Whitehead Model Research Articles

Exploring men's health in medium and high complexity care in Brazil: A deductive thematic analysis of social determinants.

Men's health is influenced by a complex interplay of social, economic, and cultural determinants. Understanding how these aspects affect the health of adult cisgender men in medium and high-complexity healthcare settings is essential for improving healthcare services and promoting better health outcomes. This study aimed to analyze the health status of adult cisgender men in medium and high-complexity healthcare settings based on social determinants and conditioners. This study employed a qualitative design involving 45 adult cisgender men receiving care in medium/high complexity services in Bahia, Brazil. Semi-structured interviews were conducted from July 2019 to February 2020, and data were interpreted based on Dahlgren and Whitehead's Model of Social Determinants of Health using deductive thematic analysis. Proximal determinants included biological aspects, preventive behaviors, lifestyle/social life, and aging processes. Intermediate factors included work conditions, access/utilization of healthcare services/medications, and psychosocial factors. Macro determinants involved income distribution, power dynamics, resource allocation, health inequalities/iniquities, morbidity, culture, political decisions, environmental factors, and structural elements. The health status of men in medium/high complexity care was profoundly influenced by structural social determinants. These determinants impacted healthcare attention, service organization, cultural influences, the reproduction of hegemonic masculinity patterns, lifestyle, social support, and socioeconomic conditions necessary to realize the right to health. Nursing practices should conduct comprehensive assessments that extend beyond physical health indicators.

How Can We Address What We Do Not Measure? A Systematic Scoping Review of the Measurement and Operationalization of Social Determinants of Health Research on Long-Acting Reversible Contraceptive among Adolescents in the US.

Teen pregnancy is often considered an adverse health outcome that accentuates gender inequities, diminishes opportunities, and jeopardizes the safety of adolescent and young adult birthing people. Long-Acting Reversible Contraceptives (LARC) have been hailed as a panacea for teen pregnancy. However, adolescents and emerging adults intersect with multiple assaults on their health and well-being due to gender inequity and racism. To establish equitable care, it is imperative to discern all barriers that influence their reproductive autonomy. This study evaluates the measurement, operationalization, and quality of research conducted on adolescents and emerging adults that analyzed the use of LARC within the social determinant of health framework (SDOH) in the US. SDOH were assessed using the Dahlgren and Whitehead model, and reports were analyzed using a modified version of the Joanna Briggs Institute (JBI) Critical Appraisal tools. Nineteen articles were included in this study. Researchers found the insufficient measurement of race, ethnicity, sexuality, and gender among studies on LARC and SDOH in adolescents and emerging adults. Future studies must measure a full range of identities in data collection to generate knowledge on the impact of SDOH and LARC use among diverse populations.

Factors affecting the mental health status of children from multicultural families in South Korea: a cross-sectional descriptive analysis of data from the multicultural adolescents panel study.

This study aimed to identify factors affecting the mental health status of children from multicultural families in South Korea. This study was based on Dahlgren and Whitehead's (1991) rainbow model as a conceptual framework and used data from the second phase of the multicultural adolescents panel study conducted by the National Youth Policy Institute. Multiple logistic regression analysis was performed using SPSS version 26.0, with p<.05 considered to indicate statistical significance. In the final model, stress (odds ratio [OR]=0.53, p<.001), life satisfaction (OR=2.09, p=.004), self-esteem (OR=1.73, p=.032), and peer support (OR=1.46, p=.019) affected the mental health status of children from multicultural families. The living and working conditions and general socioeconomic, cultural, and environmental conditions did not significantly influence the mental health status of children from multicultural families in the final model. As components of Dahlgren and Whitehead's model, individual hereditary and lifestyle factors, as well as social and community networks, affected the mental health status of children from multicultural families. Therefore, in order to improve the mental health of children from multicultural families, efforts are needed to alleviate their stress, increase life satisfaction and self-esteem, and strengthen their social support.

