Social Exclusion Research Articles

“Unachievable adulthood?!” – exploring family formation journeys of care leavers in China

ABSTRACT This study examines the family formation journeys of care leavers in China, focusing on how they plan, navigate, and face challenges during this process. Using convenience and snowball sampling, 19 participants (16 care leavers, 3 care stayers) were interviewed. Thematic analysis identified three family pathways: (i) acquaintance-matched, (ii) self-matched, and (iii) marriage “on the way”. The findings reveal ongoing social exclusion and obstacles to family formation, particularly for male care leavers, due to financial pressures, discrimination, and trauma. The study highlights the need for targeted support and social change to improve outcomes for care leavers in China.

'It's designed for someone who is not me': A reflexive thematic analysis of the unmet healthcare support needs in UK autistic adults aged 65 years and over.

Autistic people often face both physical and mental health challenges throughout their lives, which can lead to a higher risk of premature death due to health inequalities. However, we know very little about the healthcare experiences of autistic older adults. In this study, we talked with 19 autistic adults aged 65 years or above living in the United Kingdom. We found these main themes: (1) A lifetime of being misunderstood; (2) Autistic people falling between the gaps; (3) Processing autism diagnosis in later life; (4) Concerns about service pressures and scarce resources; (5) Lack of continuity of care, empathy and understanding; (6) Anxiety, alexithymia and sensory overload; and (7) Reduced social support and concerns for the future. Themes show that autistic older adults face unique healthcare access challenges because services don't consider their lifelong experiences of social exclusion. Participants also worried about age-related decline coupled with reduced social support, which makes it harder for them to get support. To address these challenges, healthcare services should provide more targeted support, make policies and funding consistent, and improve healthcare provision by providing staff training. Importantly, they must also speak with autistic older adults so they can advocate for their current and future care.

How to improve the inclusion of the elderly in the local community for better mental health?

Abstract Issue/problem Social exclusion, ageism and low health/digital literacy intertwine with growing trends in mental disorders, including abuse in Slovenian elderly. To cope with these issues, besides rising competencies, there is a need for stable and continuous partnerships of all relevant stakeholders in the local communities. Description of the problem Despite previous efforts of the Interdisciplinary Working Group (IWG) for mental health promotion in the elderly (established according to the Resolution of the National Mental Health Program, 2018-2028), there was a need for reconsidering approaches in the next Action plan (2024-2028). A national conference on decreasing social exclusion in the elderly contributed as a road map. Results Previous activities (events in the local communities, supported materials) were upgraded with a broad destigmatization campaign, (recruitment of the >>ambassadors <<) and collection of culturally adapted good practices. Better availability of information through >>info-spots << and easier participation of the elderly in cultural events was enabled. Activities of the reinforced IWG were promoted. Lessons Empowerment of key actors and their continuous cooperation could improve information flow, competencies, the inclusion of the elderly in the local community, and decrease ageism and discrimination. Developing local strategies with the crucial involvement of elderly representatives is the opportunity for more intensive and better cooperation between local policy/stakeholders, public health experts, and the target population. Regular financial support will prevent additional inequities. Key messages • The empowered, connected, and proactive community is key to preventing the elderly’s exclusion. • Approaches should be fresh, accessible, and tailored to the heterogeneous population.

The relationship between mental health and employment: a systematic review of cohort studies

Abstract Background Knowledge on the bi-directional association between employment status and mental health is important, as it affects multiple dimensions of our daily lives, both at the individual and societal level. Given that the mental health status and employment situation of individuals are likely to change over time, there is an important need for longitudinal data to better understand causality patterns in this association and the underlying mechanisms. Methods A systematic review was carried out based on the PRISMA guidelines in 3 electronic databases: PubMed, Embase, and PsycInfo. Studies eligible for inclusion were cohort studies, involving the general population, and assessing the relationship between employment status and mental health longitudinally. Results In total, 3,733 studies were identified and 36 met the inclusion criteria. The eleven studies focusing on the social causation hypothesis highlighted the negative long-term impact of unemployment and unstable employment on mental health. Four studies observed mental health improvements upon re-entering employment, although limited and in more specific contexts. The fourteen studies focusing on the health selection hypothesis found a lower probability for individuals with mental health problems in finding and maintaining employment. Finally, the eleven studies assessing the two hypothesis simultaneously found that mental health problems were both a consequence of and risk factor for poor employment status, although some important moderating factors, such as gender differences, influence the direction and strength of the association. Conclusions This review underscores the bi-directional association between the employment status and mental health of individuals, highlighting the need to develop targeted prevention (e.g. mental health support in the workplace) and interventions strategies (e.g. supported employment programs) in both the mental health and labor market systems. Key messages • The bidirectional link between employment and mental health highlights the need for concurrent responses to break the vicious cycle between poor mental health and social exclusion. • To reduce the clinical and social burden of mental health problems, gender differences must be taken into account in mental health and employment support practices and policies.

