Social Determinants Of Health Inequalities Research Articles

Advancing Equity in Health Care Among Dalits and Tribal People in India: The Progress, Current Realities, and the Way Forward.

The caste system and resulting social exclusion are important social determinants of health inequity in India. This article critically analyzes the influence of the caste system on health inequity in India, starting with a historical perspective and moving to the current status. The article argues that the caste system has deprived Dalits and tribal people in India of achieving health equity. The programs to promote health are often disease-specific and not culturally informed, leading to poor attention at the policy level to the intersecting disadvantages that make Dalits and tribal communities vulnerable, resulting in poor health. The authors suggest strengthening and promoting primary care, improving health access for Dalit and tribal populations, and the need for pivotal changes in the medical education system, shifting the emphasis from specialized care to training family physicians to be oriented toward community health needs, keeping health equity in perspective.

Prevalence and determinants of risky behaviors: a comprehensive review of substance use and sexual risk behaviors among adolescents in the United States

Adolescents are often the most vulnerable to risky behaviors due to their quest for independence, experimentation, and identity development, resulting in deep-rooted patterns that affect health across the life course. This review examines the prevalence and determinants of substance use and sexual risk behaviors among adolescents in the United States. A systematic search of peer-reviewed literature published between 1980-2023 was conducted using multiple databases. Studies focusing on U.S. adolescents aged 12-19 and reporting on prevalence or associated factors of substance use (alcohol, tobacco, marijuana, or any illicit drugs) or sexual risk behaviors (early sexual initiation, multiple partners, or inconsistent condom use) were included. The review synthesized data from 40 studies meeting inclusion criteria. Results indicate concerning rates of substance use and sexual risk-taking, with variations by demographic factors. Alcohol and marijuana use were most prevalent, reported by 30-40% of adolescents. Nearly half of high school students reported having sexual intercourse, with 40% not using condoms consistently. Prevalence was generally higher among older adolescents, sexual minorities, and some racial minority groups. Key determinants of risk behaviors were reviewed based on socioecological models including individual, interpersonal, community and societal factors. The review highlights the multilevel nature of influences on adolescent risk behaviors. Findings underscore the need for tailored interventions addressing multiple determinants. Particular attention to vulnerable groups such as African American Adolescents and social determinants of health inequities is warranted. More research on risk and protective factors and effective interventions is needed. This synthesis can inform the development of evidence-based policies and programs to reduce substance use and sexual risk behaviors among U.S. adolescents.

Social determinants of health inequalities in early phase clinical trials in Northern England

BackgroundEarly phase clinical trials in Oncology represent a subspecialised area where UK patient selection is influenced by access to Experimental Cancer Medicine Centres (ECMCs). Equity of access with respect to social determinants of health (SDoH) were explored for two major ECMCs.MethodsA retrospective cohort study including all referrals to Newcastle and Manchester ECMCs in 2021 was completed. Consent to screening or pre-screening was stratified against SDoH characteristics, including: Index of Multiple Deprivation (IMD) decile, ethnicity and distance to centre.Results1243 patients were referred for trials. IMD quintile 1 (most deprived) patients had reduced likelihood of referral compared to expected population models (OR, 0.67; 95% CI: 0.55 to 0.80, p = <0.0001). IMD quintile 5 (least deprived) had increased likelihood of referral (OR, 1.46; 95% CI: 1.17 to 1.82, p = 0.0007). Living beyond median distance from Manchester reduced the likelihood of consenting to trials (OR, 0.72; 95% CI: 0.55 to 0.94, p = 0.015). Ethnicity data represented a White British propensity.ConclusionsInequalities in socioeconomic and geographic factors influence referral and enrolment to early phase clinical trials in Northern England. This has implications for equity of access and generalisability of trial results internationally and warrants further study.

Social Determinants of Health Inequities for Older LGBT Adults: A Scoping Review.

