Social Determinants Of Health Framework Research Articles

Structural and social inequities contribute to pockets of low childhood immunisation in New South Wales, Australia

IntroductionChildhood immunisation is a safe and effective way to protect children and communities from serious diseases. In Australia childhood immunisation is generally well accepted with high coverage rates however pockets of low coverage exist. Authors conducted five previous studies in New South Wales which found socio-economic disadvantage, gender inequity, health service access barriers and under-utilisation of immunisation data, rather than ideological opposition, contributed to children’s incomplete vaccination. Material and MethodsCommon findings across those five studies were identified. Additional literature was reviewed using a number of lenses, underpinned by a social determinants of health framework. ResultsThe lensed approach allowed further exploration of the impact of financial stress, poor mental health, drug and alcohol problems, domestic violence, assumed gender roles, lack of culturally acceptable health care for Indigenous families, geography and changes to immunisation policies on families and how this may have contributed to pockets of low immunisation coverage. Social and structural inequities were revealed. These often contributed to conflicting priorities that meant children’s immunisations fell behind. DiscussionStrategies to address inequities may include reorientation of existing community based child health services to include flexible options such as drop in clinics, outreach services, home visiting and ensuring Indigenous families have access to culturally safe and acceptable services. Assistance with transport would further improve access to services. Better use of immunisation data can aid in the identification of pockets of low coverage and monitor and evaluate service effectiveness. ConclusionsGreater awareness of social and structural barriers and their impact on families can inform the design of tailored strategies that address the needs of disadvantaged children and families. Without efforts to overcome the inequities that contribute to low immunisation coverage, the status quo persists, leaving children and communities at risk of vaccine preventable diseases.

Social Determinants of Health and At-Risk Rates for Pediatric Asthma Morbidity.

Compared with population-based rates, at-risk rates (ARRs) account for underlying variations of asthma prevalence. When applied with geospatial analysis, ARRs may facilitate more accurate evaluations of the contribution of place-based social determinants of health (SDOH) to pediatric asthma morbidity. Our objectives were to calculate ARRs for pediatric asthma-related emergency department (ED) encounters and hospitalizations by census-tract in Washington, the District of Columbia (DC) and evaluate their associations with SDOH. This population-based, cross-sectional study identified children with asthma, 2 to 17 years old, living in DC, and included in the DC Pediatric Asthma Registry from January 2018 to December 2019. ED encounter and hospitalization ARRs (outcomes) were calculated for each DC census-tract. Five census-tract variables (exposures) were selected by using the Healthy People 2030 SDOH framework: educational attainment, vacant housing, violent crime, limited English proficiency, and families living in poverty. During the study period, 4321 children had 7515 ED encounters; 1182 children had 1588 hospitalizations. ARRs varied 10-fold across census-tracts for both ED encounters (64-728 per 1000 children with asthma) and hospitalizations (20-240 per 1000 children with asthma). In adjusted analyses, decreased educational attainment was significantly associated with ARRs for ED encounters (estimate 12.1, 95% confidence interval [CI] 8.4 to 15.8, P <.001) and hospitalizations (estimate 1.2, 95% CI 0.2 to 2.2, P = .016). Violent crime was significantly associated with ARRs for ED encounters (estimate 35.3, 95% CI 10.2 to 60.4, P = .006). Place-based interventions addressing SDOH may be an opportunity to reduce asthma morbidity among children with asthma.

Do social support and community engagement act as mechanisms in the association between neighbourhood income inequality and the mental health of mothers in Calgary, Canada? A mediation analysis.