11.O. Scientific session: Mental Health Among Sexual and Gender Minority Populations in Diverse Structural Stigma Environments

Abstract Research conducted across numerous countries finds that sexual minority (e.g., lesbian, gay, and bisexual [LGB]) and gender minority (e.g., transgender [T]) individuals represent high-risk populations for poor mental health and suicidality. These disparities are believed to be a consequence of a stigmatizing environment and sexual and gender minority individuals’ disproportionate exposure to stigma-based stress compared to cisgender (i.e., non-transgender) heterosexuals. Stigma occurs at multiple levels to compromise LGBT individuals’ health. At the structural level, stigma manifests as unjust laws, policies, and cultural norms that deny, or fail to protect, the equal rights of LGBT individuals. At the interpersonal level, stigma manifests as discrimination in social interactions, social exclusion, and outright victimization. At the individual level, stigma can tax LGBT individuals’ coping resources by requiring costly behavioral strategies such as concealment of one’s LGBT identity. In this workshop, four studies from different regional environment with varying degree of structural stigma will be presented, i.e., the USA, Switzerland, Rwanda, and Kenya. They resent novel findings on the processes and mechanism underlying LGBT populations increased risk of mental health and links between stigma experiences at different levels. Dr. Clark will present a study of how negative news media coverage influence suicidality among LGBT young adults in the USA using intensive longitudinal assessments. Dr. Pfister will present findings from in-depth interviews concerning suicidality with individuals representing a wide variety of sexual and gender minority identities in Switzerland. Dr. van der Star will present a study exploring how structural stigma environments are linked to interpersonal and individuals level stigma experiences in sexual minorities representing different generations of LGBT populations. Dr. Stojanovski will present data from surveys and interviews of LGBT populations in Kenya and Rwanda focusing on experiences of discrimination and mental health. Key messages • Negative media reporting, discrimination, and barriers to health care can influence mental health and suicidality among LGBT individuals. • Identity concealment may represent a mechanism through which sexual minorities navigate structurally stigmatizing climates.

Disparities in Mental Health and the Social Determinants of Health Among Privately Insured Transgender Patients in the United States

Abstract Objectives The purpose of this study was to examine disparities in mental health and the social determinants of health (SDoH) among privately insured transgender and gender minority (TGM) patients in the United States. Methods Data came from FAIR Health, a repository of private health insurance claims data covering over 150 million individuals in the United States. TGM patients (n = 274,479) were identified with medical claims that included a diagnosis for gender dysphoria or gender identity disorder. A random 5% selection of cisgender patients (n = 7,456,823) was used as a comparison group. We estimated descriptive statistics and used multivariable logistic regression models to compare health outcomes between TGM and cisgender patients. Results TGM patients were more likely to have anxiety (odds ratio [OR]=7.02; 95% confidence interval [CI]=6.94-7.09), depression (OR = 9.27; 95% CI = 9.16-9.37), post-traumatic stress disorder (OR = 9.03; 95% CI = 8.86-9.21), and substance use disorder (OR = 2.93; 95% CI = 2.86-3.00) compared to their cisgender peers. TGM patients were also more likely to have problems with education and literacy (OR = 5.95; 95% CI = 5.64-6.28), employment (OR = 3.67; 95% CI = 3.44-3.92), economic circumstances (OR = 5.74; 95% CI = 5.39-6.12), and social exclusion (OR = 7.35; 95% CI = 6.91-7.81). Compared to TGM patients living in states with transphobic policy environments, TGM patients in states with comprehensive protections from discrimination fared better. Conclusions We found wide disparities in mental health and the SDoH among privately insured TGM. More research is critically needed to better understand the health and social needs of TGM populations. Meanwhile, policymakers should consider enacting policies that would prohibit discrimination against TGM people throughout the SDoH -- or the conditions where we live, learn, work, play, and age. Health care providers should also receive education on the unique health needs of TGM patients to advance health equity.

