Promote Health Equity Research Articles

Health-promoting and adverse pathways in the healthcare experiences of LGBTQIA+ individuals: a qualitative investigation

ABSTRACT The current study investigated the healthcare experiences of LGBTQIA+ individuals from the perspective of the health equity promotion model, focusing on the factors that promote or hinder equitable healthcare pathways across diverse settings. A sample of 154 LGBTQIA+ individuals living in Italy responded to two open questions concerning their positive and negative experiences within healthcare settings related to their LGBTQIA+ identities. Thematic analysis identified two main themes: (1) health-promoting pathways, encompassing three subthemes (i.e. affirmation of LGBTQIA+ identities, non-judgemental attitudes and lack of prejudice, professional competence and education about LGBTQIA+ health needs); and (2) adverse pathways, encompassing four subthemes (i.e. cis-heteronormative assumptions, homo-transphobic attitudes, lack of competence and information, consequences of negative healthcare experiences). Barriers to accessing and utilising healthcare services were linked to professionals’ affirming attitudes, validation of LGBTQIA+ identities, (lack of) professionalism and prejudice, quality of information provided, and patient perceptions of competence in LGBTQIA+ health needs. The findings suggest that training on the specific health needs of LGBTQIA+ populations should be included in mental and medical healthcare curricula to enhance care quality, dismantle cis-heteronormative beliefs, and mitigate homo-transphobic attitudes that negatively impact the health trajectories of LGBTQIA+ individuals.

Effect of medical insurance policy on child health indicators: an empirical test of difference-in-differences model

BackgroundThe integration policy of urban and rural medical insurance of China is an important policy benefiting the people, aimed at promoting health equity and improving the level of medical security. In the present analysis, we aimed to identify the association between health policy implementation and child health taking China for example.MethodsData were drawn from the child sample of China Family Panel Studies (CFPS) 2012–2018, totaling 11,003 items, and the number of illness times, height-for-age Z-score, weight-for-age Z-score and BMI-for-age Z-score were served as health indicators. This paper used the difference-in-differences model to explore the impact of urban and rural medical insurance integration policy on children’s health and the moderating effect model to analyze the mechanism of action.ResultsOur study found that urban–rural medical insurance integration has a positive impact on reducing children’s illness and improving nutritional status, particularly among middle socioeconomic status and rural children. In provinces that implemented the policy in 2017, the realization of the integration policy decreased the number of times of children getting sick (β = −0.097, p < 0.05), and increased the BMI-for-age Z-score (β = 0.194, p < 0.05). In addition, participation in commercial medical insurance enhanced the positive impact of the integration of urban and rural medical insurance on children’s physical fitness. However, in provinces that implemented the policy in 2018, policy implementation did not change any health indicators. This may suggests a trend where the health promotion effect of the integration policy gradually emerged over time.ConclusionIt is hoped that this study will provide a policy basis and institutional reference for policy makers to construct and develop the children’s health insurance system.

Ethnic equity in Aotearoa New Zealand's COVID-19 response: A descriptive epidemiological study.

Ethnic equity in Aotearoa New Zealand's COVID-19 response: A descriptive epidemiological study.

A Flexible Framework for Urgent Public Health Climate Action.

Climate change poses profound threats to human safety, health, and well-being. Public health agencies, especially state, territorial, local, and Tribal health departments, can play an essential role in climate change adaptation and mitigation. Public health climate action can protect health, promote health equity, and increase climate change resilience. The Centers for Disease Control and Prevention has updated its original climate and health framework for practitioners and expanded its utility by developing practical guidance. The revised framework, Building Resilience Against Climate Effects, supports health departments and their partners by providing an accessible approach that can be tailored to different contexts. The framework has been updated to center justice, equity, and belonging; integrate climate change mitigation or reduction of greenhouse gas emissions that cause climate change; and address agency capacity. The Building Resilience Against Climate Effects framework also emphasizes collaboration, especially cross-sectoral and community partnerships, communication, and evaluation. Framework elements, key tactics, and guiding principles are presented in a pragmatic, step-by-step implementation guide. The implementation guide can be used by state, territorial, local, and Tribal health departments to galvanize or expand their engagement with public health climate action, which grows more urgent each year. (Am J Public Health. 2025;115(7):1062-1073. https://doi.org/10.2105/AJPH.2025.308061).