According to the social determinants of health framework, income inequality is a potential risk factor for adverse mental health. However, few studies have explored the mechanisms suspected to mediate this relationship. The current study addresses this gap through a mediation analysis to determine if social support and community engagement act as mediators linking neighbourhood income inequality to maternal anxiety and depressive symptoms within a cohort of new mothers living in the City of Calgary, Canada. Data collected at three years postpartum from mothers belonging to the All Our Families (AOF) cohort were used in the current study. Maternal data were collected between 2012 and 2015 and linked to neighbourhood socioeconomic data from the 2006 Canadian Census. Income inequality was measured using Gini coefficients derived from 2006 after-tax census data. Generalized structural equation models were used to quantify the associations between income inequality and mental health symptoms, and to assess the potential direct and indirect mediating effects of maternal social support and community engagement. Income inequality was not significantly associated with higher depressive symptoms (β=0.32, 95%CI=-0.067, 0.70), anxiety symptoms (β=0.11, 95%CI=-0.39, 0.60), or lower social support. Income inequality was not associated with community engagement. For the depression models, higher social support was significantly associated with lower depressive symptoms (β=-0.13, 95%CI=-0.15, -0.097), while community engagement was not significantly associated with depressive symptoms (β=0.059, 95%CI=-0.15, 0.27). Similarly, for the anxiety models, lower anxiety symptoms were significantly associated with higher levels of social support (β=-0.17, 95%CI=-0.20, -0.13) but not with higher levels of community engagement (β=0.14, 95%CI=-0.14, 0.41). The current study did not find clear evidence for social support or community engagement mediating the relationship between neighbourhood income inequality and maternal mental health. Future investigations should employ a broader longitudinal approach to capture changes in income inequality, potential mediators, and mental health symptomatology over time.

Reclaiming Indigenous Health in the US: Moving beyond the Social Determinants of Health.

The lack of literature on Indigenous conceptions of health and the social determinants of health (SDH) for US Indigenous communities limits available information for Indigenous nations as they set policy and allocate resources to improve the health of their citizens. In 2015, eight scholars from tribal communities and mainstream educational institutions convened to examine: the limitations of applying the World Health Organization’s (WHO) SDH framework in Indigenous communities; Indigenizing the WHO SDH framework; and Indigenous conceptions of a healthy community. Participants critiqued the assumptions within the WHO SDH framework that did not cohere with Indigenous knowledges and epistemologies and created a schematic for conceptualizing health and categorizing its determinants. As Indigenous nations pursue a policy role in health and seek to improve the health and wellness of their nations’ citizens, definitions of Indigenous health and well-being should be community-driven and Indigenous-nation based. Policies and practices for Indigenous nations and Indigenous communities should reflect and arise from sovereignty and a comprehensive understanding of the nations and communities’ conceptions of health and its determinants beyond the SDH.

Social determinants of health and cancer screening implementation and outcomes in the USA: a systematic review protocol.

BackgroundImproving the delivery, uptake, and implementation of cancer screening to meet evidence-based recommendations is needed to reduce persistent cancer health disparities in the USA. Current national public health targets emphasize the role of social determinants of health (SDOH) on cancer screening. However, there remains a need to explicate these linkages, toward the goal of identifying and implementing effective interventions that target and address SDOH to reduce inequities in cancer screening.MethodsWe will conduct a systematic review of English language peer-reviewed original research articles published between 2010 and 2021 that describe observational (qualitative and quantitative) and intervention studies conducted in the USA. In alignment with Healthy People 2030, we will include studies of breast, cervical, colorectal, and/or lung cancer screening. Guided by multiple SDOH frameworks, we will broadly define SDOH by five domain areas: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Following systematic literature searches in five databases (Ovid MEDLINE, Embase, CINAHL, Web of Science, Cochrane Library) and piloting of screening procedures, reviewers will independently screen titles/abstracts for potential relevance. Reviewer pairs will then screen full text articles for eligibility criteria. We will extract data items from included articles, including study characteristics, cancer screening intervention information, and coding of SDOH constructs. We will assess study quality using the Mixed Methods Appraisal Tool and synthesize our findings using narrative, descriptive statistics, tables, and figures. Our approach will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) recommendations.DiscussionBy completing this systematic review, we will summarize recent literature on SDOH and cancer screening, identify research gaps for inclusion of SDOH, and propose future opportunities for advancing equity in cancer screening by integrating SDOH as part of the implementation context to promote uptake, sustainability, and scale-up in the implementation of screening guidelines.Systematic review registrationPROSPERO CRD42021276582.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13643-022-01995-4.