Risk communication with asylum-seekers: Insights from the COVID-19 Pandemic experience in Munich

Abstract Background The COVID-19 pandemic has created a ‘double crisis’ for asylum-seekers, whose lives were already in crisis. Many reports indicated the syndemic consequences on asylum seekers’ health, underscoring the need for their inclusion in risk communication (RC) and community engagement (CE) and infodemic management (IM) actions. This study aims to describe RCCE experience with asylum seekers in Munich during the COVID-19 pandemic from an expert perspective and thus gain a thorough understanding of the requirements for inclusive RCCE. Methods Our qualitative study involved people who conducted COVID-19-related RCCE for asylum-seekers. Volunteers/workers of civil society organizations and health professionals were interviewed using purposeful sampling. After reviewing international guidelines, an interview form was created. The content analysis resulted in themes and categories. Results Four of the interviewees were health managers, while 8 were working in civil society organizations. The first category of the results describes the context in which RCCE occurs; syndemic factors (uncertainty; social exclusion and stigma; precarious housing; limited access to healthcare and unmet mental health needs) and pandemic management. The second category includes determinants of RCCE from both the asylum-seeker (trust; risk perception; health literacy; language; culture and gender) and RCCE member (competences; overburden; continuity) standpoint. The third category focuses on various RCCE-IM measures, including their effectiveness and consequences. Conclusions Syndemic factors hampered the effective implementation of RCCE for asylum seekers in Munich. RCCE determinants show that pre-crisis actions are necessary for an effective response and individual interactions should accompany community-level activities, particularly for female and marginalised migrants. This study’s scope will be expanded by incorporating the IM component.

“I stayed on the street, as if there was no COVID-19”: enacting practices of care with youth at risk of violence and social exclusion in Portugal

As the COVID-19 pandemic unfolded, a world of carelessness was made visible. Public health guidelines against the spread of COVID-19 (e.g., school closures, staying home, social distancing) have substantially affected youth’s health and well-being and highlighted the need for context-specific understandings of infection, risk, and care. Our research aims to contribute to a deeper understanding of the impacts of COVID-19 on boys and girls serving educational measures and placed in the custody of the juvenile justice system in Portugal during the pandemic. Sustained by the use of ethnographic principles and methods along with participatory techniques, this article uncovers complex entanglements between the public health measures to mitigate contagion and the dynamics that exacerbated socio-spatial dynamics of social exclusion and isolation, educational and (mental) health inequities, and lived and practiced forms of violence by youth-serving tutelary measures in Portugal’s six educational centers. Following Tronto’s feminist ethical–political proposal of care, I argue that COVID-19 became a lens to access youth care needs — self-care, care for others, care as essential work of nurturing affective trajectories and solidarities and promoting positive and non-violent relationships. By caring for youth stories, the engagement of researchers and professionals in this action-oriented research aimed to promote the enactment of practices of care with youth in the Portuguese detention centers as a way to positively affect their inhabited present, promote healthier lives and nurture the construction of caring and non-violent post-pandemic futures.

Labor market participation in people with intellectual disability – a follow-up study in Sweden