Review of the contribution of clinical and genetic factors to the racial disparity in taxane-induced peripheral neuropathy.

Review of the contribution of clinical and genetic factors to the racial disparity in taxane-induced peripheral neuropathy.

The impact of insufficient sleep on subjective cognitive dysfunction: Exploring the moderating role of environmental factors at the census tract level.

The impact of insufficient sleep on subjective cognitive dysfunction: Exploring the moderating role of environmental factors at the census tract level.

Designing a Patient-Centered Interdisciplinary Intervention to Promote Equitable Access to Kidney Transplantation across Health Systems: The STEPS Study.

In the United States, health inequities persist in the management of chronic kidney disease and end-stage kidney disease, including unequal access to kidney transplantation. These disparities are deeply rooted in complex social and structural determinants of health, including socioeconomic status, race, geographic location, and healthcare access. Addressing these inequities necessitates a patient-centered interdisciplinary approach to improve outcomes and promote transplant access equity. This article describes the conceptualization and design of the System Interventions to Achieve Early and Equitable Transplants (STEPS) intervention. The STEPS intervention was developed by patients, family members, professional and community stakeholders, social workers, nurses, physicians, and other health professionals to address multifactorial barriers to kidney transplantation in three large health systems in Mississippi, North Carolina, and Pennsylvania. By addressing transplant barriers through collaborative interdisciplinary interventions provided by social workers and transplant nurses, STEPS aims to empower individuals and promote systemic changes in healthcare delivery and access to kidney transplants. This intervention can be used as a model for other interdisciplinary approaches to address social and structural determinants of health to improve access to care and promote health equity.

An Updated Review of Disparities in Postmastectomy Breast Reconstruction: Causes, Consequences, and Strategies for Promoting Health Equity

An Updated Review of Disparities in Postmastectomy Breast Reconstruction: Causes, Consequences, and Strategies for Promoting Health Equity

Analysis of the Correlation Between Health Status and Social Factors Among Korean Care Workers

Amid South Korea’s demographic crisis of a declining birth rate and a rapidly aging population, care work has become an essential yet undervalued sector. This study investigates the physical and mental health conditions of domestic care workers and explores how social and structural factors shape their labor experiences.Using a mixed-methods approach, the research integrates survey data from care workers (n=345) with in-depth interviews of nine individuals working in various care roles, including certified caregivers, disability support workers, childcare teachers, and domestic workers. Quantitative findings reveal strong correlations between job satisfaction and health outcomes. Higher job satisfaction was associated with lower scores on the Oswestry Disability Index (ODI), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), indicating better physical and mental health. Significant disparities were found between care worker subcategories. Qualitative analysis further uncovered recurring themes such as emotional burden, social invisibility, dissatisfaction with compensation, and the absence of grievance mechanisms. Despite these challenges, many workers found meaning in their roles and relied on informal coping strategies such as peer support. This study underscores the urgency of addressing systemic issues in the care sector. The results call for policies that improve working conditions, recognize the social value of care work, and promote health equity. The findings contribute to advancing Sustainable Development Goals (SDGs) 3(Good Health), 5 (Gender Equality), and 8 (Decent Work and Economic Growth).

The Role of Diabetes Educators in Improving Diabetes Health Literacy

Diabetes requires lifelong, comprehensive self-management involving tasks such as diet control, medication adherence, glucose monitoring, and physical activity. These complex behaviors rely heavily on diabetes health literacy the ability to understand, evaluate, and apply health information in daily life. This article explores the components of diabetes health literacy and examines the disparities driven by socioeconomic factors. It emphasizes the critical role of diabetes educators, especially medical social workers, in addressing these gaps. Through tailored education, communication support, emotional care, and community linkage, educators empower patients to become active participants in their care. Enhancing diabetes health literacy not only improves self-management and treatment outcomes but also promotes health equity. This paper advocates a patient-centered, multidisciplinary approach to strengthen diabetes health literacy and support sustainable diabetes care.