Health Psychological Self-Sufficiency (Health-PSS): A Bottom-Up Human-Social Development Approach to Health Equity

This article presents a community-based participatory action research process in a mixed-methods study to uncover a holistic perspective on what constitutes “good health and well-being” as one of the United Nations Sustainable Development Goals. This bottom-up approach to defining health from the community perspective challenges the general government and health industry assumptions and practices to promote top-down health equity. Applying the definition of social development as “achieving a civil society based on freedom and justice”, the emerging findings adds to the social determinants of health framework in health disparities research. As multiple stakeholders added to the definitions of health and well-being, a process-based understanding of health emerged. Health psychological self-sufficiency (Health-PSS) is a process of recogniting various individual and structural barriers and reaching for improved health-related goals with hope actions leading to health empowerment in literacy, access, and outcomes. Human-social development implications for promoting health equity by building an inclusive health system with a culture of co-sufficiency that align individual and organizational processes are discussed.

Opioid Literacy Among African Americans Living in Rural Alabama: Findings From a Social Determinants of Health (SDH) Framework

Limited research examining opioid literacy among African Americans (AAs) have been conducted. The current study examined the association between opioid literacy levels among AAs in rural Alabama using the social determinants of health framework. Three subscales in the Brief Opioid Overdose Knowledge questionnaire were used to measure opioid literacy. Among a sample of 253, limited opioid literacy was found. Social contact was found to be significantly associated with overall opioid literacy (B = .36, p &lt; .05) and opioid general knowledge subscale (B = .14, p &lt; .05). For the subscale of opioid overdose response knowledge, health insurance (B =−.59, p = .06) and social contact (B = .13, p = .07) emerged as marginally significant. The findings suggest that educational interventions are needed to increase opioid literacy among rural AAs, especially among those with limited social contact.

Rural-urban differentials in the relationship between household wealth index and maternal anaemia status in Nigeria

Anaemia - a condition of low haemoglobin level in the blood is prevalent among women in Nigeria despite years of interventions. Wealth status have implications for this prevalence but there is a dearth of research examining this relationship and residential dimensions in it. The social determinant of health framework was employed to understand the rural-urban dimension of this relationship. Chi-square test and multivariate logit regression models were used to analyse data from the 2018 Nigeria Demographic and Health Survey (n=13,575). We found that anaemia status is higher among rural women (66%). The odds of being anaemic is higher with decreasing wealth status irrespective of place of residence but the odds are higher for poor women in urban areas compared to poor women in rural areas after adjusting for covariates. Maternal health interventions should be more innovative in their design of programs by being sensitive of residential dimension.

Service provider perspectives on how COVID-19 and pandemic restrictions have affected intimate partner and sexual violence survivors in Canada: a qualitative study

BackgroundThe COVID-19 pandemic may increase risk of intimate partner and sexual violence and make relevant services less accessible. This study explored the perspectives of intimate partner and sexual violence workers across Canada on how the COVID-19 pandemic has affected the survivors with whom they work.MethodsUsing a qualitative descriptive design, we interviewed 17 management and frontline staff of organizations supporting survivors of intimate partner and sexual violence across Canada. Results: We identified 4 themes that describe the impacts of COVID-19 on intimate partner and sexual violence survivors, from the perspective of service providers: (1) No escape; (2) Isolation; (3) Tough decisions; and (4) Heightened vulnerability. These narrative findings are presented first, followed by an analysis within a social determinants of health framework. Interpreting our findings against such a framework revealed a complex interplay of social determinants, notably social support, access to services, and poverty, that produced several challenges for intimate partner and sexual violence survivors during COVID-19.ConclusionAccording to service providers, intimate partner and sexual violence survivors in Canada faced several challenges during the pandemic, including reduced ability to escape their situations, increased isolation, increasingly complex decisions, and heightened vulnerability. Our findings demonstrate the critical need to adopt a broader, more holistic approach in tackling intimate partner and sexual violence by also addressing socioeconomic issues such as poverty and marginalization.

