Reduce Health Inequalities Research Articles

Project GIVE: using a virtual genetics service platform to reduce health inequities and improve access to genomic care in an underserved region of Texas

BackgroundThe utilization of genomic information to improve health outcomes is progressively becoming more common in clinical practice. Nonetheless, disparities persist in accessing genetic services among ethnic minorities, individuals with low socioeconomic status, and other vulnerable populations. The Rio Grande Valley (RGV) at the Texas-Mexico border is predominantly Hispanic/Latino with a high poverty rate and very limited access to genetic services. Funded by the National Center for Advancing Translational Sciences, Project GIVE (Genetic Inclusion by Virtual Evaluation) was launched in 2022 to reduce the time to diagnosis and increase provider knowledge of genomics in this region, with the goal of improving pediatric health outcomes. We describe our experience of establishing a virtual pediatric genomic service in this region to expeditiously identify, recruit, and evaluate pediatric patients with undiagnosed diseases.MethodsWe have utilized an innovative electronic health record (EHR) agnostic virtual telehealth and educational platform called Consultagene to receive referrals from healthcare providers in the RGV. Using this portal, genetic services, including virtual evaluation and genome sequencing (GS), are being delivered to children with rare diseases. The study has also integrated effective methods to involve and educate community providers through in-person meetings and Continuing Professional Education (CPE) events.ResultsThe recruitment efforts have proven highly successful with the utilization of Consultagene in this medically underserved region. The project’s ongoing engagement efforts with local healthcare providers have resulted in progressively more referrals to the study over time, thus improving inclusion and access to genomic care in the RGV. Additionally, the curated CPE content has been well received by healthcare providers in the region.ConclusionsProject GIVE study has allowed advanced genetic evaluation and delivery of GS through the virtual Consultagene portal, effectively circumventing the recognized socioeconomic and logistical barriers to accessing genetic services within this border community.

GIS-based assessment of spatial and temporal disparities of urban health index in Shenzhen, China.

To explore the inter-regional health index at the city level to contribute to the reduction of health inequalities. Employed the health determinant model to select indicators for the urban health index of Shenzhen City. Utilized principal component analysis, the weights of these indicators are determined to construct the said health index. Subsequently, the global Moran's index and local Moran's index are utilized to investigate the geographical spatial distribution of the urban health index across various administrative districts within Shenzhen. The level of urban health index in Shenzhen exhibits spatial clustering and demonstrates a positive spatial correlation (2017, Moran's I = 0.237; 2019, Moran's I = 0.226; 2021, Moran's I = 0.217). However, it is noted that this clustering displays a relatively low probability (90% confidence interval). Over the period from 2017 to 2019, this spatial clustering gradually diminishes, suggesting a narrowing of health inequality within economically developed urban areas. Our study reveals the urban health index in a relatively high-income (Shenzhen) in a developing country. Certain spatially correlated areas in Shenzhen present opportunities for the government to address health disparities through regional connectivity.

The COVID-19 Pandemic, Geroscience, and Intersectional Dimensions of Health and Well-being.

The coronavirus disease 2019 (COVID-19) pandemic challenged bioethical principles of research and the ability of scientific and healthcare institutions to provide equitable care. How can geroscience adapt to build equity within research protocols to better serve minoritized and marginalized communities? What lessons can geroscience take from the COVID-19 pandemic and its response? Developing geroscience approaches that incorporate such knowledge, including vaccine distribution plans and coalition-building to improve vaccine confidence, may help to reduce health inequities.

Health of single mothers and fathers in Germany. Results of the GEDA studies 2019 - 2023.