3.P. Round table: The Commercial Determinants of Health: Industry tactics shaping science, policy and our environment

Abstract Prevailing narratives on health and illness emphasise individual choice and product ‘misuse’ for the disease and environmental burdens associated with harmful industries, deflecting from the wider environment in which these choices are made. Public Health frameworks such as the Dahlgren and Whitehead model enable us to consider the broader socio-economic, cultural and environmental conditions that influence these choices (or lack thereof). Until recently, the influence of multinational corporations on these broader conditions has often been ignored, despite the global impact these corporations have in shaping science, policy and our environment. Increasingly Public Health academics and advocates are calling for an enhanced focus on these ‘commercial determinants of health’ (CDoH) to understand the ways through which corporate interests affect health, sustainability, and health inequities. The concept of CDoH considers (among other things) the harmful or damaging nature of certain products and the tactics employed by industries to protect their commercial interests. The harmful tactics employed by the tobacco industry are well documented, but there is growing evidence that similar tactics are employed by other harmful industries more generally, from alcohol, gambling and food, to agrichemical and fossil fuel industries. In addition to driving consumption (with resulting population and planetary ill health), these tactics have a cross-industry, complementary, cumulative effect; spreading misinformation, shaping ‘personal responsibility’ and ‘nanny state’ narratives, weakening regulation and undermining science and policymaking. The impact of these harms accumulates across the life-course, with differential exposure to both harmful products and tactics driving health inequities. We argue there is a need to make visible, or ‘resurface’ these tactics; at present, Public Health often fails to challenge corporate strategies and, more concerningly, can be complicit in reinforcing industry framings of issues. This session will outline how a life-course, complex systems approach can support this endeavour, exploring a range of industry strategies through a series of case studies and discussing actions needed to safeguard public understanding and policy from commercial interests. This workshop will include 3 short presentations to illuminate some of the more insidious and less overt tactics, with opportunities for questions and panel discussion. The CDoH is an emerging field in Public Health and this session will give audience members an introduction to industry strategies and influences within a life-course framework, focusing on less overt channels of influence and some of the lesser-known industries. Key messages • The commercial determinants of health present a significant threat to public and planetary health but are conspicuously absent in the majority of public health conceptual frameworks. • Framing these hidden harms and exposures within the life-course model can support awareness of CDoH and facilitate public health professionals to counter corporate influences. Speakers/Panellists Claire Mulrenan LSHTM, London, UK May Van Schalkwyk LSHTM, London, UK Nason Maani LSHTM, London, UK

The digital rainbow: Digital determinants of health inequities.

The widely used socioecological rainbow model from Dahlgren and Whitehead specifies determinants of health inequity on multiple hierarchical levels and suggests that these determinants may interact both within and between levels. At the time of its inception, digital determinants only played a minor role in tackling inequities in public health and were therefore not specifically considered. This has dramatically changed: From today's perspective, health inequities increasingly depend on digital determinants. In this article, we suggest adapting the Dahlgren-Whitehead model to reflect these developments. We propose a model that allows formulating testable hypotheses, interpreting research findings, and developing policy implications against the background of the global spread of digital technologies. This may facilitate the development of a new line of research and logic models for public health interventions in the digital age. Using the COVID-19 pandemic as a case study, we illustrate how the digitization of all aspects of life affects the different levels of determinants of health inequities in the Dahlgren–Whitehead model. In doing so, we deliberately argue for not introducing a separate digital sphere in its own right, but for understanding digitization as a phenomenon that permeates all levels of determinants of health inequities. As a result, we present a digital rainbow model that integrates Dahlgren and Whitehead's 1991 model with digital environments to identify current health promotion and research issues without changing the rainbow model's initial structure.

The role of social determinants on unhealthy eating habits in an urban area in Mexico: A qualitative study in low-income mothers with a young child at home

Overweight and obesity are a severe public health problem in Mexico. National policies to fight unhealthy eating have been implemented but they don't target social and family environment determinants. Our study aimed to gain a deeper understanding of the determinants of unhealthy eating by exploring the perspectives and experiences of low-income Mexican women with a young child at home. We conducted a purposeful sampling to include participating kindergartens in Morelos, México. Women with a child enrolled in the kindergarten were invited to focus group discussions. Afterward, women with specific profiles were invited to in-depth interviews. During analysis we applied Dahlgren and Whitehead's model of social determinants of health (SDH). Overall, we found that participants have unhealthy habits, for example: low variability in consumption patterns, regular sugar-sweetened beverages intake and insufficient fruit and vegetable intake. By low variability we mean frequently consumed products (on most days of the week) limited to a restricted food set. As for the determinants of unhealthy habits, we found at the community level that families encourage unhealthy eating. At the household and work level, tight schedules for food preparation determine unhealthy eating. And, at a socio-economic level, lack of access and money constraints shape unhealthy habits. Unhealthy habits are determined by factors on multiple levels and using an SDH approach can be an effective way to inform comprehensive strategies targeting the overweight and obesity epidemic in Mexico and other low- and middle-income countries.

