Social Determinants Of Health Inequalities Research Articles

Characterizing street-connected children and youths\u2019 social and health inequities in Kenya: a qualitative study

BackgroundStreet-connected children and youth (SCY) in Kenya disproportionately experience preventable morbidities and premature mortality. We theorize these health inequities are socially produced and result from systemic discrimination and a lack of human rights attainment. Therefore, we sought to identify and understand how SCY’s social and health inequities in Kenya are produced, maintained, and shaped by structural and social determinants of health using the WHO conceptual framework on social determinants of health (SDH) and the Convention on the Rights of the Child (CRC) General Comment no. 17.MethodsThis qualitative study was conducted from May 2017 to September 2018 using multiple methods including focus group discussions, in-depth interviews, archival review of newspaper articles, and analysis of a government policy document. We purposively sampled 100 participants including community leaders, government officials, vendors, police officers, general community residents, parents of SCY, and stakeholders in 5 counties across Kenya to participate in focus group discussions and in-depth interviews. We conducted a thematic analysis situated in the conceptual framework on SDH and the CRC.ResultsOur findings indicate that SCY’s social and health disparities arise as a result of structural and social determinants stemming from a socioeconomic and political environment that produces systemic discrimination, breaches human rights, and influences their unequal socioeconomic position in society. These social determinants influence SCY’s intermediary determinants of health resulting in a lack of basic material needs, being precariously housed or homeless, engaging in substance use and misuse, and experiencing several psychosocial stressors, all of which shape health outcomes and equity for this population.ConclusionsSCY in Kenya experience social and health inequities that are avoidable and unjust. These social and health disparities arise as a result of structural and social determinants of health inequities stemming from the socioeconomic and political context in Kenya that produces systemic discrimination and influences SCYs’ unequal socioeconomic position in society. Remedial action to reverse human rights contraventions and to advance health equity through action on SDH for SCY in Kenya is urgently needed.

Socioeconomic inequalities in maternal health service utilisation: a case of antenatal care in Nigeria using a decomposition approach

BackgroundAntenatal care (ANC) services are critical for maternal health but Nigeria performs poorly in ANC utilisation compared to other countries in sub-Saharan Africa. This study aimed to assess socioeconomic inequalities in ANC utilisation and the determinants of these inequalities in Nigeria.MethodsThe 2013 Nigeria Demographic and Health Survey data with 18,559 women was used for analysis. The paper used concentration curves and indices for different measures of ANC utilisation (no ANC visit, 1–3 ANC visits, at least four ANC visits, and the number of ANC visits). A positive (or negative) concentration index means that the measure of ANC utilisation was concentrated on the richer (poorer) population compared to their poorer (richer) counterparts. The concentration indices were also decomposed using standard methodologies to examine the significant determinants of the socioeconomic inequalities in no ANC visit, at least four ANC visits, and the number of ANC visits.ResultsNo ANC visit was disproportionately concentrated among the poor (concentration index (CI) = − 0.573), whereas at least four ANC visits (CI = 0.582) and a higher number of ANC visits (CI = 0.357) were disproportionately concentrated among the rich. While these results were consistent across all the geopolitical zones and rural and urban areas, the inequalities were more prevalent in the northern zones (which also have the highest incidence of poverty in the country) and the rural areas. The significant contributors to inequalities in ANC utilisation were the zone of residence, wealth, women’s education (especially secondary) and employment, urban-rural residence, ethnicity, spousal education, and problems with obtaining permission to seek health care and distance to the clinic.ConclusionsAddressing wealth inequalities, enhancing literacy, employment and mitigating spatial impediments to health care use will reduce socioeconomic inequalities in ANC utilisation in Nigeria. These factors are the social determinants of health inequalities. Thus, a social determinants of health approach is needed to address socioeconomic inequalities in ANC coverage in Nigeria.