Despite the research on a health-disparate population, less is known about the social determinants of health (SDOH) inequities among older lesbian, gay, bisexual, and transgender (LGBT) adults. This scoping review aimed to explore and summarize what is known in the literature regarding the SDOH among older LGBT adults. The Joanna Briggs Institute's (JBI) approach guided this scoping review, which examined 31 articles that included quantitative, qualitative, and mixed-method studies. Data were analyzed by three independent reviewers through a predesigned process of data charting, descriptive summary, and thematic analysis. Older participants were primarily LGBT and LGB. The findings identified four intersecting dimensions of individuals, social, economic, and health care system, contributing to health inequities and poor health outcomes. Given the importance of SDOH for older LGBT adults, stakeholders including health care providers need to better understand the multiple intersecting influences, provide culturally congruent health care, and integrate sources of support into the care of these sexual- and gender-minority older adults.

Does the health information system in Jordan support equity to improve health outcomes? Assessment and recommendations

BackgroundThis study is based on extensive evidence-based assessments. The aim of this paper is to evaluate how well Jordan’s health information system (HIS) incorporates social determinants of health inequity (SDHI) and to propose suggestions for future actions.MethodsAn extensive evidence-based assessment was performed. A meta-synthesis of the inclusion of the SDHI in the HIS in Jordan was conducted. After searching and shortlisting, 23 papers were analyzed using Atlas.ti 9.0 employing thematic analysis technique.ResultsThe HIS in Jordan is quite comprehensive, comprising numerous data sources, various types of information, and data from multiple producers and managers. Nevertheless, the HIS confronts several obstacles and fails to ensure the timely and secure publication of available data. The assessment of the inclusion of the SDHI in the HIS showed that the HIS allows for the measurement of progress in relation to social policies and actions but has a very limited database for supporting the inclusion of health inequity measures. One reason for the difficulty in identifying fairness is that certain crucial information necessary for this task cannot be obtained through the available institutional HIS or population survey tools. Additionally, relevant modules for fairness may be missing from population surveys, possibly due to a failure to fully utilize the capabilities of the institutional HIS.ConclusionThere are opportunities to make use of Jordan’s dedication to fairness and its already established strong HIS. Some social determinants of health exist in the HIS, but much more data, information, and effort are needed to integrate the SDHI into the Jordanian HIS. A proposal from a regional initiative has put forward a comprehensive set of indicators for integrating SDHI into HIS, which could aid in achieving health equity in Jordan.

Social determinants of health in Brazil during the COVID-19 pandemic: strengths and limitations of emergency responses.

Economic crises often expose the most vulnerable to higher health risks and tend to exacerbate existing inequalities. The Social Determinants of Health (SDoH) framework illustrates many layers of inequalities that would affect outcomes of the COVID-19 pandemic. The impacts of emergency policy responses considering the SDoH framework are important for all sectors in policymaking. However, its assessment in Global South countries is limited, due to high informality rates and data availability. We address this gap using a unique dataset that allows for the analysis of occupational categories before and after the COVID-19 pandemic in Brazil, incorporating the emergency assistance provided in 2020. Results show that, although labor earnings fell 4% for the self-employed at each death from COVID-19, increasing unemployment and inactivity among the typically most vulnerable, those effects were offset by emergency policies, reducing poverty. Groups often considered less vulnerable, such as formal employees, had an increase. The policy responses to this shock served then as a leveler of previous SDoH, despite ignoring the health-risk gradient there is along the income distribution. A poverty rebound that ensued after the sudden discontinuation of those policies is a lesson for future crises, and on how SDoH inequalities should be addressed.

Reconsidering economic interventions to reduce oral health inequalities.

Despite the general recognition of economic factors as fundamental upstream social determinants of health inequalities, interventions to improve health and reduce inequalities tend to focus on proximal health determinants. However, recent socioeconomic crises have increased the focus on economic factors. Health-related approaches to address economic factors can be divided into two categories: (1) indirect approaches, such as financial support for obtaining dental care and fiscal policies targeting unhealthy commodities and (2) direct approaches, such as cash transfers or provision of a universal basic income. For indirect approaches, policies reducing out-of-pocket payments for dental care appear to improve access to services and reduce oral health inequalities. Price policies targeting tobacco and sugar through taxation are associated with declines in periodontal disease and caries, and sugar taxation appears to reduce oral health inequalities. As regards direct approaches, studies on cash transfers to low-income individuals have found no positive impact on dental visits, while results in relation to caries prevention were inconclusive. No dental studies examined the effect of a population approach to income security, such as basic income. Research on economic interventions for oral health inequalities is scarce, and studies using causal inference methods and natural experiments are urgently needed.