Climate change and health in informal settlements: a narrative review of the health impacts of extreme weather events

In this paper, we present a narrative review of primary research on the health impacts of extreme weather events in urban informal settlements published between 1990 and June 2021. We include 54 studies and examine the health impacts of extreme weather events and how these were determined. We find that these events impact health directly by causing mortality, injury and disease and through indirect pathways by impacting livelihoods, access to healthcare, coping strategies and adaptive capacity. Drawing on the social determinants of health framework to frame our analysis, we find that health impacts are determined by multiple intersecting factors, relating to individual circumstances, material conditions, health status, and political and socio-economic context. Consequently, vulnerability varies between and within informal settlements. Overall, we show that responding to and minimising these health impacts requires an intersectional approach to understand and address these contextual root causes of vulnerability.

Social determinants of opioid use behaviors among adults in the United States

ABSTRACT Background The non-medical use of prescription opioids and heroin use remain serious public health issues in the United States. Yet, there remains a lack of research attempting to systematically identify specific social determinants linked to these behaviors using national data sources. Methods Using data from the National Survey on Drug Use and Health and the social determinant of health framework, this study examines the associations between five specific social determinant of health domains and past-year opioid use behaviors – heroin and non-medical prescription opioid use – among U.S. adults aged 18 and older, controlling for more downstream determinants of health. The five social determinant of health domains included the following: (1) economic stability, (2) educational attainment, (3) health care access, (4) neighborhood, and (5) social and community context. Results Separate models investigating the independent relationships between the five domains and opioid use behaviors found that various social determinants were significant predictors, after controlling for individual behaviors and health status. The full model assessing all five domains showed that social and community context, economic stability, and neighborhood determinants were associated with opioid use behaviors. Conclusions Social determinants tied to opioid use behaviors among American adults may largely be driven by social and community context, economic stability, and neighborhood conditions. Limitations of this study are discussed.

Pandemics: Historical Perspective and Vulnerabilities Among Minority Elderly

While infectious organisms surround us, critical circumstances need to occur for a pandemic to develop, such as that of the novel coronavirus disease 2019 (COVID-19), declared by the World Health Organization in March 2020. Prior pandemics had many feautres in common with COVID-19. Pandemics can expose weaknesses in public health response systems, as well as vulnerabilities in the populations who are most susceptible to adverse outcomes, and can lead to scapegoating of specific groups and attempts to conceal the disease. COVID-19 has disproportionately impacted the mental and physical health of minority seniors, and caused significant economic hardships. Long-standing social determinants of mental and physical health have led to health disparities highlighted by COVID-19, and demonstrate the complex intersection of health, medical comorbidities, and barriers to access to culturally competent physical and mental healthcare. The pandemic has caused significant mental health problems even among those who were spared the infection, primarily manifested as social isolation, depression, anxiety and opioid use disorders. Public health measures, including screening, vaccinations, and access to quality healthcare can all mitigate adverse outcomes. Similarly, best practices that include collaborations between social service agencies and faith-based groups are effective strategies to bring these mitigating strategies nearer to the minority seniors who are most in need. Addressing vaccine hesitancy is a critical component of ending this pandemic. Future research should bring together practitioners, public health agencies, and community-based organizations for the collaborative design and implementation of effective, culturally competent interventions to address the medical, psychosocial, and behavioral health needs of ethnic/racial minority older adult communities in the face of COVID-19 and other chronic health conditions. Using the Social Determinants Of Health framework as a guide, clinicians and researchers can work to address structural and systemic racism and poverty and create targeted interventions to COVID-19 and to prevent future pandemics.

Social Determinants, Risk Factors, and Needs: A New Paradigm for Medical Education.

COVID-19 and the escalation of racism and bias that has come in its wake have had a devastating impact on health professions students. In addition to academic challenges and personal health risks, aspects of students’ lives that have often gone unnoticed or inadequately addressed have come to light. Financial constraints that impact access to housing and food, neighborhood safety in light of the spike in hate crimes, and the bias inherent in the continuum from premedical education to undergraduate and graduate medical education are some examples. The authors believe that to better understand students’ lived experiences and determine how to best support them, the social determinants of health framework should be applied. This framework, the social determinants of education, encompasses concepts such as social risk factors and social needs in an effort to focus more intentionally on what can be done at a policy, institutional, and individual level. In response to the pandemic, the authors expanded their appreciation of students’ risk factors and needs by advancing the scope and refining the definitions of 3 key determinants: from well-being to the power of individual and communal resilience, from equity to centering racial justice, and from student health to public health and infection prevention. The authors propose applying this same paradigm to the lived experiences of staff in medical education, whose needs are often neglected in favor of students and faculty, and who, in many cases, were the most negatively impacted by COVID-19 of all the constituents in an academic health center.

