Reduction Of Social Inequalities Research Articles

Effect of fluoridated water on invasive NHS dental treatments for adults: the LOTUS retrospective cohort study and economic evaluation.

Most water fluoridation studies were conducted on children before the widespread introduction of fluoride toothpastes. There is a lack of evidence that can be applied to contemporary populations, particularly adolescents and adults. To pragmatically assess the clinical and cost effectiveness of water fluoridation for preventing dental treatment and improving oral health in a contemporary population of adults, using a natural experiment design. Retrospective cohort study using routinely collected National Health Service dental claims (FP17) data. National Health Service primary dental care: general dental practices, prisons, community dental services, domiciliary settings, urgent/out-of-hours and specialised referral-only services. Dental patients aged 12 years and over living in England (n = 6,370,280). Individuals exposed to drinking water with a fluoride concentration ≥ 0.7 mg F/l between 2010 and 2020 were matched to non-exposed individuals on key characteristics using propensity scores. Primary: number of National Health Service invasive dental treatments (restorations/'fillings' and extractions) received per person between 2010 and 2020. Secondary: decayed, missing and filled teeth, missing teeth, inequalities, cost effectiveness and return on investment. National Health Service Business Services Authority dental claims data. Water quality monitoring data. Predicted mean number of invasive dental treatments was 3% lower in the optimally fluoridated group than in the sub/non-optimally fluoridated group (incidence rate ratio 0.969, 95% CI 0.967 to 0.971), a difference of -0.173 invasive dental treatments (95% CI -0.185 to -0.161). This magnitude of effect is smaller than what most stakeholders we engaged with (n = 50/54) considered meaningful. Mean decayed, missing and filled teeth were 2% lower in the optimally fluoridated group, with a difference of -0.212 decayed, missing and filled teeth (95% CI -0.229 to -0.194). There was no statistically significant difference in the mean number of missing teeth per person (0.006, 95% CI -0.008 to 0.021). There was no compelling evidence that water fluoridation reduced social inequalities in treatments received or missing teeth; however, decayed, missing and filled teeth data did not demonstrate a typical inequalities gradient. Optimal water fluoridation in England in 2010-20 was estimated to cost £10.30 per person (excluding original setup costs). Mean National Health Service treatment costs for fluoridated patients 2010-20 were 5.5% lower per person, by £22.26 (95% CI -£23.09 to -£21.43), and patients paid £7.64 less in National Health Service dental charges per person (2020 prices). Pragmatic, observational study with potential for non-differential errors of misclassification in fluoridation assignment and outcome measurement and residual and/or unmeasured confounding. Decayed, missing and filled teeth data have not been validated. Water fluoridation cost estimates are based on existing programmes between 2010 and 2020, and therefore do not include the potentially significant capital investment required for new programmes. Receipt of optimal water fluoridation between 2010 and 2020 resulted in very small health effects, which may not be meaningful for individuals, and we could find no evidence of a reduction in social inequalities. Existing water fluoridation programmes in England produced a positive return on investment between 2010 and 2020 due to slightly lower National Health Service treatment costs. These relatively small savings should be evaluated against the projected costs and lifespan of any proposed capital investment in water fluoridation, including new programmes. National Health Service dental data are a valuable resource for research. Further validation and measures to improve quality and completeness are warranted. This trial is registered as ISRCTN96479279, CAG: 20/CAG/0072, IRAS: 20/NE/0144. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR128533) and is published in full in Public Health Research; Vol. 12, No. 5. See the NIHR Funding and Awards website for further award information.