Experience of South and Southeast Asian minority women in Hong Kong during COVID-19 pandemic: a qualitative study

BackgroundHong Kong has a relatively low incidence rate of COVID-19 across the globe. Nevertheless, ethnic minorities in Hong Kong, especially South Asians (SAs) and Southeast Asians (SEAs), face numerous physical, mental, social, economic, cultural and religious challenges during the pandemic. This study explores the experiences of SA and SEA women in a predominantly Chinese metropolitan city.MethodsTen SA and SEA women were recruited and face-to-face interviews were conducted. Questions about participants’ daily life experience, physical and mental health conditions, economic situation and social interaction amid COVID-19 pandemic were asked to assess the impact of COVID-19.ResultsSAs and SEAs have a distinctive family culture, and women experienced significant physical and mental impact of COVID-19 due to their unique gender role in the family. In addition to taking care of their family in Hong Kong, SA and SEA women also had to mentally and financially support family members residing in their home countries. Access to COVID-related information was restricted due to language barrier. Public health measures including social distancing imposed extra burden on ethnic minorities with limited social and religious support.ConclusionsEven when COVID-19 incidence rate is relatively low in Hong Kong, the pandemic made life even more challenging for SAs and SEAs, which is a community already struggling with language barriers, financial woes, and discrimination. This in turn could have led to greater health inequalities. Government and civil organizations should take the social determinants of health inequalities into account when implementing COVID-19-related public health policies and strategies.

Structural Inequities in Self-compassion and Parental Burnout.

When parenting-related stressors and coping resources are chronically imbalanced, there is risk of parental burnout, and consequent negative impact on parent and child wellbeing. The objective of this study was to determine the relations between structural and social determinants of health inequities, self-compassion (a theoretically indicated coping practice), and parental burnout during the COVID-19 pandemic. Participants were parents (n = 2324) with at least one child aged 4-17 in the household recruited from NORC's AmeriSpeak Panel (a probability-based panel providing coverage of 97% of the US household population). Parents completed an online or telephone questionnaire in English or Spanish in December 2020. Structural equation modeling was used to test a system of relations between income, race and ethnicity, parental burnout, and parent and child mental health. Indirect effects and moderation by self-compassion were also tested. On average, parents experienced symptoms of burnout several days per week. Symptoms were the most frequent among parents with the least income, as well as female-identified and Asian parents. More self-compassion was associated with less parental burnout, and fewer parent and child mental health difficulties. Black and Hispanic parents were more self-compassionate compared to white parents, helping to explain similar levels of parental burnout and relatively better mental health outcomes, despite comparatively more stressors. Self-compassion is a potentially promising target for interventions aiming to address parental burnout; however, such efforts must not detract from critical structural changes to reduce parenting stressors, particularly those impacting parents experiencing systemic racism and other forms of socioeconomic disadvantage. This study is not preregistered. The online version contains supplementary material available at 10.1007/s12671-023-02104-9.

Downing the Master's Tools? New Research Strategies to Address Social Determinants of Health Inequalities.

A dramatic increase in the volume of research literature referencing social determinants of health (SDH) since the report of the World Health Organization Commission on the topic in 2008 has not been matched by expansion of policies and interventions to reduce health inequalities by way of SDH. This article argues that familiar hierarchies of evidence that privilege clinical epidemiology as used in evidence-based medicine are inappropriate to address SDH. They misunderstand both the range of relevant evidence and the value-based nature of standards of proof. A richer conceptual armamentarium is available; it includes several applications of the concepts of epidemiological worlds and the lifecourse, which are explained in the article. A more appropriate evidentiary approach to SDH and health inequalities requires "downing the master's tools," to adapt Audre Lorde's phrase, and instead applying a multidisciplinary approach to assessing the evidence that adequately reflects the complexity of the relevant causal pathways. Doing so is made more difficult by the power structures that shape research priorities, yet it is essential.