Abstract Background Work is vital to people’s health and quality of life. The Convention on the Rights of Persons with Disabilities affirms the right to work on an equal basis with others including an opportunity to earn a living by work, but evidence shows that people with intellectual disability (ID) are at greater risk of unemployment and social exclusion. Due to the lack of comprehensive data for longitudinal follow-ups, information on long-term labor market participation (LLMP) in people with ID is scarce. This study aimed to investigate factors of importance for LLMP in individuals with ID in Sweden. Methods The study was based on data from the upper secondary school for pupils with ID between 2001 and 2020 (N = 26,905) and from the longitudinal integrated database for health insurance and labor market studies. A sample of gainfully employed in 2011 (n = 2,719), was followed with respect to LLMP until 2020. Odds ratios (ORs) with 95% confidence intervals (CI) for associations between educational, sociodemographic, and work factors and LLMP (i.e. gainful employment throughout the follow-up), were estimated stratified on sex. Results LLMP was twice as likely in men compared with women, OR 2.06 (1.78-2.58) as was work in the private sector. Factors of significance for LLMP in men and women alike were: completed national education program, OR 3.40 (3.06-3.86) and OR 2.91 (2.40-3.54), parents’ education; compulsory school in mothers’, OR 1.22 (1.06-1.41) and 1.24 (1.00-1.55) and in fathers’ OR 1.35 (1.17-1.56) and 1.49 (1.20-1.85), while municipality of residence was significant only in men, OR 1.30 (1.10-1.56). Conclusions Public health prevention for disadvantaged groups requires accurate and up-to-date knowledge. Using unique register-based data, this is the first study on LLMP in people with ID in Sweden. Knowledge on what social determinants may strengthen LLMP is important since limited LLMP increases the risk of missing out on health benefits that employment may offer. Key messages • There was a significant gender difference in long-term labor market participation in people with intellectual disability in Sweden. • There is a need for increased knowledge on what social determinants may strengthen long-term labor market participation in people with intellectual disability.

Early life social predictors of longitudinal relations between childhood BMI and overeating

Abstract Introduction The progression of obesity is a continuous process involving a complex system of genetic, environmental, and behavioural factors. Socioeconomic disadvantage as well as psychological distress may lead to overeating, subsequently associated with increased energy intake and weight gain. Recent evidence indicated that the association between childhood obesity and overeating might be bidirectional. Therefore, this study aimed to longitudinally investigate the directionality of the association between childhood BMI and overeating and to identify antecedent early childhood predictors. Methods The study sample included 5,777 children from the European Longitudinal Study of Parents and Children (ELSPAC), collected between 18 months and 11 years of child age. The outcomes were child BMI and overeating. Predictors included maternal BMI, maternal education, single-parent households, financial difficulties, and adverse childhood experiences (ACEs). The random intercept cross-lagged panel model (RI-CLPM) was applied. Results The results showed temporal stability in the development of overeating and BMI, with a bidirectional relationship that strengthened over time. The child’s BMI was predicted by maternal BMI (β = 0.37, p < 0.001). The child’s overeating was predicted by maternal BMI (β = 0.13, p < 0.001), but a stronger effect was found for ACEs (β = 0.24, p < 0.001). ACEs mediated the impact of maternal education, financial difficulties, and single parenthood on overeating with indirect effects of β = -0.01 (p = 0.005), β = 0.04, (p < 0.001), and β = 0.07 (p < 0.001), respectively. Conclusions We observed stable bidirectional longitudinal effects, with a stronger association from BMI to overeating. The results suggested two main pathways: one linked to maternal BMI and early childhood BMI increase followed by overeating, and the other associated with ACEs mediating the effect of early childhood socioeconomic factors on overeating, leading to gradual BMI gain. #NGEU Key messages • The study revealed a stable bidirectional association between childhood BMI and overeating, with a stronger association from BMI to overeating. • There are two potential pathways in childhood obesity development, one involving maternal BMI, and the second associated with social disadvantage and ACEs.

How can health practitioners support children and young people in social care?

Abstract Health practitioners are responsible for safeguarding, delivering preventive and responsive care for children and young people in social care settings. However, drivers and determinants that place children in care settings lie outside of the doctor’s office. In fact, primary care health practitioners often deal with children and young people who face or are at risk of severe neglect, abuse or vulnerability outside the care system. Recent findings from the UK’s Millennium cohort study have repeatedly demonstrated that social disadvantage in the early years accounts for more than 2/3 of health inequalities in adolescence. Professor Saxena is a practising GP with 25 years of experience of inner-city primary care and global expert on primary care of children. She will present dilemmas posed in clinical settings for health practitioners and professionals working in a broad range of areas including public health, education settings and social care. What responsibility do health professionals have when they encounter children living in social care settings? What should they be especially alert to? How can they make a difference to reduce health inequality faced by young people growing up in the care system.