Changes in segregation patterns in medium-sized cities in the state of São Paulo between 2000 and 2010

Brazil underwent political and economic changes that led to a reduction in social inequalities between 2000 and 2010. Studies indicated that during the same period, there was an increase in the level of residential segregation in metropolitan spaces, as opposed to a reduction accompanying the inequalities. This paper contributes to this body of studies, by analyzing residential segregation in medium-sized cities, quantitatively and spatially, during the period between 2000 and 2010. The study aims to quantify the degree of segregation in five medium-sized cities in the state of São Paulo and analyze the evolution of their spatial patterns, via a comparative perspective. The measurement of segregation, using global and local spatial indices, has indicated an increase in residential segregation similar to those identified by studies for metropolitan areas, in which the highest and lowest income groups are markedly the most segregated. However, this was not the case for all cities, an unchanged degree and pattern of segregation were also identified during the same period in one of the cities. These results are discussed within the context of the urban changes that have taken place in medium-sized cities, such as the valorization of real estate in specific sectors of the cities, amidst the continued process of peripheralization of the low-income population.

Artificial intelligence for SDG 4 of the 2030 agenda: Transforming education to achieve quality, equality, and inclusion

The objective of this article is to discuss the possibility of using generative artificial intelligence (AI) to enhance teaching practices and pedagogical support to improve the quality of education provided to young people in elementary and secondary schooling. This issue is linked to the global perspective of a shortage of teachers, which directly affects the Sustainable Development Goal 4 (SDG 4), concerning the enhancement of education quality as a target for global sustainable development. From this viewpoint, the potential use of AI may also relate to the improvement of educational quality and the reduction of social inequalities, yielding indirect effects on other sustainable development goals. As a method, we intend to conduct an extensive theoretical discussion addressing the challenges for teacher education and work worldwide, utilizing existing data from databases such as UNESCO, the UN, and the OECD, among others. In addition to data on teachers, we plan to analyze the potential for creating an artificial intelligence, based on existing ones but trained for the specific contexts of each country’s educational system. The goal is to examine the potential for formatting artificial intelligence to provide pedagogical support for teachers, such as: grading of objective and discursive assessments, individualized intelligent tutoring, analysis of students’ individual pedagogical development, preparation of individual student diagnoses, suggestions of specific pedagogical actions based on curricula and materials used, and all other pedagogical actions that support teachers in their educational journey. This work was funded by CAPES, CNPq and FAPEMIG.

Are Land Use and Cover Changes and Socioeconomic Factors Associated with the Occurrence of Dengue Fever? A Case Study in Minas Gerais State, Brazil

Several studies have already demonstrated the relationship between the loss of natural habitats and the incidence of diseases caused by vectors, such as dengue, which is an acute fever disease that is considered a serious public health problem. The aim of the present study was to investigate the relationship between the number of dengue cases and land use and cover changes (LUCC) and socioeconomic and climatic factors by municipality, using the state of Minas Gerais as a case study. For this, secondary data obtained from openly available sources were used. Natural vegetation cover data were obtained from the MAPBiomas platform and dengue occurrence data from the Ministry of Health, in addition to eight socioeconomic parameters from the Brazilian Institute for Geography and Statistics and precipitation data from the Brazilian Agricultural Research Corporation (EMBRAPA, Sete Lagoas, Minas Gerais). Between 2015 and 2019, 1,255,731 cases of dengue were recorded throughout the state of Minas Gerais, ranging from 0 to 227 per thousand inhabitants between municipalities. The occurrence of dengue was distributed throughout all regions of Minas Gerais and was associated with LUCC and socioeconomic factors. In general, municipalities with a net loss of natural vegetation, predominantly located in the Cerrado biome, had the highest number of dengue cases in the studied period. Additionally, the occurrence of dengue was associated to three socioeconomic parameters: population density, human development index (both positively), and Gini inequality index (negatively). These results indicate that, contrary to expectations, municipalities with better social conditions had more dengue cases. Our study indicates that natural vegetation is, directly or indirectly, involved in the ecosystem service of dengue control, despite the occurrence of this disease being affected by multiple factors that interact in a complex way. Thus, policies towards reducing deforestation must be complemented by a continuous investment in public health policies and a reduction in social inequalities to efficiently control dengue fever.