Designing a generic, adaptive protocol resource for the measurement of health impact in cash transfer pilot and feasibility studies and trials in high-income countries

IntroductionIn the context of the COVID-19 pandemic, upstream interventions that tackle social determinants of health inequalities have never been more important. Evaluations of upstream cash transfer trials have failed to capture comprehensively the impacts that such systems might have on population health through inadequate design of the interventions themselves and failure to implement consistent, thorough research measures that can be used in microsimulations to model long-term impact. In this article, we describe the process of developing a generic, adaptive protocol resource to address this issue and the challenges involved in that process. The resource is designed for use in high-income countries (HIC) but draws on examples from a UK context to illustrate means of development and deployment. The resource is capable of further adaptation for use in low- and middle-income countries (LMIC). It has particular application for trials of Universal Basic Income but can be adapted to those covering other kinds of cash transfer and welfare system changes.MethodsWe outline two types of prospective intervention based on pilots and trials currently under discussion. In developing the remainder of the resource, we establish six key principles, implement a modular approach based on types of measure and their prospective resource intensity, and source (validated where possible) measures and baseline data primarily from routine collection and large, longitudinal cohort studies. Through these measures, we seek to cover all areas of health impact identified in our theoretical model for use in pilot and feasibility studies.ResultsWe find that, in general, self-reported measures alongside routinely collected linked respondent data may provide a feasible means of producing data capable of demonstrating comprehensive health impact. However, we also suggest that, where possible, physiological measures should be included to elucidate underlying biological effects that may not be accurately captured through self-reporting alone and can enable modelling of long-term health outcomes. In addition, accurate self-reported objective income data remains a challenge and requires further development and testing. A process of development and implementation of the resource in pilot and feasibility studies will support assessment of whether or not our proposed health outcome measures are acceptable, feasible and can be used with validity and reliability in the target population.DiscussionWe suggest that while Open Access evaluation instruments are available and usable to measure most constructs of interest, there remain some areas for which further development is necessary. This includes self-reported wellbeing measures that require paid licences but are used in a range of nationally important longitudinal studies instead of Open Access alternatives.

Lessons learned about policymaking: Moving an emergency department-initiated screening protocol to systemwide input in the development and implementation process.

Lessons learned about policymaking: Moving an emergency department-initiated screening protocol to systemwide input in the development and implementation process.

Integrated care systems and equity: prospects and plans

PurposePolicies on integrated care have waxed and waned over time in the English health and care sectors, culminating in the creation of 42 integrated care systems (ICSs) which were confirmed in law in July 2022. One of the four fundamental purposes of ICSs is to tackle health inequalities. This paper reports on the content of the overarching ICS plans in order to explore how they focus on health inequalities and the strategies they intend to employ to make progress. It explores how the integrated approach of ICSs may help to facilitate progress on equity.Design/methodology/approachThe analysis is based on a sample of 23 ICS strategic plans using a framework to extract relevant information on health inequalities.FindingsThe place-based nature of ICSs and the focus on working across traditional health and care boundaries with non-health partners gives the potential for them to tackle not only the inequalities in access to healthcare services, but also to address health behaviours and the wider social determinants of health inequalities. The plans reveal a commitment to addressing all three of these issues, although there is variation in their approach to tackling the wider social determinants of health and inequalities.Originality/valueThis study adds to our knowledge of the strategic importance assigned by the new ICSs to tackling health inequalities and illustrates the ways in which features of integrated care can facilitate progress in an area of prime importance to society.

Corporate Social Responsibility Framework: An Innovative Solution to Social Determinants of Health in the USA.