EHT and environmental justice at EPA Victoria: Aspirations and regulatory realities

Abstract EPA Victoria (Australia) is a statutory authority that regulates polluting activities and advises other Victorian government departments on relevant policy settings. In 2016, a public health function was installed at EPA Vic to provide emergency health messaging during pollution events, review research evidence of environmental-health relationships and assess industry-contracted health risk assessments of polluting entities. An Environmental Health Tracking Network (EHTN) is under development to support these activities. The EHTN is an agile data and analytical infrastructure for translating expertise across an expanding multidisciplinary network of public health researchers, EPA operational staff and public sector policy makers. Its current interactive dashboards calculate health impacts and associated costs of air pollution scenarios, model land-use influences on land and water contamination and identify coincidences of sociodemographic-, urban environment- and pollution exposure-disadvantage in a high spatial resolution environmental justice (EJ) framework. Regulatory leverage of EHTN intelligence, however, requires legislated EJ thresholds and/or legally tractable costing of industry-externalised human health impacts. Thus, to establish triggers for more stringent conditions on polluting activities and promote equity of interventions and regulations, novel regionally and EJ specific health risk functions are required. Considering these ambitions and challenges, the EHTN at EPA Vic is focussed on 1) identifying and characterising vulnerable populations at high spatial resolution, 2) estimating associated exposure-health effect size modifications using primary epidemiological methods and 3) applying these to health impact and cost assessments of pollution and waste. We seek defensible grounds on which to impose more stringent standards for polluters and redress entrenched social, health and economic disadvantage. Speakers/Panelists Hanna Tolonen THL, Helsinki, Finland

Mindful Transportation: A Conceptual Framework for Enhancing Accessibility for People with Disabilities in Malaysia

This conceptual paper explores the integration of mindfulness principles into the development of transportation services for people with disabilities (PWDs) in Malaysia. Transportation plays a critical role in promoting inclusivity and enhancing the quality of life for PWDs, yet accessibility remains a significant challenge due to infrastructural barriers, lack of awareness, and limited empathy from service providers. Drawing on the concepts of mindfulness, which are rooted in awareness, empathy, and responsiveness, this paper proposes a framework that emphasizes inclusivity, respect, and collaboration among key stakeholders. The proposed framework emphasizes the need for a holistic approach that incorporates physical accessibility, staff training, and policy reforms. Inclusivity involves modifying infrastructure to meet universal design standards, while empathy requires transport providers to understand the unique challenges faced by PWDs and offer compassionate, tailored services. Responsiveness, a key element of mindfulness, calls for flexible and adaptive transport services that cater to the real-time needs of PWDs, ensuring that they can access public transportation with ease and dignity. By applying this mindful approach, the transportation system can become more accommodating and respectful toward PWDs, thereby reducing social exclusion and improving their mobility. This paper contributes to the growing body of literature on disability inclusion and provides actionable strategies for policymakers, transport providers, and disability organizations to work together in creating a more accessible public transportation system. Future research should investigate the practical application of this framework and its potential to drive policy changes that benefit PWDs across Malaysia.

Inequities faced by those with substance use disorder (SUD)

Abstract This presentation delves into the inequities faced by individuals with substance use disorder (SUD), with a particular focus on people who use drugs (PWUD) and people who inject drugs (PWID). Individuals contending with SUD encounter multifaceted barriers that hinder access to appropriate care and support. This presentation will highlight the discourse surrounding biases that exacerbate health disparities among PWUD and PWID. Structural stigma and discriminatory practices not only impede access to healthcare services but also perpetuate social exclusion, amplifying the challenges faced in seeking help and support. PWUD and PWID often require tailored interventions that address not only their substance use but also co-occurring physical and mental health conditions. However, the fragmented nature of healthcare delivery and the lack of integration between substance use treatment and mainstream healthcare services pose significant obstacles to holistic care provision. Drawing on empirical evidence and lived experiences, this presentation explores strategies to dismantle the barriers faced by individuals with SUD in Norway. Ultimately, this presentation aims to foster dialogue that addresses the inequities entrenched in healthcare systems around the world. By advocating for a compassionate and inclusive approach to SUD care, we can strive towards a society where all individuals, regardless of their substance use history, can access the support and resources they need to lead healthy and fulfilling lives.