The principle of contributory capacity and the non-correction of the personal income tax table

The tax issue in Brazil is marked by intense discussions, especially regarding tax reform, due to conflicts of interest between the application of taxes and the state's funding needs. The search for a fair and coherent taxation system that respects principles such as equality and contributive capacity is a constant challenge. The Income Tax, a federal tax established in the 1988 Constitution, is governed by the principles of generality, universality, and progressivity, affecting profits from business activities and personal income. The legislation advocates for the progressive application of rates, aiming at fiscal justice and the reduction of social inequalities. However, the last update to the calculation bases for the Personal Income Tax (IRPF) occurred in 2015, and the lack of monetary correction since then has raised questions about the offense to the principle of contributive capacity, due to the disregard for inflation and the decrease in citizens' purchasing power.

How does heritage contribute to inclusive growth?

PurposeThe first objective of this article is to analyse the reasons to pursue inclusive growth, that is economic growth accompanied by a reduction of social inequalities in different dimensions. The second objective of the article is to develop a systematised framework to understand the different channels and enablers by which heritage can contribute to inclusive growth through a review of specialised literature.Design/methodology/approachThe methodology of this article is based on an exhaustive review of existing literature around models of economic development and their ability to decrease social inequalities. It critically reviews theoretical and empirical studies on existing economic approaches and links them with the heritage policy field.FindingsThe article finds that countries should pursue inclusive development since it is a fundamental condition for social cohesion, trust and society's overall well-being and because it enables economic growth to be sustainable through time. It also identifies four channels through which heritage can contribute to inclusive development: in its public good dimension, in its capacity to equalise opportunities, in its ability to reduce social, educational and health disparities and in its capacity to decrease spatial income inequalities through regeneration processes.Research limitations/implicationsThe framework, that is developed to categorise the different channels and enablers through which heritage could contribute to inclusive growth, is not empirically tested. Further research could approach this by estimating a difference in difference model. However, data limitations could limit this objective in the short-term.Originality/valueIts originality relies in the development of a conceptual framework that is aimed at shaping heritage policies that target, at the same time, the reduction of inequalities and economic growth.

Social–Emotional Skills in Five-to-Six-Year-Olds in Social Hotspots in Germany: Individual Trajectories in a Prospective Cohort

AbstractSocial–emotional skills as valid predictors for subsequent school success should be promoted in early childhood. Preschools are a relevant setting to reach children from families with low socioeconomic status. The federal state law for children´s day-care and preschools in the state of Mecklenburg-Western Pomerania offers preschools in difficult social areas financial support for the individual targeted promotion. Prospective longitudinal observational data of a cohort: annual application of Dortmund Developmental Screening for Preschools domains “social competence” and “social interaction” over two years of 5-to-6-year-olds. Calculation of prevalence rate ratios and ratios of rate of improvements are divided by rate of deteriorations after one year. The proportion of children with inconclusive findings in “social competence” decreases. > 50% have no finding after one year. In “social interaction,” the proportion of children with inconclusive findings increases. Both domains detected more improvements than deteriorations for all children after one year. The indicated improvement of developmental risks is possibly associated with a reduction of social inequalities and tend to improve equal opportunities for all children at school start. Nevertheless, results of some children are deteriorating. More effective promotion of social–emotional skills is needed also for children without developmental risks—especially for children with internalizing problems. Trial registration: German Clinical Trials Register, ID: DRKS00015134, Registered on 29 October 2018, retrospectively registered.

Maternal capital predicts investment in infant growth and development through lactation.