Reported M\u0101ori consumer experiences of health systems and programs in qualitative research: a systematic review with meta-synthesis

BackgroundPersistent inequities in health experiences and outcomes are observed for Māori compared to non-Māori in Aotearoa New Zealand. We conceptualised factors associated with Māori consumer experiences of health programs and services and characterise how the recommendations arising from qualitative research inform strategies to address inequities.MethodsIn this systematic review, electronic literature searching was conducted in February 2018. Qualitative studies reporting Māori consumer experiences of health services and programs in Aotearoa New Zealand were eligible. Māori consumer experiences of health services were mapped to the WHO Commission of Social Determinants of Health (CSDH) conceptual framework on health inequities as related to: (i) the socioeconomic and political context; (ii) socioeconomic positioning; or (iii) intermediary factors that increase exposure to health-compromising conditions. Recommendations to improve consumer experiences were mapped to the CSDH framework for tackling social determinants of health inequities as policy directions on: (i) unequal consequences of illness (individual interaction); (ii) risks of exposure to health-damaging factors (community); (iii) exposures to health-damaging factors (public policies); and (iv) mitigating effects of socioeconomic and political stratification (environment).ResultsFifty-four studies were included. Māori consumer experiences mapped to social determinants of health inequities were most frequently related to direct interactions with health services and programs, particularly patient-clinician interactions (communication, relationships) and cultural competencies of clinicians and the system. Key recommendations by researchers mapped to potential strategies to address inequity were identified at all levels of the political, social and health system from individual interactions, community change, and broader public and system-level strategies. Recommendations were predominantly focused on actions to reduce risks of exposure to health-damaging factors including health literacy interventions, increased resources in cultural competencies and Māori capacity in health service development and workforce.ConclusionsMāori consumer experiences of health services and programs are an important informer of variables that impact health inequity. Strategies to tackle health inequities informed by Māori consumer experiences can be drawn from existing empirical research. Future qualitative exploration of how socioeconomic, political and public policies influence Māori consumer experiences of health services and programs could inform a broader range of structural policies to address health inequities.

Status of Health, Education and Income Inequality in Iran

Introduction: Education and income inequality are two important social determinants of health inequality. Every society for improving health status should focus on income equality and education for all. A review of the current situation helps to identify and improve the weaknesses in Iran. Methods: This study was descriptive and data collection was done by documentary study method. This researchtried to study various global databases, papers and global reports to search the status of Iran in comparison to other countries in different regions. Result: Studies have shown that inequality in income and wealth. Although the situation in Iran is better than the Persian Gulf countries, more inequality is observed in Iran in comparison to other parts of the world, including the United States and Western Europe. In terms of health, among the fifty major causes of death, Iran is ranked first and fourth in global terms due to road accidents and illicit drug use. At the same time, mortality from liver cancer, skin cancer, epilepsy, cervical cancer, kidney cancer, and cancer are in good condition compared to other countries in the world. In the field of education, the state of Iran in primary education, the exclusion of children from primary education, the guarantee of equal access for women and men to higher education and the eradication of gender inequality in participating in education is in a better situation than other parts of the world, but has been weaker than many other countries in the number of preschool years and pre-school education. Conclusion: The status of Iran in income inequality and education showed challenges that should be improve. These two as social determinants of health inequalities have an enormous role in health status. Sustainable development goals can be a guideline for developing the current situation.

Społeczne uwarunkowania nierówności w zdrowiu

Społeczne uwarunkowania nierówności w zdrowiu

Social Determinants of Health Inequities in Indigenous Canadians Through a Life Course Approach to Colonialism and the Residential School System.