Health status, healthcare use and prevention in Travellers in Nouvelle Aquitaine, France, 2019-2022

Abstract Background The poor health status of underserved populations is compounded by low vaccination uptake, leading to a greater risk of epidemics. On October 2017, a measles outbreak started in the southwest of France among under-vaccinated social groups, including Travellers. We aimed to describe the health status, healthcare use and child measles-mumps-rubella (MMR) vaccination coverage in Travellers according to their environmental and living conditions. Methods A cross-sectional study with a three-stage random sample design was conducted between October 2019 and March 2022 in the Nouvelle-Aquitaine region in France. Trained social workers administered face-to-face questionnaires to collect data on adults and children. Anthropometric measurements, vaccination records, and data using an environmental exposure questionnaire were also collected. Results The participation rate was high (73.6%), with 1030 adults and 337 children included. Concerning the adults, 36.6% had obesity, 14.4% reported diabetes, 24.7% hypertension, and 14.4% major depression. The prevalence of major depression was significantly higher in adults living in precarious and unauthorized housing than in those with adequate housing (19.8 vs. 14.7%, p = 0.03). The unmet health care needs in the last 12 months was 48.4%. With regard to children, 45.3% had full (i.e., 2-dose) MMR vaccination coverage at 24 months and 17.9% had obesity. Finally, 74.5% of the households experienced housing insecurity, and 22.2% did not have a supply of drinking water. Conclusions Traveller children and adults faced deleterious environmental and living conditions potentially affecting their health, healthcare use, and vaccination coverage. These results demonstrate the need for urgent interventions for underserved populations which take into account their difficult living conditions. Key messages • Travellers have a greater burden of chronic diseases than the general French population and measles-mumps-rubella vaccination coverage among Traveller children is lower than in the general population. • The more precarious the housing, the more likely Travellers are to report having a chronic disease (social exclusion gradient).

Public–private partnerships and human development

Abstract The restructuring of a state is crucial for promoting human development. For this reason, public–private partnerships (PPPs), the so-called “fourth revolution” in reinventing the state, have become a global strategy of choice. Yet, existing studies on PPPs mainly analyze their effect on growth or inequality, not human development. This article uses data from the human development index (HDI) database to investigate the impact of PPP projects on human development. With the increasing scale of public infrastructure investments and the need to improve public services, it is necessary to examine whether PPPs are justified in improving social welfare. We conducted the analysis for all low- and middle-income countries using propensity score matching (PSM) and multivariate analysis. Additionally, we present the HDI predictions. We believe that assessing the impact of public–private cooperation on increasing social welfare, reducing social exclusion, and implementing investments with a robust social impact is essential. Overall, we found a statistically significant effect of PPPs on human development, demonstrating that the growing scale of PPP investments in low- and middle-income countries enhances their HDI.

Assessing Greece’s social vulnerability patterns in times of perma-crisis (2008–2022)

IntroductionThe study aims to map and analyse the development of social vulnerability patterns in Greece through a perma-crisis context (economic crisis, austerity, covid-19, energy, and inflation crisis) over the period 2008-2022.MethodsThe paper rests on the construction of a composite index of four key pillars of social vulnerability (employment, living conditions, health, and education) consisting of 15 selected variables obtained from the official Eurostat datasets and using PCA analysis.ResultsOur findings show that social vulnerability patterns in Greece demonstrate a considerable shift during the stated period where certain social groups (i.e., NEETs and precarious workers) seem to suffer the most. The first pattern (2008-2016) is largely characterized by the intensity and severity of the economic crisis and austerity measures, which contributed to the exacerbation of social vulnerability. The second pattern (2017-2022) presents a gradual decline mainly due to the recovery of the economy and a decrease in unemployment rates featuring a strong tendency to reach the pre-crisis levels in the years to come.DiscussionThe high levels of social vulnerability leading to social exclusion, poverty, and the widening of inequalities, impede the country’s resilience and recovery efforts and undermine social cohesion.