Maternal capital (MC) is a broad term from evolutionary biology, referring to any aspects of maternal phenotype that represent resources available for investment in offspring. We investigated MC in breastfeeding mothers of late preterm and early term infants, examining its relationship with infant and breastfeeding outcomes. We also determined whether MC modified the effect of the relaxation intervention on these outcomes. The data was collected as part of a randomized controlled trial investigating breastfeeding relaxation in 72 mothers of late preterm and early term infants. Indicators of MC (socioeconomic, social, somatic, reproductive, psychological, and cognitive) were collected at baseline at 2-3 weeks post-delivery. Principal Component Analysis was conducted for the MC measures and two components were identified: 1."Subjective" maternal capital which included stress and depression scores, and 2."Objective" maternal capital which included height, infant birth weight, and verbal memory. Univariate linear regression was conducted to assess the relationship between objective and subjective MC (predictors) and infant growth, infant behavior, maternal behavior, and infant feeding variables (outcomes) at 6-8 weeks. The interaction of MC and intervention assignment with outcomes was assessed. Higher objective MC was significantly associated with higher infant weight (0.43; 95%CI 0.21,0.66) and length z-scores (0.47; 95%CI 0.19,0.76), shorter duration of crying (-17.5; 95%CI -33.2,-1.9), and lower food (-0.28; 95%CI -0.48,-0.08) and satiety responsiveness (-0.17; 95%CI -0.31,-0.02) at 6-8 weeks. It was also associated with greater maternal responsiveness to infant cues (-0.05, 95%CI -0.09,-0.02 for non-responsiveness). Greater subjective maternal capital was significantly associated with higher breastfeeding frequency (2.3; 95%CI 0.8,3.8) and infant appetite (0.30; 95%CI 0.07,0.54). There was a significant interaction between the intervention assignment and objective MC for infant length, with trends for infant weight and crying, which indicated that the intervention had greater effects among mothers with lower capital. Higher MC was associated with better infant growth and shorter crying duration. This was possibly mediated through more frequent breastfeeding and prompt responsiveness to infant cues, reflecting greater maternal investment. The findings also suggest that a relaxation intervention was most effective among those with low MC, suggesting some reduction in social inequalities in health.

Changes in cycling practices in France during the Covid-19 pandemic. An illusory reduction in inequalities

IntroductionThe Covid-19 health crisis and the attendant pro-bicycle policies have accelerated the development of urban cycling worldwide. Bicycle traffic flows have generally been well documented, with particular focus on utilitarian trips during lockdowns. However, little research has examined the profiles of social groups affected by changes in bicycle use. That is the purpose of this article, which examines the socio-spatial factors behind changes in utilitarian and recreational cycle use. MethodsThe study is based on a nationwide questionnaire completed by 7343 cyclists in France between May and October 2021. The analyses are based on bivariate treatments, tests of independence, logistic regressions, and additional comments by some respondents (n = 1594). ResultsOur results show both utility and leisure cycling were more likely to have increased than decreased over the period under study. However, while utility practice was driven by fear of Covid-19 but inhibited by teleworking, recreational practice was driven by both working-at-home and by the desire to get out for some physical exercise. Compensatory phenomena, blurring the boundary between leisure and utility, are perceptible. Reductions in both the gender gap and the income gap in bicycle use are measured. However, since these were mainly forced changes and since inequalities in access to cycling persist, the narrowing of these gaps cannot be interpreted as steps toward gender or class equality. ConclusionsThe article recommends further research to assess the persistence of observed changes in leisure and utility cycling. At the same time, it warns against the pitfall of considering that a reduction in inequalities in cycling practices implies a reduction in social inequalities.

Mitigation of Socio-Economical Inequalities on the Profile of Healthcare Workers Infected with SARS-CoV-2 upon Vaccination: The Experience of a Brazilian Public Healthcare Institution during the Omicron Wave