The living situation of single parents is often characterised by sole responsibility for family and household, problems in reconciling work and family life, and a high risk of poverty. In a comparative perspective with parents in partner households, the health of single mothers and fathers was analysed, considering differences in their social status. The analyses are based on data from the GEDA studies 2019 - 2023 (7,999 women, 6,402 men). Prevalences for single mothers and fathers and mothers and fathers living in partner households were calculated for self-rated health, chronic diseases, depressive symptoms, smoking and utilisation of professional help for mental health problems. In multivariate models, adjustments were made for income, education, employment status and social support, and interactions with family type were included. Single mothers and fathers show higher prevalences for all health indicators in comparison to parents living in partner households. Also after adjustment, the differences between family types remain significant. The health of single mothers also varies partially with income, employment status and social support. Health promotion measures have to consider that single parents are a heterogeneous group. In addition to strengthening personal skills, policy and setting-based interventions aim to reduce health inequalities.

Understanding the daily life needs of older public assistance recipient subgroups in Japan: A qualitative study.

Transition from individual-level treatment to social-level intervention should be made to improve peoples daily living conditions for reducing health inequality, which is a major global public health concern. Older public assistance recipients in Japan are socially vulnerable and require healthcare, long-term care, daily living, and social care support. Understanding the diverse daily living needs among public assistance recipient subgroups would prompt the development of novel support measures in the welfare sector. Therefore, this study aimed to understand the daily life needs of older recipient subgroups (segments) created quantitatively in our previous study. We interviewed four caseworkers at municipal welfare offices in 2021; the interview data were analyzed using a qualitative descriptive method to describe the daily life needs of the five older recipient segments for each sex. Five themes of daily life needs were demonstrated: i) housing, ii) financial, iii) welfare service, iv) healthcare, and v) no daily life needs. Consequently, we identified the daily life needs of some older recipient segments, indicating the necessity for support interventions. Future research would help interview other professionals from various backgrounds to further understand the daily life needs of older recipient segments.

Tuberculosis and Chronic Hepatitis B Virus Infection Screening Among Non-US-Born Persons in an Integrated Health System in California.

Tuberculosis infection (TBI) and chronic hepatitis B virus (HBV) infection disproportionately affect non-US-born persons. Early identification and treatment are critical to reduce transmission, morbidity, and mortality, but little is known about screening in the United States. We conducted a cross-sectional study in a large integrated California health system in September 2022 assessing TBI and HBV screening among persons aged ≥18 years who were born in countries with high TB burden (TB disease incidence rates ≥20/100 000 population) and/or HBV burden (hepatitis B surface antigen seroprevalence >2%). Of 510 361 non-US-born persons born in countries with high TB burden, 322 027 (63.1%) were born in countries with high HBV burden and 188 334 (36.9%) in countries with only high TB burden. Among persons born in countries with high TB and HBV burden, 29.6% were screened for TBI, 64.5% for HBV, and 23.4% for TBI and HBV; 9.9% had TBI and 3.1% had HBV infection. Among persons born in countries with high TB burden only, 27.9% were screened for TBI and 7.5% had TBI. Among non-US-born persons from countries with high TB and HBV burden, we found low screening rates and elevated prevalence of TBI and chronic HBV infection. Cotesting for TBI and HBV infection in non-US-born persons from countries with high TB and HBV burden might improve outcomes by identifying persons who warrant TBI treatment, HBV treatment, or HBV vaccination. Increased screening is the first step in reducing health inequities and overall disease burden.

Bridging the Gap: Reducing Health Inequities in Access to Preventive Health Care Services in Rural Communities in the Philippines.

We used an implementation science framework to investigate perceived health inequities in preventive health care initiatives in rural communities in the Philippines. We also identified health equity-focused quality improvement strategies. Three health care providers and 12 barangay clinic patients were interviewed. Patient interviews showed that social determinants of health, respect, and attitudes toward health care providers affected patient empowerment to engage in self-management for noncommunicable diseases (NCDs). Health care providers identified six challenges in managing NCDs: (a) inefficient work processes; (b) staffing shortages; (c) insufficient access to low-cost medications; (d) inadequate primary preventive health education from the schools; (e) health care not considered a priority; and (f) lack of local government support. Inadequate preventive health care and education intensify health access and resource inequities in rural communities in the Philippines. A multi-sectoral plan may improve rural health infrastructure and education toward improving health care access and decreasing care disparities.