Interrogating Patterns of Cancer Disparities by Expanding the Social Determinants of Health Framework to Include Biological Pathways of Social Experiences.

The objective of this article is to call for integrating biological pathways of social experiences in the concept model of cancer disparities and social determinants of health (SDH) fields. Black, Indigenous, and People of Color (BIPOC) populations experience more negative outcomes across the cancer continuum. Social conditions are instrumental in better understanding the contemporary and historical constructs that create these patterns of disparities. There is an equally important body of evidence that points to the ways that social conditions shape biological pathways. To date, these areas of research are, for the most part, separate. This paper calls for a bridging of these two areas of research to create new directions for the field of cancer disparities. We discuss inflammation, epigenetic changes, co-morbidities, and early onset as examples of the biological consequences of social conditions that BIPOC populations experience throughout their lifespan that may contribute to disproportionate tumorigenesis and tumor progression.

Work Demands and Cognitive Health Inequities by Race and Ethnicity: A Scoping Review.

This scoping review aimed to chart the scientific literature on the association between workplace demands with cognitive health, and whether race and ethnicity have a direct or indirect relationship between occupational complexity and cognitive health. PRISMA scoping review guided this study. Peer-reviewed articles were drawn from 5 databases. Inclusion criteria were populations aged 18 and older, U.S.-based studies, a comprehensive conceptualization of workplace demands, and cognitive health outcomes. All articles were screened by title and abstract; qualifying articles proceeded to full-text review. The majority of studies drew from theories that did not interrogate heterogeneity and minority aging experiences. Consequently, the majority of studies did not include race and ethnicity in their analyses. A small and growing body of research drew from critical perspectives and interrogated cognitive health inequities by race and ethnicity within the context of workplace demands. The association between workplace demands and cognitive health is not linear when race and ethnicity are examined. Emerging evidence suggests interventions to improve substantive complexity among racial and ethnic minorities, and individuals with low education are a promising avenue for intervention research. We discuss integrating emerging theories, such as minority stress and revised social determinants of health frameworks, to sharpen the focus and broaden our understanding on racial and ethnic cognitive health inequities in an emerging area of prevention research. This research can advance our basic understanding of preventable health inequities as well as provide important information for interventions.

A county-level analysis of unemployment and mental health in the Southeastern U.S.: applying a social determinants of health framework

ABSTRACT Informed by a Social Determinants of Health framework, this study examines associations between county-level unemployment rates and two county-level indicators of mental health challenges. With 2017 data from County Health Rankings, the study focuses on 418 counties in the southeastern U.S., a region with longstanding unmet service needs and ongoing mental health care challenges. Linear regression models show positive associations between unemployment and two county-level indicators of mental health challenges, while accounting for multiple social determinants of health. The study illustrates how county-level analysis can help social workers target mental health needs and increase access to care.

Associations Between Social Determinants of Health and Adolescent Contraceptive Use: An Analysis From the National Survey of Family Growth.