Background: COVID-19 increased health inequalities worldwide. Even among healthcare workers, social-economical features enhanced the risk of infection (having positive serology) during the first outbreak. The Omicron variant changed the pandemic course and differs from previous variants in many aspects (molecular, clinical, and epidemiological). Herein, we investigated if the profile of our hospital SARS-CoV-2-positive workers during the Omicron outbreak was the same as the first COVID-19 wave. Methods: Socio-demographics, previous infection, and vaccine status of 351 healthcare workers from our institution during the Omicron outbreak were compared between SARS-CoV-2-negative and -positive workers, using chi-square tests. These data were confronted with the profile observed at the beginning of the pandemic. Results: Compared to the original COVID-19 wave, higher odds of SARS-CoV-2 positivity in highly exposed workers in our hospital and a loss of impact of public transportation and other socio-demographic features in SARS-CoV-2 transmission were observed. Conclusions: Our data suggest the current phase of the pandemic is associated with a reduction of social inequalities among healthcare workers in Rio de Janeiro, possibly due to vaccine-associated protection. Therefore, a worldwide effort to advance vaccination coverage, especially for healthcare workers in developing countries, should be reinforced.

ОЦЕНКА И АНАЛИЗ РОЛИ И МЕСТА НАЛОГА НА ДОХОДЫ ФИЗИЧЕСКИХ ЛИЦ В ДОХОДАХ КОНСОЛИДИРОВАННОГО БЮДЖЕТА РФ

This article is devoted to the issues of assessing and analyzing the role of personal income tax in the structure of consolidated budget revenues. The relevance of these issues is due to the need to transform social inequalities, which in the Russian Federation amount to 13% as of 2023. The issue of social inequality stimulates the growth of the state’s economy: GDP increases and the income gap decreases. One of the levers of influence on these economic processes is personal income tax. This payment ensures a balance of economic efficiency and a reduction in social inequality, in particular, in the context of federal districts.

CHALLENGES IN PLANNING URBAN SUSTAINABILITY POLICIES IN THE CITY OF SÃO PAULO

The city of São Paulo in Brazil represents the most important urban center in South America due to its geospatial, demographic, and economic characteristics. The present study aimed to investigate in what way the city of São Paulo considers e acts to issues related to urban sustainability. To this end, a bibliographic review about urban sustainability was first carried out. In a second step, through qualitative and exploratory research, in-depth interviews were conducted with people who represented the views of the public and private sector, the academy, and civil society dealing with sustainable projects in São Paulo. Among the main results, it was possible to conclude that, despite the small advances that the city has managed to make in recent years, it cannot yet be considered sustainable. For this scenario to be more positive in the future, it is essential that the municipality acts on three fronts: urban planning, reduction of social inequality, and environmental education.

The Idea of Supreme Peace (Taiping) in Premodern Chinese Philosophies of History

The paper examines the development of the idea of Supreme Peace (taiping 太平) in premodern Chinese philosophies of history. It is shown that while Daoists identified it with the pristine unity of humans and nature, Han Confucians equated Supreme Peace with the harmonious social system under the rule of one of the first Chinese emperors or Confucius. In the latter case, the notion of taiping was reduced to a descriptive category, which was then employed by historiography but ridiculed in the critical thought of Wang Chong. With Huainanzi and the Xiang’er commentary to Laozi, the Daoists started to argue that it is possible to restore the Supreme Peace under new historical conditions. This was systematically developed in the Scripture of Supreme Peace (Taipingjing), which offered a detailed depiction of the future era of equality and freedom. However, after this radicalization, the idea of taiping was utilized by imperial propaganda and disappeared from the dominant philosophical discourse. An exception to this rule was Li Gou (1009–1059), who envisaged Supreme Peace as an ideal socio-economic system resulting from endowing peasants with land and money. A similar vision was expressed by Gong Zizhen (1792–1841), for whom Supreme Peace had to entail land equalization and the reduction of social inequalities. Similarly to Taipingjing, however, Gong Zizhen described taiping as the culmination point of the increase of human knowledge. With such an approach, the premodern Chinese views of Supreme Peace became noticeably close to Western progressivism, and therefore inspired the utopian project of Kang Youwei.

The Regionalization Process for Universal Health Coverage in Brazil (2008-2015).