Exploring variation in beach environments and physical activity by neighbourhood socioeconomic status in Perth, Australia

ABSTRACT Beaches are important settings for physical activity, with their quality (safety, amenities, aesthetics) influencing how well they support health. The quality of beaches may differ across neighbourhoods, with higher socioeconomic status neighbourhoods having disproportionately better access to beaches. This study examined the attributes of and activities taking place in beaches by neighbourhood socioeconomic status. Seventy-six beaches in Perth, Western Australia, were audited using a modified version of the BlueHealth Environmental Assessment Tool (BEAT), which assesses the health enhancing attributes and activities taking place in blue spaces. Analysis of variance was used to examine differences of beach attributes by differing socioeconomic status neighbourhoods. An exploratory regression analysis examined associations between beach features and activities conducted in and around the beaches, and how this varied by neighbourhood socioeconomic status. Several attributes related to aesthetics, accessibility, path networks, and safety varied by socioeconomic status, with higher socioeconomic status neighbourhoods scoring better. Small but significant variations in built environment features (e.g. cafes, playgrounds) were associated with playing with a child. Disparities in beach quality across socioeconomic levels suggest the need for further research and strategies to improve beach environments to enhance physical activity and promote health equity.

Invisible Engines of Resistance: How Global Inequities Drive Antimicrobial Failure

Antimicrobial resistance (AMR) is considered a global healthcare emergency in the 21st century. Although the evolution of microorganisms through Darwinian mechanisms and antibiotic misuse are established drivers, the structural socioeconomic factors of AMR remain insufficiently explored. This review takes on an analytical perspective, drawing upon a wide spectrum of evidence to examine the extent to which socioeconomic factors contribute to the global proliferation of AMR, with an emphasis on low- and middle-income countries (LMICs). The analytical review at hand was carried out through a search for relevant articles and reviews on PubMed, Google Scholar, the Centers for Disease Control and Prevention, and the World Health Organization database using combinations of the keywords “antimicrobial resistance,” “socioeconomic factors,” “low- and middle-income countries,” “surveillance,” “healthcare access,” and “agriculture.” Preference was given to systematic reviews, high-impact primary studies, and policy documents published in peer-reviewed journals or by reputable global health organizations. Our analysis identifies a complex interplay of systemic vulnerabilities that accelerate AMR in resource-limited settings. A lack of regulatory frameworks regarding non-prescription antibiotic use enables the proliferation of multi-drug-resistant microorganisms. Low sewer connectivity facilitates the environmental dissemination of resistance genes. Proper antibiotic selection is hindered by subpar healthcare systems and limited diagnostic capabilities to deliver appropriate treatment. Additionally, gender disparities, forced migration, and climate-driven zoonotic transmission compound the burden. During the COVID-19 pandemic, antimicrobial misuse surged, further amplifying resistance trends. AMR is not solely a biological phenomenon, but a manifestation of global inequity. Mitigation requires a transformation of policy directed toward a “One Health” strategy that incorporates socioeconomic, environmental, and health system reforms. Strengthening surveillance, investing in infrastructure, regulating pharmaceutical practices, and promoting health equity are essential to curb the rising tide of resistance.

Leveraging social media for public health nutrition in low- and middle-income countries: Addressing malnutrition, enhancing food security, and promoting health equity

Malnutrition, in all its forms, remains a pressing global public health challenge disproportionately impacting low- and middle-income countries (LMICs). Despite progress, significant gaps in nutrition equity persist. The widespread adoption of social media, now exceeding five billion users worldwide, offers new, low-cost opportunities for scalable public health nutrition interventions. However, a comprehensive synthesis of its applications, effectiveness, and limitations within LMICs remain limited. This narrative review explores the role of social media in promoting public health nutrition across LMICs. It critically examines how digital platforms have been leveraged to improve nutrition education, promote dietary behaviour change, enhance food security, and advance health equity. The review also highlights key challenges and proposes directions for research and policy reform. Social media interventions show promise for increasing nutrition knowledge, engaging underserved populations, and supporting maternal and adolescent health. However, barriers such as the digital divide, low media literacy, misinformation, and unregulated marketing of ultra-processed foods (UPFs) limit broader impact. Integrating digital inclusion strategies and stronger policy frameworks is essential. Social media holds transformative potential for promoting health equity and addressing malnutrition in LMICs. To realise this, governments and stakeholders must address digital access gaps, regulate commercial influences, and support community-driven, evidence-based content delivery.