This research assessed social determinants of contraceptive use among a nationally representative sample of adolescents. This study analyzed nationally representative, publicly available data from the 2013-2015 National Survey of Family Growth (NSFG). The sample consisted of sexually active males and females between the ages of 15 and 19 (n = 775). Independent variables were social determinant questions asked on the NSFG, selected based on the Healthy People Social Determinants of Health Framework. We tested associations between adolescents' social determinants of health and 2 outcomes, use of any contraceptive at last sex, and effectiveness level of contraceptive method at last sex. Results indicated high contraceptive use at last intercourse (91.5%) and a significant association between any use of contraceptive and family structure (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [CI] = 1.04-4.03), employment (AOR = 2.00, 95% CI = 1.06-3.77), and education (AOR = 3.43, 95% CI = 1.06-11.13). Few participants reported use of a highly effective method of pregnancy prevention (4.3%). In regression analyses, access to health care (AOR = 0.34, 95% CI = 0.14-0.84) and language and literacy (AOR = 2.92, 95% CI = 1.03-8.26) were found to be associated with using moderately effective contraceptive method to prevent pregnancy compared with not using any method. Although adolescents report overall high rates of contraceptive use, not all contraceptives have the same rates of effectiveness, and adolescents are often choosing those with lower effectiveness. This study found low rates of highly effective contraceptives to prevent pregnancy use (ie, intrauterine device and implant). It is also important to further explore the associations between family structure (measured in this study as intact childhood family) and distal links to contraceptive use. Future research should also further distinguish pathways to adolescent decision-making to use contraceptive methods to protect against STIs and pregnancy.

Scoping review of maternal and newborn health interventions and programmes in Nigeria

ObjectiveTo systematically scope and map research regarding interventions, programmes or strategies to improve maternal and newborn health (MNH) in Nigeria.DesignScoping review.Data sources and eligibility criteriaSystematic searches were conducted from 1...

Older women's perceptions of the impact of homelessness on their health needs and their ability to access healthcare

ObjectiveThis study explored the healthcare needs and barriers to health services in older homeless women in the Perth metropolitan area, Western Australia. MethodsTwenty‐two older women experiencing homelessness completed a questionnaire and semi‐structured interview. Data were analysed using descriptive statistics and thematic analysis. ResultsThe study highlighted that these women had complex and inter‐related issues that affected their health. The nine major themes that emerged from the interview data consisted of: safe accommodation; financial insecurity; experience of trauma and abuse; stigma, embarrassment and fear of being judged; the health impact of not fulfilling their role as family nurturer; mental health; complex interaction of physical and mental health issues; healthcare costs; and the need for ongoing psychosocial and healthcare support once housed. ConclusionProvision of safe and secure accommodation is pivotal to women's health, as is the need for greater understanding of the impact of poverty, women's traditional roles, social disconnection and domestic violence, and ongoing access to healthcare and support services. Implications for public healthA structural and systemic approach based on a social determinants of health framework is required to address the health needs of the increasing numbers of older women becoming homeless in this country.

Factors associated with opioid-involved overdose among previously incarcerated people in the U.S.: A community engaged narrative review.

People with a history of incarceration are at high risk for opioid overdose. A variety of factors contribute to this elevated risk though our understanding of these factors is deficient. Research to identify risk and protective factors for overdose is often conducted using administrative data or researcher-derived surveys and without explicit input from people with lived experience. We aimed to understand the scope of U.S. research on factors associated with opioid overdose among previously incarcerated people. We did this by conducting a narrative review of the literature and convening expert panels of people with lived experience. We then categorized these factors using a social determinants of health framework to help contextualize our findings. We first conducted a narrative review of the published literature. A search was performed using PubMed and APA PsycInfo. We then convened two expert panels consisting of people with lived experience and people who work with people who were previously incarcerated. Experts were asked to evaluate the literature derived factors for completeness and add factors that were not identified. Finally, we categorized factors as either intermediary or structural according to the World Health Organization's Social Determinants of Health (SDOH) Framework. We identified 13 papers that met our inclusion criteria for the narrative review. Within these 13 papers, we identified 22 relevant factors for their role in the relationship between overdose and people with a history of incarceration, 16 were risk factors and six were protective factors. Five of these were structural factors (three risk and two protective) and 17 were intermediary factors (13 risk and four protective). The expert panels identified 21 additional factors, 10 of which were structural (six risk and four protective) and 11 of which were intermediary (eight risk and three protective). This narrative review along with expert panels demonstrates a gap in the published literature regarding factors associated with overdose among people who were previously incarcerated. Additionally, this review highlights a substantial gap with regard to the types of factors that are typically identified. Incorporating voices of people with lived experience is crucial to our understanding of overdose in this at-risk population.