions taken by the HE team. Conclusions Despite the strong cultural influence, HE proves to be a fertile ground and it must be encouraged in indigenous and riverside communities. The actions taken by the HE team should consider the local reality in every step of the process of implementation. In spite of the context in which locals of indigenous and riverside communities are inserted, HE promotes an autonomous development of their quality of life. Key messages Health education is one of the pillars of the national policy of basic health care in Brazil and is fundamental to promote better quality of life in vulnerable populations. Encouraging interventions in vulnerable communities contributes directly to the autonomous development of quality of life.

Nutritional status of children of Haitian descent and their demographic, socioeconomic and health characteristics in Cuiabá, State of Mato Grosso (MT), Brazil

The scope of this study was to analyze the distribution of anthropometric variables according to demographic, socioeconomic, and health characteristics among children of Haitian descent between 0 and 5 years of age living in Cuiabá-MT. It consists of a cross-sectional and census-based study with data collected between August 2016 and February 2017. The dependent variables were body mass index (BMI) and height-for-age z-score, using Student's t-Test and ANOVA in the statistical analysis. A total of 67 children, 73.2% to 24 months of age and 34.3% being male, were evaluated. There was a significant proportion of families with per capita income of less than 1/4 of the minimum wage (65.6%), with no home monitoring for the family health strategy (88.1%), and long working hours for mothers (43.3%). The onset of prenatal care until the third month of pregnancy and female sex were associated with higher BMI averages. For height-for-age, an association with lower mean values was found for households with more than one resident per room, higher age range of the child, and child-care in daycare centers. Thus, although few factors have an association with the anthropometric indications evaluated, it is necessary to consider the precarious socioeconomic conditions in which these children find themselves.

Formação política via autoeducação no movimento hiphop: experiências de rappers ativistas no Brasil

Este artigo apresenta resultados de pesquisa sobre a formação política de rappers ativistas no Brasil. Rappers são compositores e cantores do gênero musical rap, um dos quatro elementos do hip-hop, movimento artístico-cultural surgido no gueto novaiorquino na década de 1970. Não raramente esses artistas extrapolam as fronteiras da música e se dedicam a atividades assistenciais, culturais e políticas direcionadas às populações de seus bairros e da periferia urbana de modo geral. Considerando que esses sujeitos, em geral, vivem em precárias condições socioeconômicas, têm conturbadas histórias de vida e contam com níveis de escolaridade baixos e medianos, cabe investigar o modo pelo qual se formam politicamente. Sustenta-se, aqui, a existência de uma dinâmica autoeducativa no âmbito do movimento hip-hop. Processo que contribuiria decisivamente para a educação política de rappers, uma vez que estes localizam a) na audição da música rap, b) na composição do seu próprio rap e c) nas vivências no interior do movimento hip-hop momentos-chave da constituição de sua visão de mundo. Produções musicais e atividades político-culturais promoveriam, assim, momentos significativos de reflexão sobre a condição social de negros e pobres no Brasil. Mediante pesquisa etnográfica, foram reunidos materiais oriundos de entrevistas individuais, diálogos informais, letras musicais e observação de atividades e situações que tiveram a participação de rappers ativistas da cidade de Marília-SP. Letras musicais e entrevistas registradas em sites, revistas e documentários também compuseram um conjunto de informações sobre o ativismo e a formação política de rappers de outras cidades e regiões brasileiras.

Depressão materna e fatores de risco associados

Este estudo teve como objetivo analisar a frequência para a depressão pós-parto e os fatores de risco associados em uma amostra de mães de bebês nascidos em cidade de porte médio e arredores da região central do Rio Grande do Sul (RS). A pesquisa foi realizada em Hospital Escola no qual os bebês realizavam triagem auditiva neonatal, no período de março a maio de 2010. A amostra do estudo foi composta por 183 díades mães- bebês. Para a coleta de dados foi utilizado um roteiro de entrevista sobre informações socioeconômicas, demográficas, obstétricas e psicossociais e a aplicação do Inventário de Depressão de Beck (BDI). A maioria da amostra estudada não apresentou indícios de depressão pós-parto (56,1%), sendo que os fatores de risco associados significativamente com a depressão foram à baixa renda familiar e o não planejamento da gravidez. As precárias condições socioeconômicas da mulher e o não planejamento da gestação foram os fatores que influenciaram significativamente no aparecimento da depressão no período pós-parto na amostra estudada.

Analysis of population vulnerability to environmental technological risks in the urban area of the city of Manaus-AM

Este trabalho procura identificar e caracterizar a situação de vulnerabilidade populacional aos riscos tecnológicos ambientais nos bairros da área urbana de Manaus-AM, Brasil. As fontes geradoras desses riscos, identificadas e caracterizadas como ameaças que tenham potencial de causar algum dano foram: termelétricas, indústrias que utilizam solventes e/ou gases, áreas portuárias, áreas de disposição de resíduos, áreas aeroportuárias e depósito de combustíveis. A elaboração da base de dados foi realizada por meio do levantamento de informações disponibilizadas pelos órgãos locais, federais e agências nacionais; trabalho de campo, a fim de certificar a operação das fontes geradoras de risco; e uso de Sistema de Informação Geográfica. Os bairros da cidade de Manaus foram classificados em cinco categorias de vulnerabilidade, resultantes da combinação de três dimensões: densidade populacional; Índice de Desenvolvimento Humano Municipal – Dimensão Renda; e ocorrência de fatores geradores de risco. Os resultados apontam que os fatores de risco tecnológico estão concentrados na região sul da cidade, embora os bairros que apresentam maior ocorrência de fatores de risco estejam situados nas zonas norte e leste, zonas que também apresentam os piores IDH. A distribuição da população concentra-se no eixo nordeste–sudoeste, com destaque para os bairros a sudoeste, onde localizam-se os bairros mais antigos e o centro histórico da capital. Os níveis mais elevados de vulnerabilidade encontram-se na região nordeste, onde estão localizados bairros de condições socioeconômicas precárias e muito povoados. Este trabalho, nesse sentido, ao identificar e caracterizar as áreas críticas de vulnerabilidade e de concentração de fatores de risco tecnológico, traz subsídios relevantes para o planejamento de políticas públicas e desenvolvimento de estratégias para a prevenção de riscos e danos à saúde da população. Os resultados expõem cenários que devem ser alvos de políticas direcionadas à redução das problemáticas, podendo e devendo ser o planejamento urbano uma ferramenta para atenuar esses níveis.