Variability in disease presentation: Diagnostic challenges and emerging solutions

Diagnostic accuracy is often challenged by variability in disease presentation across populations. This study examines the key factors contributing to atypical symptomatology and diagnostic uncertainty. Through a synthesis of current literature, key influences are identified, including genetics, comorbidities, age, sex, social, and environmental determinants of health. Healthcare disparities further complicate diagnosis, particularly in under-resourced settings. Emerging tools such as machine learning and biomarkers offer promise for improving precision but require an inclusive design to prevent the reinforcement of existing healthcare inequities. This paper highlights the need for flexible, patient-centered diagnostic models and policies that account for clinical diversity and promote health equity.

Advancing health equity and the role of digital health technologies: a scoping review.

Health disparities persist, posing significant health, social and economic challenges. Digital health technologies (DHTs) present a promising opportunity to address these inequities and advance health equity. Despite this potential, a comprehensive and structured overview of existing frameworks and guidelines on advancing health equity and a clear understanding of the potential of DHTs in their implementation to systematically close the healthcare gap is yet to be done. To this end, our objectives are twofold: first, to identify frameworks and guidelines that promote health equity and second, to pinpoint the role of DHTs as an avenue for their implementation. We conducted a scoping review informed by Arksey and O'Malley's five-stage framework, methodological guidelines by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A comprehensive search was conducted across seven databases on 6 December 2023: PubMed, EMBASE, Cochrane, PsycINFO, Scopus, Web of Science and WISO. We included primary and secondary studies published in English between 2010 and 2023 focusing on advancing health equity for priority populations. For the analysis, we applied multistaged coding approaches to answer our twofold objective. The search identified 6419 studies, of which 38 met our final inclusion criteria and were included in this review. We extracted 559 recommendations on advancing health equity and synthesised these into 82 distinct recommendations across five levels of initiative and 19 areas of initiative. Thereby, 24% of the included studies explicitly mentioned the use of (digital) technology with 10 impact opportunities on advancing health equity. Our synthesis offers key insights into the advancement of health equity across different levels of initiative and the role of DHTs in their implementation. This offers practitioners and researchers alike a comprehensive overview to make health equity advancement more tangible and actionable. https://osf.io/94pht.

Exploring multifaceted roles of metformin in therapeutic applications, mechanistic insights, and innovations in drug delivery systems across biological contexts: a systematic review.

Metformin, a biguanide derivative, serves as a fundamental therapeutic agent in managing type 2 diabetes mellitus (T2DM) and is gaining recognition for its wider therapeutic applications, by the United Nations Sustainable Development Goal (SDG) 2030 priorities for promoting good health (SDG 3). This systematic review investigates the diverse roles of metformin, focusing on its therapeutic applications, mechanisms of action, and advancements in drug delivery systems. Employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and an optimised search strategy within Scopus and Web of Science databases, 33 high-quality studies were identified and classified into three primary thematic domains:(1) Therapeutic Applications, emphasising metformin's role in cancer, cardiovascular diseases, neurodegenerative disorders, and polycystic ovary syndrome (PCOS); (2) Mechanisms of Action, examining key pathways such as AMP-activated protein kinase (AMPK) activation, mitochondrial respiratory chain complex I inhibition, and gut microbiota modulation; and (3) Innovations in Drug Delivery Systems, investigating advanced strategies including nanoparticles, pH-responsive hydrogels, and microneedles to enhance metformin's bioavailability, targeted delivery, and patient adherence. This review highlights the challenges of conventional metformin administration, such as gastrointestinal side effects and absorption limitations, while discussing advancements in drug delivery technologies designed to address these issues. Implementing metformin in non-diabetic contexts faces challenges related to cost and regulatory issues. This review synthesises evidence from preclinical and clinical studies, positioning metformin as a versatile therapeutic agent for various chronic conditions and highlighting the necessity for ongoing research into its mechanisms and delivery technologies. The findings indicate that metformin may play a role in enhancing sustainable healthcare solutions by promoting health equity and advancing global health objectives, consistent with SDG 2030.

Intimate Partner Violence Perpetration and PrEP Use Among Sexual Minority Men: The Mediating Roles of Internalized Homonegativity and PrEP Stigma.