Indigenous populations in Canada have experienced social, economic, and political disadvantages through colonialism. The policies implemented to assimilate Aboriginal peoples have dissolved cultural continuity and unfavorably shaped their health outcomes. As a result, indigenous Canadians face health inequities such as chronic illness, food insecurity, and mental health crises. In 2015, the Canadian government affirmed their responsibility for indigenous inequalities following a historic report by the Truth and Reconciliation Commission of Canada. It has outlined intergenerational traumata imposed upon Aboriginals through decades of systemic discrimination in the form of the Residential School System and the Indian Act. As these policies have crossed multiple lifespans and generations, societal conceptualization of indigenous health inequities must include social determinants of health (SDOH) intersecting with the life course approach to health development to fully capture the causes of intergenerational maintenance of poor health outcomes. To provide culturally sensitive care for those who have experienced intergenerational trauma, health care providers should be aware of and understand two key SDOH inequity influencing the indigenous life course, including the residential school system and loss of socioeconomic status, over time due to colonialism.

Health inequalities and well-being in times of financial and political crisis in Brazil, a case study

ABSTRACTBackground: Although global efforts have resulted in improvements in health and well-being across the world, economic downturns can rapidly undermine achievements in this area. Methods: Using Gallup World Poll data (n = 7,084) this study assessed the changes in health status and well-being before (2009–2013) and during (2015–2017) the current financial and political crisis in Brazil and their association with the Social Determinants of Health Inequalities. Health and well-being were measured by the Personal Life Index and the Life Evaluation Index. Descriptive analysis and logistic regression models were conducted. Results: A significant deterioration of well-being was found during the crisis, with a 29% decline (63–44%) in the prevalence of respondents classified as ‘thriving' in life. Food security, age and social support were the best predictors of health status and well-being, mitigating the association of health and well-being with income and unemployment. Education and community environment also showed strong association with well-being, and satisfaction with healthcare system played an important role in health status. Conclusions: In order to protect health and well-being during such crisis, policies should pay particular attention on enhancing the access to food, healthcare system, educational system, community environment (quality of air, water and infrastructure) and fostering social support.

Priorities and recommended actions for how researchers, practitioners, policy makers, and the affected community can work together to improve access to hepatitis C care for people who use drugs

It is estimated that 6.1 million people with recent injecting drug use (PWID) are living with hepatitis C virus (HCV). Although HCV-related morbidity and mortality among PWID continues to increase, the advent of direct acting antiviral (DAA) HCV regimens with cure rates >95% provides an opportunity to reverse the rising burden of disease. Additionally, given evidence that opioid substitution therapy and high-coverage needle and syringe programs can reduce HCV incidence by up to 80%, there is an opportunity to reduce HCV transmission with increased coverage of harm reduction services. However, there are significant patient, provider, health system, structural, and societal barriers that impede access to HCV prevention and care for PWID. The International Network on Hepatitis in Substance Users (INHSU), in collaboration with the Australasian Society for HIV, Viral Hepatitis, Sexual Health Medicine (ASHM), Harm Reduction International, the Canadian Network on Hepatitis C, Canadian Research Initiative in Substance Misuse, the National Viral Hepatitis Roundtable, Médecins du Monde and CATIE, held a roundtable discussion prior to the Harm Reduction Conference in Montreal, Canada on 13th May 2017 to discuss how to improve HCV prevention and care for PWID. Over 100 international researchers, practitioners, policy makers, advocates, and affected community members came together to discuss shared priorities for action, develop actionable next steps and to create partnerships to enable application of priorities. This paper highlights the key priority areas identified by participants including: enhancing global coverage of harm reduction services; addressing punitive drug policies; ensuring access to affordable HCV diagnostics and treatment; improving the evidence-base for HCV prevention, testing, linkage to care and treatment; implementing integrated HCV programs; advancing peer-based models of HCV care; and tackling social determinants of health inequalities for PWID. This paper also highlights the recommended actions for each priority identified by the participants from this roundtable.