The objective of this article is to analyze the development of the public and private offer for the universalization of health services, specifically, for the progression of the public network. The time period examined is from 2008 to 2015, when there was considerable economic growth and expansion of private health insurance and an unprecedented historical period with economic growth and reduction of social inequality. Across 5570 municipalities, the multivariate analysis model was used to estimate the level of concentration and the imbalance (heterogeneity) of installed health capacity of the network of health care services. Public spending on investment and human resources showed positive variation in all regions and in almost all population strata. The offer by the Unified Health System (public) of primary health care increased by 8000 new establishments in all regions, especially in previously uncovered cities and cities that had shortages of public health services. Public universalization almost reached its maximum, with about 70% of municipalities. The only setback was the significant reduction of 50% in the number of private establishments in primary health care services. The data suggest a positive movement toward the universalization of health services in Brazil, with the concentration of high-complexity care and the heterogeneity of the installed capacity being points for improvement.

Control and prevention of infectious diseases from a One Health perspective.

The ongoing COVID-19 pandemic has caught the attention of the global community and rekindled the debate about our ability to prevent and manage outbreaks, epidemics, and pandemics. Many alternatives are suggested to address these urgent issues. Some of them are quite interesting, but with little practical application in the short or medium term. To realistically control infectious diseases, human, animal, and environmental factors need to be considered together, based on the One Health perspective. In this article, we highlight the most effective initiatives for the control and prevention of infectious diseases: vaccination; environmental sanitation; vector control; social programs that encourage a reduction in the population growth; control of urbanization; safe sex stimulation; testing; treatment of sexually and vertically transmitted infections; promotion of personal hygiene practices; food safety and proper nutrition; reduction of the human contact with wildlife and livestock; reduction of social inequalities; infectious disease surveillance; and biodiversity preservation. Subsequently, this article highlights the impacts of human genetics on susceptibility to infections and disease progression, using the SARS-CoV-2 infection as a study model. Finally, actions focused on mitigation of outbreaks and epidemics and the importance of conservation of ecosystems and translational ecology as public health strategies are also discussed.

Artes e Educação do Campo: reflexões sobre a LEDOC da UFT/UFNT

Este artigo tem o objetivo de discutir a implantação e vigência do curso de Licenciatura em Educação do Campo (LEdoC), com habilitação em Artes e Música, na Universidade Federal do Norte do Tocantins (UFNT), no campus de Tocantinópolis. O curso se destaca por ser um dos dois cursos existentes no Brasil voltado para a formação de educadoras e educadores do campo para atuação específica na disciplina de Arte no Ensino Fundamental e Médio, nas escolas do campo. Para a reflexão desenvolvida, utiliza-se uma abordagem qualitativa de caráter descritivo e documental, realizando uma análise interpretativa dos dados pesquisados. Existindo desde 2014, o curso já formou três turmas em uma trajetória de construções e reconstruções, com o fito de buscar um olhar crítico para o percurso vivenciado e se adaptar às necessidades de reconfigurações curriculares, a fim de proporcionar uma educação pública e de qualidade. Visando formar educadores e educadoras para atuar com as Artes Visuais, a Música e o Teatro, a LEdoC da UFNT-Tocantinópolis resiste buscando efetivar a democratização do acesso à educação, ao contribuir para a construção de uma formação de qualidade que auxilie na melhoria da vida das populações camponesas, na construção de um projeto de sociedade mais igualitário, solidário e na diminuição das desigualdades sociais.
 Palavras-chave: artes, formação de professores, LEdoC, PROCAMPO.
 