Cisgender sexual minority men (SMM) report intimate partner violence (IPV) at rates comparable to or higher than heterosexual cisgender women, often linked to increased HIV risk. This study explores the relationship between IPV perpetration and pre-exposure prophylaxis (PrEP), considering the potential mediating effects of sexual orientation related minority stress and PrEP stigma. Utilizing baseline data from the Empowering Relationships and Opportunities for Safety (EROS) cohort, this cross-sectional study examined survey data from partnered cisgender SMM in the U.S. Through online and community recruitment, participants were assessed for IPV perpetration using a validated measure, while internalized homonegativity and related stigma were evaluated through standardized scales. Current PrEP use was assessed through self-report and confirmed through dried blood spot assays. Of the 500 participants, 125 (25%) reported IPV perpetration, with perpetration of identity-related IPV (e.g., threatening to out a partner to family or coworkers; telling partner to act straight) significantly higher among non-PrEP users; mean number of identity-related IPV perpetration items endorsed was 0.21 (SD = 0.53) among non-PrEP users compared to 0.02 (SD = 0.14) among PrEP users. Perpetration of identity-related IPV was positively correlated with internalized homonegativity (r =.19, p <.001), experienced sexual orientation discrimination (r =.15, p <.01), and PrEP stigma (r =.14, p <.001). A logistic regression mediation analysis found that, separately, internalized homonegativity (OR = 0.97, 95% CI [0.94-0.99]) and PrEP stigma (OR = 0.48, 95% CI [0.40, 0.57]) had significant associations with PrEP use, and that each mediated the relationship between perpetration of identity-related IPV and PrEP use as demonstrated by their significant indirect effects (OR = 0.88, 95% CI [0.78, 0.98] and (OR = 0.77, 95% CI [0.60, 0.98], respectively). The study underscores internalized homonegativity and PrEP stigma as critical mediators of the relationship between perpetration of identity-related IPV and PrEP use among SMM. Findings call for interventions aimed at reducing internalized homonegativity, PrEP stigma and enhancing PrEP access while addressing IPV dynamics. Future research should further delineate these pathways to inform culturally sensitive interventions promoting health equity among SMM.

A desk audit of perimenopause and menopause resources on ACCHO websites for Indigenous women.

Objective: This study examines whether Indigenous women can easily access information about perimenopause and menopause through the Aboriginal Community Controlled Health Organisation (ACCHO) sector. Background: Indigenous women in Australia often face significant health inequities, including limited access to healthcare resources tailored to their specific cultural needs. While Aboriginal Community Controlled Health Organisations (ACCHOs) offer specific information about Indigenous health, it is not clear whether they are fully tailored to all stages of the life course for women. Study design and methods: This study is a desk audit of resources available from ACCHO websites for Indigenous women as they transition through perimenopause and menopause. Results: The audit identified 114 ACCHO websites. Of these, only 2 provided information or resources about perimenopause or menopause. In comparison, 81 websites provided resources for mums and bubs, and 43 websites provided resources for Elders. Conclusion: This desk audit highlights a critical gap in healthcare resources for Indigenous women transitioning through perimenopause and menopause. Addressing this gap is essential for promoting health equity and improving health outcomes. There is a pressing need for comprehensive, culturally safe resources to support Indigenous women during this life stage. Implications for research, policy, and practice: This desk audit highlights the urgent need for Indigenous-led research to address the specific perimenopause and menopause needs of Indigenous women. It calls for the development of culturally safe resources within ACCHOs to fill this critical gap. Healthcare providers must integrate these resources into practice to enhance health equity and outcomes for Indigenous women. What is already known about the topic? Indigenous women in Australia face significant health inequities, including limited access to healthcare resources tailored to their life course needs. Indigenous women’s experiences of perimenopause and menopause are not well understood or known. To date, no research in Australia about perimenopause and menopause has been led by Indigenous researchers. What this paper adds This paper identifies a critical gap in the availability of perimenopause and menopause resources for Indigenous women within the ACCHO sector. It underscores the necessity for culturally safe, comprehensive resources to support Indigenous women during these life stages. The paper advocates for prioritising the development and integration of these resources into ACCHO services to enhance health equity and outcomes for Indigenous women across the lifespan.