Assessing changes in social determinants of health inequalities in South Africa : a decomposition analysis

BackgroundDespite various policy interventions that have targeted reductions in socio-economic inequalities in health and health care in post-Apartheid South Africa, evidence suggests that not much has really changed. In particular, health inequalities, which are strongly linked to social determinants of health (SDH), persist. This study, thus, examines how changes in the SDH have impacted health inequalities over the last decade, the second since the end of Apartheid.MethodsData come from information collected on social determinants of health (SDH) and on health status in the 2004, 2010 and 2014 questionnaires of the South African General Household Surveys (GHSs). The health indicators considered include ill-health status and disability. Concentration indices and Oaxaca-Blinder decomposition of change in a concentration index methods were employed to unravel changes in socio-economic health inequalities and their key social drivers over the studied time period.ResultsThe results show that inequalities in ill-health are consistently explained by socio-economic inequalities relating to employment status and provincial differences, which narrowed considerably over the studied periods. Relatedly, disability inequalities are largely explained by shrinking socio-economic inequalities relating to racial groups, educational attainment and provincial differences.ConclusionThe extent of employment, location and education inequalities suggests the need for improved health care management and further delivery of education and job opportunities; greater effort in this regard is likely to be more beneficial in some way.

Area reputation as an under-acknowledged determinant of health inequalities: evidence from a systems evaluation of a major community empowerment initiative in England

BackgroundArea reputation (AR) refers to the ways that geographical localities are portrayed (eg, in media coverage) either positively or negatively. AR is rarely recognised as a social determinant of health inequalities and is not adequately considered in public health interventions. Using residents' accounts from a study of a major community empowerment initiative in England (Big Local), we aimed to map the potential health consequences of AR and see how it can be challenged through resident-led action. MethodsIn-depth longitudinal fieldwork included over 300 interviews in 15 areas covered by the Big Local initiative and a review of newspapers in two areas. Participants were aged over 18 years, resident or working locally, and active in Big Local. The fieldwork sites were geographically mixed (eg, wards, housing estates) and relatively deprived. AR was identified to be important for a third of areas, with data generation in these sites additionally investigating how AR was targeted for action. Qualitative data were coded in NVivo (version 11). Narrative memos were developed around particular themes and compared and contrasted across sites. COREQ criteria guided the reporting of findings. FindingsResidents reported that negative AR influenced community self-esteem and wellbeing and material investment into the area (eg, preventing people visiting). Negative media coverage perpetuated the poor reputation of areas. Residents also perceived that AR was shaped by public officials, local politicians, estate agents, and the public. Direct collective action taken through Big Local included publicity work to resist negative portrayals of areas in local newspapers. Indirect actions included festivals and neighbourhood improvements to increase the likelihood that visitors would view areas as safe and desirable places to visit. Findings also highlighted the civic roles of residents, challenging stereotyped images of communities living in disadvantaged areas. InterpretationPoor AR can influence life chances and quality of life through material and psychosocial pathways. Little empirical evidence exists on how to improve AR, so our study contributes to addressing this gap. A limitation is that we did not investigate why AR was not a priority in other similarly deprived areas. Strategies for addressing area-based disadvantage should consider AR as a mechanism for health and incorporate resident-led action to shift negative perceptions. FundingNational Institute for Health Research (NIHR) School for Public Health Research.

Why Socio-Economic Inequalities in Health Threaten Relational Justice. A Proposal for an Instrumental Evaluation

In this article, we argue that apart from evaluating the causes and the social determinants of health inequalities, an evaluation of the effects of health inequalities is due. For this, we propose the ideal of relational equality as an evaluative framework, and test to what extent health inequalities threaten this ideal of a society of equals. We identify three ways in which they do (i.e. via unequal risks to stigmatization, unequal risks to unemployment and unequal risks to unequal pension enjoyments) and argue that these risks are especially great for those lower down the socio-economic strata. We thus conclude that equality in health is instrumental to social justice, and that socio-economic inequalities in health are not only unjust due to their causes but also due to their consequences. We continue to argue that our instrumental approach opens a perspective to mitigate the identified injustices by changing society, rather than reducing inequalities in health, and argue that this is an advantage in the light of the realistic assumption that (part) of the socio-economic health inequalities will persist. The article thus offers a complementary approach to both the evaluation and the mitigation of the injustice of socio-economic inequalities in health.