Expand firms' corporate social responsibility (CSR) framework to systematically address social determinants of health (SDOH) in their communities and improve firms' performance (FP). GAP: The U.S. healthcare systemhas struggled to improve population health outcomes while enhancing delivery performance. An oft-overlooked contributor to this deficit is SDOH inequities, accounting for 25-60% of deaths in the USA annually. Ironically, most healthcare firms do not view investment in SDOH, a neglected phenomenon, to develop sustainable healthy communities as their direct responsibility due to the "wrong pocket problem." Although extant literature theorizes theCSR construct, there is a paucity of research on SDOH integration with the CSR framework. We integrate a quantitative and qualitative study with supplementary literature on CSR and SDOH using the grounded theory method by researching fourteen health plan firms across the USA. Research reveals early efforts undertaken by top-performing healthcare insurers to address SDOH and provides evidence that such measures can be integrated profitably under CSR as a competitive advantage. Contributes to CSR theory and practice by providing an empirical model and expanding its framework to address SDOH systematically. Key implications are as follows: (1) healthcare firms to link with unconventional partners, such as housing authorities, food banks, employment agencies, and schools; (2) the entire healthcare supply chain to collaborate with social enterprises and regulators to develop sustainable communities; (3) policymakers must incentivize firms to align social equity and corporate goals; and (4) long-term view on CSR, SDOH, and healthy living (HL) will in-turn eliminate social inequities while enhancing FP.

Examination of cross-group contact at work and school in relation to acute and retrospective discrimination experiences and drinking to cope for Black and White young adult drinkers.

Black drinkers experience more alcohol problems compared to White drinkers at comparable levels of alcohol use (Mulia et al., 2009; Witbrodt et al., 2014; Zapolski et al., 2014). Research has found that Black compared to White drinkers endorse drinking to cope more frequently via retrospective report (Bradizza et al., 1999; Cooper et al., 2008). Additional research is needed to understand contributors to these racial differences. The primary aim of the present study was to examine how quality and frequency of cross-group contact at work and/or school relates to experiencing discrimination and, in turn, drinking to cope. Seventy-two young adult drinkers (Mage = 25, 72% female, 28% male; 64% Black, 36% White) completed baseline questionnaires and a subset (n = 50) completed a 17-day ecological momentary assessment (EMA) protocol. Cross-group contact frequency and quality was assessed at baseline while discrimination and coping motives were assessed via retrospective report at baseline and acutely via EMA. Accounting for sociodemographic covariates, path analyses utilizing retrospective measures revealed a significant indirect pathway from race to coping motives through quality of work/school cross-group contact and discrimination experiences related to assumptions of inferiority. Identical path analyses utilizing the acute EMA data revealed a significant indirect pathway from race to coping motives through quality of work/school cross-group contact. Improving cross-group contact at work and school may reduce drinking to cope. Additional research examining multiple domains of discrimination, quality of cross-group contact, and alcohol problems over time is needed to further understanding of social determinants of health inequities in alcohol problems. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Public understanding and awareness of and response to monkeypox virus outbreak: A cross-sectional survey of the most affected communities in the United Kingdom during the 2022 public health emergency.

Our objective was to examine the public response to public health and media messaging during the human monkeypox virus (MPXV) outbreak in the UK, focusing on at-risk communities. A co-produced, cross-sectional survey was administered in June and July 2022 using community social media channels and the Grindr dating app. Basic descriptive statistics, logistic regression, and odds ratio p values are presented. Of 1932 survey respondents, 1750 identified as men, 88 as women, and 64 as gender non-conforming. Sexual identity was described as gay/lesbian/queer (80%), bisexual (12%), heterosexual (4%), and pansexual (2%); 39% were aged <40 years; 71% self-identified as White, 3% as Black, 8% as Asian, 2%as LatinX, and 11% as 'Mixed or Other' heritage groups. In total, 85% were employed and 79% had completed higher education. A total of 7% of respondents identified themselves as living with HIV. Overall, 34% reported limited understanding of public health information, 52% considered themselves at risk, 61% agreed that people with MPXV should isolate for 21 days, 49% reported they would first attend a sexual health clinic if symptomatic, 86% reported they would accept a vaccine, and 59% believed that MPXV originated from animals. The most trusted sources of information were healthcare professionals (37%), official health agencies (29%), and mainstream media (12%). Vaccine acceptability was very high, yet the understanding and acceptance of public health information varied. Social determinants of health inequalities already shaping the UK landscape risk were compounded in this new emergency. Engagement with structurally disadvantaged members of affected communities and better dissemination of public health messaging by trusted healthcare professionals are essential for the public health response.