Evaluation of simulation-based intervention for implicit bias mitigation: A response to systemic racism

BackgroundTraining health care professionals to mitigate implicit biases can reduce health inequities caused by racism. Implicit bias mitigation strategies (IBMS) have been shown to reduce biased behaviors. This study aimed to determine the impact of IBMS practice simulation on learners’ behaviors and family experience in one hospital unit. MethodsThis study used a quasi-experimental design in a large pediatric hospital. In total, 195 participants completed a simulation-based education intervention. Learners practiced IBMS with Simulated Participants. Participant perceptions were measured at four time points, and translational outcomes were collected using survey results and other outcomes. ResultsSituational judgment test results improved postintervention and at follow-up. Participants reported using IBMS skills at time points three and four. Internal and External Motivation Scale and family satisfaction scores remained unchanged. Family experience measures improved, showing decreases in security dispatch calls for perceived family escalation and in deny entries and behavioral contracts stratified by race. ConclusionsSimulation can shift perspectives and behaviors. More research is needed on the impact of simulation-based interventions on IBMS skill development and translational outcomes.

Embracing Labor Neuraxial Analgesia as a Tool to Reduce Health Inequities and Hemorrhage-related Maternal Morbidity

Embracing Labor Neuraxial Analgesia as a Tool to Reduce Health Inequities and Hemorrhage-related Maternal Morbidity

Measure What Matters: Toward Multi-Sectoral Action to Improve Child and Youth Health and Well-being

Despite Canada’s strengths and widespread acknowledgment of the importance of children and youth, this country recently ranked 30th among 38 high-income countries on indicators of their well-being (UNICEF Innocenti 2020). While there are limited data readily available for monitoring within and across jurisdictions, Alberta compares worse than Canadian averages on indicators of early development vulnerability and child abuse (PHAC 2023a). The Alberta government convened a Child and Youth Well-being Review (GOA 2021) and Action Plan (GOA 2022a) to understand and address the pandemic’s adverse impacts. Indigenous and racialized children and youth, children in low-income families and children with disabilities were highlighted as being disproportionately impacted. In addition, the review found significant gaps in mental health, education, social data and evidence along with fragmentation of data within ministries and service systems (GOA 2021). Influences on child and youth health, well-being and health inequity have social, environmental and economic origins that extend beyond health policy boundaries (Lopez et al. 2021; Vargas-Barón, Diehl and Small 2022; Clark et al. 2020; Patton et al. 2016). Yet, public policy can be a powerful intermediary between children’s conditions and outcomes (UNICEF 2020). Cross-sectoral, whole-of-society approaches are required to improve child and youth health and well-being and government ministries have important roles to play (Akseer et al. 2020; De Montigny, Desjardins and Bouchard 2019; Leppo et al. 2013). Meaningful and accessible measurement and monitoring information is required to support co-ordinated, cross-sectoral decision-making and policy strategies to improve health outcomes and reduce health inequities (OECD 2021). Information is required about child and youth material living standards, physical and mental health, social lives and learning and education (OECD 2021). While definitions of child and youth well-being vary depending on diverse perspectives and cultural, social and local contexts, many established indicators and frameworks can be tailored to local community needs and priorities (OECD 2021).

How can health systems approach reducing health inequalities? An in-depth qualitative case study in the UK

BackgroundAddressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system’s level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions.MethodsIn-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach.ResultsInterviews (n = 14) with wide representation from local authority (n = 8), NHS (n = 5) and voluntary, community and social enterprise (VCSE) sector (n = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system’s approach to reducing health inequalities was evident as was collective action and involving people, with links to a “strong third sector”. Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system.ConclusionWe provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system’s working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.

Implications of child poverty reduction targets for public health and health inequalities in England: a modelling study between 2024 and 2033.