Canadian trends in the social determinants of health inequalities, a census-mortality linkage approach

IntroductionMortality inequalities by income and education levels have historically been estimated using an area-based approach in Canada. Although useful in measuring socioeconomic inequalities overtime, this method underestimates the level of inequality and only allows the examination of a single dimension at a time.
 Objectives and ApproachTo create a series of census linked datasets that allowed for the examination of health inequalities across different socioeconomic dimensions. Specifically, five census cycles (beginning with the 1991 Census) were probabilistically and deterministically linked to different health outcomes (mortality, cancer, hospitalization) to create the Canadian Census Health and Environment Cohort (CanCHEC). Each dataset was created using a similar methodological approach which allowed for the measurement of these health inequalities over time. Mortality inequalities by both income and education level (including multidimensional) for all causes and cause-specific groups were examined.
 ResultsFive census linked datasets were constructed that followed mortality for a period of up to 20 years. The 1991 CanCHEC includes 2.6 million adults, the 1996 and 2001 CanCHECs include 3.5 million adults respectively, and the 2006 and 2011 CanCHECs include 5.9 and 6.5 million people respectively. Findings revealed a stair-stepped gradient in all-cause and cause-specific mortality by educational attainment and income quintile across each time period. The lowest mortality rates were among the university educated and richest income quintile and highest mortality rates among those with less than high school graduation and the poorest income quintile. The gradient differed by cause of death groupings. Over the 25-year time period, the mortality gradient trend varied by socioeconomic dimension and cause of death.
 Conclusion/ImplicationsThese data show clear mortality inequalities by socioeconomic position across the different time periods. These linked datasets can help advance knowledge in understanding health inequalities in Canada as well as provide a tool for on-going surveillance of health inequalities by different socioeconomic dimensions.

Reframing "participation" and "inclusion" in public health policy and practice to address health inequalities: Evidence from a major resident-led neighbourhood improvement initiative.

There is a need for greater conceptual clarity in place-based initiatives that seek to give residents of disadvantaged neighbourhoods more control over action to address the social determinants of health inequalities at a local level. In this article, we address this issue as it relates to the concepts of participation and inclusion. We draw on qualitative data generated during the first phase of the Communities in Control Study, a longitudinal multisite independent evaluation of the impact of Big Local on the social determinants of health and health inequalities. Big Local is a resident-led area improvement initiative in England, funded by the UK Big Lottery Fund. Initiatives focused on community empowerment are increasingly prominent in public health policy and practice globally. Approaches emphasise the promotion of greater control over decisions and action among individuals, groups, and communities, particularly those living in disadvantaged circumstances. However, when it comes to participation and inclusion in taking action and making decisions, the field is characterised by conceptual confusion. This risks undermining the impact of these initiatives. While participation and inclusion are necessary conditions for empowerment and collective control, they are not necessarily sufficient. Sufficiency requires attention to the breadth of participation (i.e., to inclusion) and to the depth of participation (i.e., the extent to which it is experienced as empowering and ultimately enables the exercise of collective control over decisions and actions). In observing how different Big Local resident-led partnerships across England are tackling the day-to-day challenges of engaging with their communities, we reveal the potential for policy and practice of reframing, and therefore clarifying (to highlight the different roles they have) the concepts of participation and inclusion in terms of depth and breadth.

Multidimensionality of Health Inequalities: A Cross-Country Identification of Health Clusters through Multivariate Classification Techniques.