Social determinants of health inequity in Iran: a narrative review.

COVID-19 burden the health system by influencing several aspects of social determinants of health (SDH). We review SDH inequity in Iran with notice on COVID-19 pandemic and sanctions. The Databases such as MEDLINE, Scopus, and Google Scholar were searched. The SDH components were extracted regarding the effect of COVID-19 and sanctions. Global burden of disease was used to evaluate the impact of sanctions on mortality in Iran. The literacy rate improved over the last decades but, there is still inequality between provinces. Age and regional inequity exists, regarding NCD mortality. Food insecurity varies in different regions between 20% and 60%.Providing care for a growing aging population, with a large burden of NCDs and disabilities will be the major issue in the next decade. The decrease slop of mortality rate due to NCDs, have become smoother since impose of sanctions, while, cancer mortality have changed upwards. COVID-19, and sanctions negatively impacts lower socioeconomically vulnerable groups due to preexisting conditions which wider the existing inequity in SDH are adding a heavy burden of inequity in Iran. Iran, similar to large numbers of countries, face inequity at regional level in different SDH related issues. The COVID-19 pandemic showed that economic status and health are aligned. Sanctions superimposed on the COVID-19 pandemic cause harm to millions of innocent people. One of the main goals of health authorities is to reduce SDH inequity in order to achieve the goal of "health for all". To tackle these inequities, prompt action is needed.

Climate change, society, and health inequities.

Climate change, society, and health inequities.

Problematic Child Media Use During the COVID-19 Pandemic.

Assess how family stressors (including structural stressors, social determinants of health inequities, and parent psychological distress) relate to media rule implementation and problematic child media use during the coronavirus disease 2019 pandemic. Nationally representative survey of 1000 United States parents with at least one 6 to 17 year old child was conducted in October through November 2020. Problematic use was greater in families where parents were employed full time, present in the home (eg, working from home), had low levels or formal educational attainment, and were experiencing more psychological distress. Although there was a small decline in the number of media-related rules implemented during the pandemic (fewer parents enforced screen limits on weekdays or weekends or limited screen use at mealtimes), there was no association between rule implementation and problematic media use. Family stressors were associated with problematic child media use during the coronavirus disease 2019 pandemic. As we emerge from the pandemic, it will be important to help parents adjust their family's media practices cognizant of the fact that additional children may have developed problematic screen use behaviors. Such efforts should center the role of structural and social determinants of health inequities on the stressors that families experience and that impact media use.

System resilience and neighbourhood action on social determinants of health inequalities: an English Case Study.

Aims:This article seeks to make the case for a new approach to understanding and nurturing resilience as a foundation for effective place-based co-produced local action on social and health inequalities.Methods:A narrative review of literature on community resilience from a public health perspective was conducted and a new concept of neighbourhood system resilience was developed. This then shaped the development of a practical programme of action research implemented in nine socio-economically disadvantaged neighbourhoods in North West England between 2014 and 2019. This Neighbourhood Resilience Programme (NRP) was evaluated using a mixed-method design comprising: (1) a longitudinal household survey, conducted in each of the Neighbourhoods For Learning (NFLs) and in nine comparator areas in two waves (2015/2016 and 2018/2019) and completed in each phase by approximately 3000 households; (2) reflexive journals kept by the academic team; and (3) semi-structured interviews on perceptions about the impacts of the programme with 41 participants in 2019.Results:A difference-in-difference analysis of household survey data showed a statistically significant increase of 7.5% (95% confidence interval (CI), 1.6 to 13.5) in the percentage of residents reporting that they felt able to influence local decision-making in the NFLs relative to the residents in comparator areas, but no effect attributable to the NRP in other evaluative measures. The analysis of participant interviews identified beneficial impacts of the NRP in five resilience domains: social connectivity, cultural coherence, local decision-making, economic activity, and the local environment.Conclusion:Our findings support the need for a shift away from interventions that seek solely to enhance the resilience of lay communities to interventions that recognise resilience as a whole systems phenomenon. Systemic approaches to resilience can provide the underpinning foundation for effective co-produced local action on social and health inequalities, but they require intensive relational work by all participating system players.