We investigated the potential impacts of child poverty (CP) reduction scenarios on population health and health inequalities in England between 2024 and 2033. We combined aggregate local authority-level data with published and newly created estimates on the association between CP and the rate per 100 000 of infant mortality, children (aged <16) looked after, child (aged <16) hospitalisations for nutritional anaemia and child (aged <16) all-cause emergency hospital admissions. We modelled relative, absolute (per 100 000) and total (per total population) annual changes for these outcomes under three CP reduction scenarios between 2024 and 2033-low-ambition (15% reduction), medium-ambition (25% reduction) and high-ambition (35% reduction)-compared with a baseline CP scenario (15% increase). Annual changes were aggregated between 2024 and 2033 at national, regional and deprivation (IMD tertiles) levels to investigate inequalities. All CP reduction scenarios would result in substantial improvements to child health. Meeting the high-ambition reduction would decrease total cases of infant mortality (293; 95% CI 118 to 461), children looked after (4696; 95% CI 1987 to 7593), nutritional anaemia (458, 95% CI 336 to 574) and emergency admissions (32 650; 95% CI 4022 to 61 126) between 2024 and 2033. Northern regions (eg, North East) exhibited the greatest relative and absolute benefit. The most deprived tertile would experience the largest relative, absolute and total benefit; under high-ambition reduction, total infant mortality cases were predicted to fall by 126 (95% CI 51 to 199) in the most deprived tertile compared with 71 (95% CI 29 to 112) in the least between 2024 and 2033. Achieving reductions in CP could substantially improve child health and reduce health inequalities in England.

Exploring health inequalities in Gypsy and Traveller communities in the UK.

Health inequalities between groups of people are often unjust and avoidable and are influenced by social determinants of health, the non-medical factors that influence health outcomes. Gypsy and Traveller communities experience significant health inequalities, including barriers to accessing healthcare services and suboptimal health outcomes compared with the general population. This article provides an overview of health inequalities in relation to Gypsy and Traveller communities and examines three social determinants of health - discrimination and racism, accommodation and access to healthcare - that influence these inequalities. The authors propose that accurate data collection as well as delivery of culturally competent health services and care may facilitate access to healthcare for Gypsy and Traveller communities and potentially reduce health inequalities.

Improving Medical and Surgical Care: A Qualitative Study of Medical Students' Experience With Language Barriers in Healthcare.

Objective This study aims to investigate the experiences of medical students in teaching and practice concerning communication with patients exhibiting limited English proficiency (LEP). With a growing population in the United Kingdom facing language barriers, this research explores the challenges encountered by medical students, emphasizing the need for enhanced medical education in this domain. Methods A qualitative technique was used to recruit 20 medical students enrolled in a Medicine MBBS degree program at a UK institution. Convenience sampling was utilized, and five separate focus groups were conducted. Semi-structured interview schedules guided discussions surrounding encounters with patients necessitating the use of interpreters. Thematic analysis was employed to identify recurring patterns and themes. Results Three primary themes emerged from the data analysis: interpersonal relations, feasibility, and duties and responsibilities. The findings underscore the challenges faced by medical students when communicating with patients having LEP. The study provides valuable insights into the nuanced aspects of these encounters, shedding light on the complex interplay between language barriers and effective healthcare delivery. Conclusion This research contributes to the limited body of qualitative literature on medical students' experiences in managing language barriers with patients. The identified themes provide a foundation for modifying medical education curricula to better equip students to address communication challenges associated with linguistic diversity. The study advocates for the integration of these experiences into medical training, emphasizing the broader implications for healthcare delivery and the reduction of health inequalities in linguistically diverse patient populations. The study also recommends the usage of up-to-date translation services built into the electronic healthcare records. This relationship minimizes inaccuracy in presenting the results of patient diagnostic films and tests, reduces wait times for treatment, and contributes to an overall cost reduction within this healthcare sector.