Despite major efforts in scientific literature to explain and understand the social determinants of health inequalities, the complex association between social causes and health outcomes remains empirically questionable and theoretically puzzling. To date, the studies on social determinants of health has mainly been generated by research techniques and methods that were developed to answer specific questions about the causes and effects of particular indicators on specific health outcomes. The present exploratory study follows a complex system approach to capture the interdependence between socioeconomic status, lifestyles, and health in a single measure that enables international comparisons of population health. Specifically, this study is aimed to: (a) classify individuals’ state of health according the usage of multidimensional data on physical and mental health, SES, lifestyles and risk behaviors, in order to (b) compare the relative strength of the different predictors of health groups (or clusters) at the individual-level and, finally, (c) to measure the level of health inequalities between different countries. From a complex system approach, this study uses multivariate classification methods to compare health groups in a sample of 29 countries and shows that interdependence models may be useful to describe and compare between-country health inequalities that are not visible through techniques for the analysis of dependence. The present work offers two fundamental contributions. On the one hand, this study compares the relative relevance of different indicators that are susceptible to affect individual health outcomes; on the other hand, the resulting multidimensional classification of countries according health clusters provides an alternative for inter-country health comparisons.

Health inequalities between employed and unemployed in northern Sweden: a decomposition analysis of social determinants for mental health

BackgroundEven though population health is strongly influenced by employment and working conditions, public health research has to a lesser extent explored the social determinants of health inequalities between people in different positions on the labour market, and whether these social determinants vary across the life course. This study analyses mental health inequalities between unemployed and employed in three age groups (youth, adulthood and mid-life), and identifies the extent to which social determinants explain the mental health gap between employed and unemployed in northern Sweden.MethodsThe Health on Equal Terms survey of 2014 was used, with self-reported employment (unemployed or employed) as exposure and the General Health Questionnaire (GHQ-12) as mental health outcome. The social determinants of health inequalities were grouped into four dimensions: socioeconomic status, economic resources, social network and trust in institutional systems. The non-linear Oaxaca decomposition analysis was applied, stratified by gender and age groups.ResultsMental health inequality was found in all age groups among women and men (difference in GHQ varying between 0.12 and 0.20). The decomposition analysis showed that the social determinants included in the model accounted for 43–51% of the inequalities among youths, 42–98% of the inequalities among adults and 60–65% among middle-aged. The main contributing factors were shown to vary between age groups: cash margin (among youths and middle-aged men), financial strain (among adults and middle-aged women), income (among men in adulthood), along with trust in others (all age groups), practical support (young women) and social support (middle-aged men); stressing how the social determinants of health inequalities vary across the life course.ConclusionsThe health gap between employed and unemployed was explained by the difference in access to economic and social resources, and to a smaller extent in the trust in the institutional systems. Findings from this study corroborate that much of the mental health inequality in the Swedish labour market is socially and politically produced and potentially avoidable. Greater attention from researchers, policy makers on unemployment and public health should be devoted to the social and economic deprivation of unemployment from a life course perspective to prevent mental health inequality.

Addressing Health Equity Through Action on the Social Determinants of Health: A Global Review of Policy Outcome Evaluation Methods.

Background: Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research. Methods: We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensions evaluated. Results: We found a growing number of a wide range of policies being evaluated for health equity outcomes using a variety of research designs. The majority of studies employed an observational research design, most of which were cross-sectional, however, other approaches included experimental designs, simulation modelling, and meta-analysis. Regression techniques dominated the analytical approaches, although a number of novel techniques were used which may offer advantages over traditional regression analysis for the study of distributional impacts of policy. Few studies made intra-national or cross-national comparisons or collected primary data. Despite longstanding challenges of attribution in policy outcome evaluation, the majority of the studies attributed change in physical or mental health outcomes to the policy being evaluated. Conclusion: Our review provides an overview of methodological approaches to health equity policy outcome evaluation, demonstrating what is most commonplace and opportunities from novel approaches. We found the number of studies evaluating the impacts of public policies on health equity are on the rise, but this area of policy evaluation still requires more attention given growing inequities.

Politics, policies and processes: a multidisciplinary and multimethods research programme on policies on the social determinants of health inequity in Australia

IntroductionThe development and implementation of multisectoral policy to improve health and reduce health inequities has been slow and uneven. Evidence is largely focused on the facts of health inequities rather...

What Enables and Constrains the Inclusion of the Social Determinants of Health Inequities in Government Policy Agendas? A Narrative Review.