 Arts and Rural Education: reflections on LEDOC at UFT/UFNT
 ABSTRACT. This article aims to discuss the implementation and validity of the degree course in Rural Education, with specialization in Arts and Music, at the Federal University of Northern Tocantins (UFNT), in the Tocantinópolis campus. The course stands out for being one of the two existing courses in Brazil aimed at the formation of countryside educators to work specifically in the discipline of Art in Elementary and Secondary Education in rural schools. In the developed reflection, a qualitative approach of descriptive and documental character is used, performing an interpretative analysis of the researched data. Existing since 2014, the course has already graduated three classes in a trajectory of constructions and reconstructions, with the purpose of seeking a critical look at the course and adapting to the needs of curricular reconfigurations, in order to provide a public and quality education. Aiming to train educators to work with the Visual Arts, Music and Theater, the course of the UFNT-Tocantinópolis resists seeking to democratize the access to education, by contributing to the construction of a quality education that helps to improve the lives of peasant populations, in the construction of a more egalitarian and solidary society project and in the reduction of social inequalities.
 Keywords: arts, teacher education, LEdoC, PROCAMPO.
 
 Arte y Educación Rural: reflexiones sobre el LEDOC de la UFT/UFNT
 RESUMEN. Tiene como objetivo discutir la implementación y la validez del curso de grado en Educación de Campo, con especialización en Artes y Música, en la Universidad Federal do Norte do Tocantins (UFNT), en el campus de Tocantinópolis. El curso se destaca por ser uno de los dos cursos existentes en Brasil destinados a la formación de educadores de campo para trabajar específicamente en la disciplina de Arte en la Educación Primaria y Secundaria en escuelas rurales. Para la reflexión desarrollada, se utiliza un enfoque cualitativo de carácter descriptivo y documental, realizando un análisis interpretativo de los datos investigados. Existente desde 2014, el curso ya ha graduado tres clases en una trayectoria de construcciones y reconstrucciones, con el objetivo de buscar una mirada crítica sobre la trayectoria vivida y adaptarse a las necesidades de las reconfiguraciones curriculares, con el fin de proporcionar una educación pública y de calidad. Con el objetivo de formar educadores para trabajar con las Artes Visuales, la Música y el Teatro, el curso de la UFNT-Tocantinópolis resiste buscando democratizar el acceso a la educación, contribuyendo a la construcción de una educación de calidad que ayude a mejorar la vida de las poblaciones campesinas, en la construcción de un proyecto de sociedad más igualitario y solidario y en la reducción de las desigualdades sociales.
 Palabras clave: artes, formación de profesores, LEdoC, PROCAMPO.

Comparative analysis of human development indicators: Tanger-Tetouan-Al Hoceima region

Human development is more than a question of the accumulation of wealth, income, or economic growth. It must be human-centred. This is why concerns as necessary as respect for human rights, the reduction of social inequalities and poverty, the promotion of equal opportunities between men and women are indeed relevant. This considers human resources not only as a means of growth but, more fundamentally, as an end of growth. The demographic variable was always a serious problem to decision-makers in different countries. It is considered to be at the root of the various handicaps of development. Morocco has carried out throughout the last forty years’ population policies to improve the well-being of its citizens. To highlight regional and provincial disparities in Morocco, we are based in this work on indices of human development, namely, SDI, ASDI, MLDI using the process of the data warehouse. Finally, we have analyzed and visualized these indices with Power BI software to make a comparative analysis of TTA provinces. Findings show that Tanger-Assilah province has a great value with 0.77 of MLDI. However, Chefchaouen province has the less one with 0.56. This study has been performed to help to establish efficient decisions and making operational insights.

Communities on the move: community participation in health in rural territories of Buenaventura District in Colombia