Uptake of COVID-19 vaccines and association with hospitalisation due to COVID-19 in pregnancy: Retrospective cohort study

ObjectivesTo determine demographic and clinical characteristics associated with uptake of COVID-19 vaccines among pregnant women, and quantify the relationship between vaccine uptake and admission to hospital for COVID-19. BackgroundPregnant women are at increased risk of severe adverse outcomes from COVID-19. Since April 2021, COVID-19 vaccines were recommended for pregnant women in the UK. Despite this, evidence shows vaccine uptake is low. However, this evidence has been based only on women admitted to hospital, or on qualitative or survey-based studies. MethodsRetrospective cohort study including all pregnancies ending between 18 June 2021 and 22 August 2022, among adult women registered with a Northwest London general practice. Statistical analyses were mixed-effects multiple logistic regression models. We conducted a nested case-control analysis to quantify the relationship between vaccine uptake by end of pregnancy and hospitalisation for COVID-19 during pregnancy. ResultsOur study included 47,046 pregnancies among 39,213 women. In 26,724 (57%) pregnancies, women had at least one dose of vaccine by the end of pregnancy. Uptake was lowest in pregnant women aged 18–24 (33%; reference group), Black women compared with White (37%; OR 0.55, 95% CI: 0.51 to 0.60), and women in more deprived areas (50%; reference group). Women with chronic conditions were more likely to receive the vaccine than women without (Asthma OR 1.21, 95% CI: 1.13 to 1.29). Patterns were similar for the second dose. Women admitted to hospital were much less likely to be vaccinated (22%) than those not admitted (57%, OR 0.22, 95% CI: 0.15 to 0.31). ConclusionsWomen who received the COVID-19 vaccine were less likely to be hospitalised for COVID-19 during pregnancy. COVID-19 vaccine uptake among pregnant women is suboptimal, particularly in younger women, Black women, and women in more deprived areas. Interventions should focus on increasing uptake in these groups to improve health outcomes and reduce health inequalities.

Health promotion

In 1986, the Ottawa Charter established health promotion as a central objective of governments in order to reduce health inequalities. It is a key concept that forms an integral part of nurses' training and missions.

Aiming for transformations in power: lessons from intersectoral CBPR with public housing tenants (Québec, Canada).

Intersectoral collaborations are recommended as effective strategies to reduce health inequalities. People most affected by health inequalities, as are people living in poverty, remain generally absent from such intersectoral collaborations. Community-based participatory research (CBPR) projects can be leveraged to better understand how to involve people with lived experience to support both individual and community empowerment. In this paper, we offer a critical reflection on a CBPR project conducted in public housing in Québec, Canada, that aimed to develop intersectoral collaboration between tenants and senior executives from four sectors (housing, health, city and community organizations). This single qualitative case study design consisted of fieldwork documents, observations and semi-structured interviews. Using the Emancipatory Power Framework (EPF) and the Limiting Power Framework (LPF), we describe examples of types of power and resistance shown by the tenants, the intersectoral partners and the research team. The discussion presents lessons learned through the study, including the importance for research teams to reflect on their own power, especially when aiming to reduce health inequalities. The paper concludes by describing the limitations of the analyses conducted through the EPF-LPF frameworks and suggestions to increase the transformative power of future studies.

Validation of the extended e-health literacy scale: structural validity, construct validity and measurement invariance