Background: Despite decades of evidence gathering and calls for action, few countries have systematically attenuated health inequities (HI) through action on the social determinants of health (SDH). This is at least partly because doing so presents a significant political and policy challenge. This paper explores this challenge through a review of the empirical literature, asking: what factors have enabled and constrained the inclusion of the social determinants of health inequities (SDHI) in government policy agendas? Methods: A narrative review method was adopted involving three steps: first, drawing upon political science theories on agenda-setting, an integrated theoretical framework was developed to guide the review; second, a systematic search of scholarly databases for relevant literature; and third, qualitative analysis of the data and thematic synthesis of the results. Studies were included if they were empirical, met specified quality criteria, and identified factors that enabled or constrained the inclusion of the SDHI in government policy agendas. Results: A total of 48 studies were included in the final synthesis, with studies spanning a number of country-contexts and jurisdictional settings, and employing a diversity of theoretical frameworks. Influential factors included the ways in which the SDHI were framed in public, media and political discourse; emerging data and evidence describing health inequalities; limited supporting evidence and misalignment of proposed solutions with existing policy and institutional arrangements; institutionalised norms and ideologies (ie, belief systems) that are antithetical to a SDH approach including neoliberalism, the medicalisation of health and racism; civil society mobilization; leadership; and changes in government. Conclusion: A complex set of interrelated, context-dependent and dynamic factors influence the inclusion or neglect of the SDHI in government policy agendas. It is better to think about these factors as increasing (or decreasing) the ‘probability’ of health equity reaching a government agenda, rather than in terms of ‘necessity’ or ‘sufficiency.’ Understanding these factors may help advocates develop strategies for generating political priority for attenuating HI in the future.

Social Hazards as Manifested Workplace Discrimination and Health (Vietnamese and Ukrainian Female and Male Migrants in Czechia).

Social hazards as one of the dimensions of workplace discrimination are a potential social determinant of health inequalities. The aim of this study was to investigate relations between self-reported health and social hazard characteristics (defined as—discrimination as such, violence or threat of violence, time pressure or work overload and risk of accident) among Vietnamese and Ukrainian migrants (males and females) in Czechia by age, education level and marital status. This study is based on data from a survey of 669 immigrants in Czechia in 2013. Logistic regression analysis indicates that the given independent variables (given social hazards and socio-demographic characteristics), as predictors of a quality of self-reported health are more important for immigrant females than for males, irrespective of citizenship, albeit only for some of them and to differing extents. We found out that being exposed to the selected social hazards in the workplace leads to worsening self-rated health, especially for females. On the other hand, there was no statistically significant relationship found between poor self-rated health and discrimination as such. Reality calls for more research and, consequently, better policies and practices in the field of health inequalities.

Social determinants of health and local government: understanding and uptake of ideas in two Australian states

Objective:To examine the awareness and perceptions of local government staff about the social determinants of health (SDoH) and health inequity and use of these ideas to shape policy and practice. Methods:96 staff at 17 councils in South Australia or New South Wales responded to questions in a pilot online survey concerning: sources of knowledge about, familiarity with the evidence on, attitudes towards, and uses of ideas about the social determinants of health. Eight of 68 SA councils and 16 of 152 NSW councils were randomly selected stratified by state and metropolitan status. Differences between states and metropolitan/non‐metropolitan status were explored. Results:The majority of respondents (88.4%) reported some familiarity with ideas about the broad determinants of health and 90% agreed that the impact of policy action on health determinants should be considered in all major government policy and planning initiatives. Research articles, government/professional reports, and professional contacts were rated as important sources of knowledge about the social determinants of health. Conclusion:Resources need to be dedicated to systematic research on practical implementation of interventions on social determinants of health inequities and towards providing staff with more practical information about interventions and tools to evaluate those interventions. Implications:The findings suggest there is support for action addressing the social determinants of health in local government. The findings extend similar research regarding SDoH and government in NZ and Canada to Australian local government.