69-OR: Health Disparities in Type 2 Diabetes Outcomes for Transgender and Nonbinary Patients—A Nationwide Study

Introduction and Objective: Transgender, non-binary, and genderqueer people experience systematic barriers in receipt of medical care. Our objective was to understand patterns of diabetes treatment/outcomes for this population. Methods: Patients with an ICD code diagnosis of T2DM between 01/01/2021 and 01/13/2024 in nationwide Epic EHR data were included and A1c control, receipt of antidiabetic medication classes, and rates of diabetes complications were analyzed by self-reported gender identity. Results: A total of 4,689,434 were newly diagnosed with T2DM. Among those who provided gender identity, 6,325 (0.4%) were of a gender minority group. Gender minority patients tended to have higher A1c at diagnosis (Figure 1). Compared to cisgender female patients, transgender male and transgender female patients were less likely to have A1c &amp;lt;7% (OR 0.75, 95% CI 0.70-0.81 and OR 0.73, 95% CI 0.69-0.77) and more likely to receive insulin (OR 1.18, 95% CI 1.10-1.28 and OR 1.25, 95% CI 1.17-1.33). Transgender male patients were less likely to receive TZDs, DPP4i, or SGLT2i. Transgender male and transgender female patients were more likely to have ketoacidosis (OR 2.94, 95% CI 2.50-3.45 and OR 2.63, 95% CI 2.27-3.05), and transgender female patients were more likely to have diabetic foot ulcers (OR 2.06, 95% CI 1.71-2.48) and lower limb amputations. Conclusion: Greater attention to diabetes care is needed to promote health equity for gender minority patients. Disclosure J.B. Lusk: None. F. Li: None. E. OBrien: Research Support; Pfizer Inc. S. Aymes: None.

1226-P: Current Sociodemographic Disparities in Continuous Glucose Monitor (CGM) Use—Shifting from Access to Wear Time

Introduction and Objective: Inequities in CGM use contribute to health disparities among teens with type 1 diabetes (T1D). Recent changes in insurance coverage and standards of care may have reduced systemic barriers to CGM access. Here, we describe current disparities in CGM access and wear time by race/ethnicity and type of insurance to inform research and quality improvement efforts. Methods: We extracted data on race, ethnicity, sex, insurance, access to CGM, past 14-day CGM wear time (percentage), HbA1c, and age and duration of diagnosis from the electronic health records of teens (n=402, Mean Age=14 years, 52% Male) with T1D attending an endocrinology appointment at a children’s hospital in the northeastern United States between April 2023 and April 2024. Chi-Square and one-way ANOVA with post-hoc Tukey tests were used to compare HbA1c, CGM access, and CGM wear time by race/ethnicity and type of insurance. Results: Almost all (97%) teens had access to CGM and wore CGM on average 86% of the past 14 days (SD=22%). HbA1c differed by race/ethnicity (F[2, 380]=36.46, p &amp;lt;.001) and insurance (F[3, 392]=8.82, p &amp;lt;.001). White youth (M=7.5%) had lower HbA1c than Black (M=9.6%, p &amp;lt;.001) or Hispanic youth (M=8.7%, p =.001); HbA1c was higher among youth with public (M=8.7%) than private insurance (M=7.6%, p &amp;lt;.001). Compared to White youth (98%), fewer Black youth (92%) had access to CGM (χ2[1]=5.52, p=.02); no differences emerged by type of insurance. CGM wear time differed by race/ethnicity (F[2, 320]=9.62, p &amp;lt;.001) and insurance (F[3, 329]=3.70, p=.012). Black (M=79%, p =.014) and Hispanic (M=74%, p =.002) youth used CGM fewer days than White youth (M=89%); wear time was lower among youth with public (M=81%) than private insurance (M=89%, p=.008). Conclusion: Inequities in HbA1c and CGM use persist. Our findings extend the literature by demonstrating inequities in CGM wear time. Future research aiming to promote health equity may benefit from improving CGM wear time as well as CGM access. Disclosure G.S. Shepps: None. N.D. Boone: None. C. Thomas: None. C. Yang: None. A. Gannon: None. M.A. Alderfer: None. P. Enlow: None. Funding National Institute of General Medical Sciences (P20GM144270)