BackgroundGiven the rapid proliferation and use of online health resources, many of which may be of dubious quality, there is an increasing need to develop electronic health literacy (e-health literacy) skills among the population of internet users. E-health literacy encompasses the skills and abilities needed to access, understand, validate, evaluate, interpret, and apply online health-related information. Measuring e-health literacy has become crucial for developing targeted interventions, assessing their impact, and producing high-quality research findings that can inform health policy and clinical practice, which can lead to improved health outcomes and potentially reducing health inequalities. The scales need to be valid and reliable so that decisions are based on high-quality data. In this regard, the issue of the measurement invariance of scales across different demographic groups has been neglected. This is critical, as assessments should be valid across different sociodemographic groups to avoid bias when comparing them. The aim of this study was to validate the Extended e-health literacy scale (eHEALS-E) on general population and investigate its structural validity and internal consistency, construct validity in terms of convergent and discriminant validity, and examine its measurement invariance across gender, age, education and social status.MethodsThe data were collected as a part of a national health literacy survey conducted by the Slovenian National Institute of Public Health. For this survey the initial eHEALS-E scale was revised in order to address its limitations and applicability to general population. Based on a nationally representative sample, the final sample for the analysis comprised 1,944 individuals who at least occasionally used one of the various internet services to obtain health-related information. Multiple group confirmatory factor analysis was used to examine the measurement invariance of the scale.ResultsWith some adjustments, the measurement model of the revised 6-dimensional eHEALS-E scale demonstrated a good fit to the data (χ2 = 2508, df = 282, RMSEA = 0.064, SRMR = 0.070, CFI = 0.90). The scale had good internal consistency (alpha = 0.89). Although evidence of the scale’s convergent and discriminant validity was partially provided, the analysis revealed robust measurement invariance across sociodemographic groups.ConclusionsWith a minor limitation, the scale ensures an unbiased e-health literacy assessment across different social groups, which is crucial for interventions that aim to reduce health-related social inequalities. This ensures that the interventions derived from the assessment of reality are equally valid and effective for everyone, regardless of their sociodemographic background.

Co-Creating a Synchronous Tele-Education Program With Community-Dwelling Older Adults Using a Participatory Approach: A Mixed-Methods Study.

There is a pressing need to include older individuals in health education and uncover their specific needs. Leveraging the advantages of digitized health education, this study employed a participatory approach to engage community-dwelling older adults in co-creating a synchronous tele-education program, with dementia as the focus due to its rising prevalence and associated stigma in Singapore. Our findings demonstrate the preliminary effectiveness and feasibility of tele-education. Participants' feedback and recommendations provided valuable insights and could guide the future development of a comprehensive tele-education program. Participants' satisfaction with the co-design workshops also indicates the potential of involving older generations in the design process of user-centered digital health interventions in online environments. Moving forward, the study advocates collaboration among health institutes, government and social agencies, and community organizations, alongside systematic evaluation of the long-term impacts of tele-education, with the aim of improving health outcomes and reducing health inequalities among the older population.

New models of health and social care for people in later life: mapping of innovation in services in two regions of the United Kingdom using a mixed method approach

BackgroundInnovation for reforming health and social care is high on the policy agenda in the United Kingdom in response to the growing needs of an ageing population. However, information about new innovations of care being implemented is sparse.MethodsWe mapped innovations for people in later life in two regions, North East England and South East Scotland. Data collection included discussions with stakeholders (n = 51), semi-structured interviews (n = 14) and website searches that focused on technology, evaluation and health inequalities. We analysed qualitative data using framework and thematic analyses. Quantitative data were analysed descriptively.ResultsOne hundred eleven innovations were identified across the two regions. Interviewees reported a wide range of technologies that had been rapidly introduced during the COVID-19 pandemic and many remained in use. Digital exclusion of certain groups of older people was an ongoing concern. Innovations fell into two groups; system-level ones that aimed to alleviate systems pressures such as preventing hospital (re)admissions, and patient-level ones which sought to enhance health and wellbeing directly. Interviewees were aware of the importance of health inequalities but lacked data to monitor the impact of innovations on these, and evaluation was challenging due to lack of time, training, and support. Quantitative findings revealed that two thirds of innovations (n = 74, 67%) primarily focused on the system level, whilst a third (n = 37, 33%) primarily focused on the patient-level. Overall, over half (n = 65, 59%) of innovations involved technologies although relatively few (n = 12, 11%) utilised advanced technologies. Very few (n = 16, 14%) focused on reducing health inequalities, and only a minority of innovations (n = 43, 39%) had undergone evaluation (most of which were conducted by the service providers themselves).ConclusionsWe found a wide range of innovative care services being developed for people in later life, yet alignment with key policy priorities, such as addressing health inequalities, was limited. There was a strong focus on technology, with little consideration for the potential to widen the health inequality gap. The absence of robust evaluation was also a concern as most innovations were implemented without support to monitor effectiveness and/or without plans for sustainability and spread.