7.O. Skills building seminar: Initiating change: Mainstreaming equity and diversity in public health

Abstract Background Consideration of the increasing population cultural and ethnic diversity and the widening of social gaps is essential for narrowing health inequities. While tailored and targeted measures for populations at risk of social disadvantage are needed, mainstreaming and integration of diversity and inclusion perspectives in all public health measures are required. To our knowledge, the EU Joint Action for Cardiovascular diseases and diabetes (JACARDI) is the first large-scale program to apply a systematic and harmonized approach for integrating equity and diversity perspectives. Objectives The main objective of the workshop is skills building in integration of equity and diversity perspectives in practice through: 1) Introducing the key requirements for achieving EU-wide programme change, drawing from several decades of experience in projects conducted in over 30 countries, including those partnered with the World Health Organization, governments and industry. 2) Outlining a practical tool in the format of an equity and diversity matrix designed for integrating equity and diversity perspectives developed within the JACARDI project to support implementation of 142 sub-projects in 21 partner countries. 3) A practical participatory group work based on the JACARDI equity and diversity maturity matrix, followed by a moderated discussion. The workshop acts as a valuable platform for sharing and building collaborative knowledge across European countries and empowering participants as initiators for sustainable, more equitable, and diversity inclusive public health actions. It provides practical and concrete skills on equity and diversity that participants can apply in their work and disseminate within their organizations. The presentations will build knowledge, while group work and the moderated discussion will build skills among participants on the workshop topic. Format of the workshop Two presentations followed by participatory group work and a moderated discussion among workshop participants and presenters. Key messages • Population diversity should be systematically mainstreamed in public health to effectively and sustainably narrow persisting health inequities. • An equity and diversity maturity matrix can be used as a practical tool for systematic integration and monitoring of diversity perspectives in practice.

Thermal inequality and heat-related adaptive capacity: A systematic review

Abstract Background Extreme heat is an important public health concern. Heat stress exposure and related adaptive capacity are not equally distributed across social groups, generating thermal inequality. We implemented a systematic review to answer the question: In the general population, what is the effect of social disadvantage on exposure to subjective and objective heat stress and adaptive capacity to prevent/reduce exposure to heat stress? Methods We searched for peer-reviewed journal articles published between 2005 and 2024. Screening and data extraction were conducted by one reviewer, with a second screening and extracting 10% for comparison. Synthesis included identification and description of specific social groups unequally exposed to heat stress and with lower adaptive capacity as well as a narrative description of the evidence and identification of research gaps. Results We identified 114 relevant publications. 53% included evidence on objective heat stress, 19% subjective heat stress, and 58% adaptive capacity. Nearly half came from North America (47%), 24% from Asia, and 17% from Europe. Publishing increased over time, from 0 articles in 2005 to 20 articles in 2023. Most studies considered socioeconomic status (SES) (87%), while fewer focused on race/ethnicity or other social factors. Across global regions, lower-SES populations, immigrants, and racial/ethnic minorities are generally more exposed to heat stress and have lower adaptive capacity, and lower-SES and minority neighborhoods are generally hotter and less green. Most studies of objective heat stress use imprecise measures, such as land surface temperature, which are not representative of experienced temperatures. Conclusions This review summarizes the available evidence on inequalities in heat stress exposure and adaptive capacity for the first time and identifies important research gaps related to heat stress measurement and social factors beyond SES. Key messages • Heat stress exposure and related adaptive capacity are not equally distributed across social groups, generating thermal inequality. • Social inequalities must be considered during climate change adaptation planning.

An ecological perspective of psychological distress predictors among minoritized populations facing a collective crisis: the case of Arab-Palestinians during the COVID-19 pandemic in Israel

ABSTRACT The study examined predictors of psychological distress among Arab-Palestinians in Israel during COVID-19 from an ecological perspective. Participants (n = 665) completed questionnaires assessing their sense of danger, resource loss, social support, barriers to accessing formal support, social exclusion and ethnic discrimination, and depression, anxiety, and somatization. Our structural equation model accounted for 68% of the psychological distress variance. Individual, interpersonal, community, and socio-political variables were significantly interrelated, and associated with psychological distress. The socio-political context of Arab-Palestinians highlighted specific challenges and resilience factors. Results underscore the necessity of a holistic approach and context-sensitive policies to address psychological distress among minoritized populations.