BackgroundSocial and community participation is a fundamental component of the development of renewed primary healthcare (PHC). With the recognition of health as a right, such participation is a significant part of the design of public policies aimed at this sector. These policies contribute not only to overcoming inequity in the provision of this type of services but also to a reduction in social inequalities as a whole. Through a comparative analysis, this study aimed to explain the conditions through which ethnic-rural territories of the Colombian Pacific coast participate in health to contribute to the generation of policies and programs in territories with similar conditions.MethodsThe work was developed through the use of multiple techniques and strategies for information collection and analysis. These include several semi-structured interviews, multiple observation exercises and analysis based on a set theory, i.e., qualitative comparative analysis (QCA). The latter aims to develop a model that provides a count of the main causal combinations that allow high community participation in health.ResultsKey findings include how the trajectory of social mobilization and existence of a robust community social fabric became two critical conditions for community participation in the context of social exclusion. The presence of variables such as the implementation of PHC, guarantee of social rights, and trust in institutions, is underestimated as sufficient causal conditions for obtaining this result. Therefore, it is essential to recognize the existence, validity, and importance of processes, experiences, and resourcefulness of political natures, which aim at transforming the daily reality of the inhabitants of these communities. These also set a potential space and scenario for managing the communities’ main problems, including health, in the absence of institutionality that guarantees access to their social rights.ConclusionThis study points out the importance of understanding community participation as a political activity, expanding exchange dynamics and dialogs between institutions, rulers, and communities to provide social responses in health and well-being to communities and to understand local realities and their own community dynamics.

Physical and psychosocial work factors as explanations for social inequalities in self-rated health.

We investigated the contribution of physical and psychosocial work factors to social inequalities in self-rated health (SRH) in a sample of Danish 40 and 50 years old occupationally active women and men. In this longitudinal study, the study population consisted of 3338 Danish women and men. Data were collected by postal questionnaires in 2000 (baseline) and 2006 (follow-up). The independent variable, socioeconomic position (SEP), was assessed by the highest achieved educational level at baseline. We conducted gender-stratified parallel multiple mediation analyses. In the mediation analyses, SEP was categorised as SEP I, II, III, VI and V among men. Among women, SEP was dichotomised into SEP I-IV and V. The outcome, SRH, was assessed at baseline and follow-up. A wide range of physical and psychosocial work factors were included as potential mediators. We found a social gradient in SRH across all levels of SEP among men. Among women, we only found a poorer SRH among those with the lowest SEP. Mediation analyses showed that work factors together accounted for 56% of the social inequalities in SRH among men and 44% among women. In both genders, ergonomic exposures and job insecurity seemed to play the major role for social inequalities in SRH. For women only, we also found noise to contribute to the social inequalities in SRH. Physical and psychosocial work factors partially explained social inequalities in SRH among both genders. Improvement of the working environment can potentially contribute to the reduction of social inequalities in health.

Medical education in Brazil: public health as a didactic-pedagogical structure

Abstract Medical education in Brazil has a Flexnerian structure whose guidelines were instituted in the Americas in the early twentieth century, which led the academic to settle in the office and in the hospital with a focus on the biological processes of the health-disease process. However, since the 1970s, increasing social inequality in Brazil has led to marked poverty with a lack of access to basic health care for most of the Brazilian population. The 1988 Federal Constitution treats health as a democratic process where the social issue is fundamental to the development of the nation. The Italian health movement, guided by social studies by Giovanni Berlinguer, inspired the Brazilian Health Reform Movement. In this regard, the hospital-centered view began to be questioned. Wide critical-reflexive movements were being built in society and in the academy, looking for improvements in the population's quality of life. Issues related to promotion, treatment and prevention, both in medical training and in management and assistance, were gradually being incorporated into medical education. But it was in the national medical education change project that the National Curriculum Guidelines (DCN), launched in 2014, culminated. The medical course at the Federal University of Fronteira Sul - Chapecó campus (UFFS-Ch), in the state of Santa Catarina, was created in 2015, fully complies with the new guidelines and is supported by the Public Health. This orientation is guided by the political, economic and social development of the Country within a civilizing process that is based on the social and environmental determinants of health, with respect to the relations of society in its history and in its territory. In this way, medical training at UFFS has a vision of the health-disease process that transcends the individual and addresses the community, with a proposal to transform society based on democracy and social justice. Key messages To present a counterpoint between the Brazilian Health Reform and its inspiring one, an Italian, in the search to overcome social inequality, through a civilizing process based on Democracy and Health. To present a medical course based on the transformation of medical education with a structure in Public Health in order to provide a reduction in social inequality in Brazil.