Effects of the coronavirus disease 2019 pandemic and the policy response on childhood obesity risk factors: Gender and sex differences and recommendations for research

SummaryChildhood obesity is a public health concern globally, with generally higher prevalence rates in boys compared to girls. Although biological sex is an important determinant, gender roles and norms influence the exposure and vulnerability to risk factors for noncommunicable diseases. Norms and roles might be reinforced or change due to coronavirus disease 2019 (COVID‐19) related measures as well as the exposure to risk factors for childhood obesity. COVID‐19 related changes, such as home confinement, influence a child's risk of obesity. Using Dahlgren and Whitehead's model of the main determinants of health, this paper aims to provide a roadmap for future research on sex, gender, and childhood obesity during the time of COVID‐19. It examines how COVID‐19 has led to important changes in children's general socioeconomic, cultural, and environmental conditions, social and community networks, and individual lifestyle factors and how these may affect a child's risk for obesity. It focuses on the influence of gender and sex and outlines key considerations and indicators to examine in future studies concerned with promoting health and gender equity and equality. We need to understand the differential impact of COVID‐19 related measures on girls' and boys' risk for obesity to adequately react with preventive measures, policies, and programs.

Suicide in the elderly: approach to social determinants of health in the Dahlgren and Whitehead model.

Identify in literature the social determinants of health related to suicide in the elderly, according to the model proposed by Dahlgren and Whitehead. Integrative review of articles indexed in the databases BDENF, CINAHL, LILACS, and MEDLINE, with the following main descriptors: aged, suicide, social determinants of health, and risk factors. Primary studies were included which addressed social determinants of health and suicide in the elderly. From the 19 articles analyzed, three categories emerged: proximal social determinants of health (male gender, mental disorders, physical illnesses, white race, 70-74 years old); intermediate social determinants of health (substance abuse, use of alcohol or psychotropic drugs, marital status, marital, social, and family problems, violence, previous suicide attempt, history of admission to psychiatric service); and distal social determinants of health (schooling, economic issues, sanitation, stressful events). Proximal determinants have more effects on suicide. Intermediate determinants are composed mainly of changeable factors. Distal determinants showed lesser associations.

What causes the burden of stroke in Scotland? A comparative risk assessment approach linking the Scottish Health Survey to administrative health data.

BackgroundThe availability of robust evidence to inform effective public health decision making is becoming increasingly important, particularly in a time of competing health demands and limited resources. Comparative Risk Assessments (CRA) are useful in this regard as they quantify the contribution of modifiable exposures to the disease burden in a population. The aim of this study is to assess the contribution of a range of modifiable exposures to the burden of disease due to stroke, an important public health problem in Scotland.MethodsWe used individual-level response data from eight waves (1995–2012) of the Scottish Health Survey linked to acute hospital discharge records from the Scottish Morbidity Record 01 (SMR01) and cause of death records from the death register. Stroke was defined using the International Classification of Disease (ICD) 9 codes 430–431, 433–4 and 436; and the ICD10 codes I60-61 and I63-64 and stroke incidence was defined as a composite of an individual’s first hospitalisation or death from stroke. A literature review identified exposures causally linked to stroke. Exposures were mapped to the layers of the Dahlgren & Whitehead model of the determinants of health and Population Attributable Fractions were calculated for each exposure deemed a significant causal risk of stroke from a Cox Proportional Hazards Regression model. Population Attributable Fractions were not summed as they may add to more than 100% due to the possibility of a person being exposed to more than one exposure simultaneously.ResultsOverall, the results suggest that socioeconomic factors explain the largest proportion of incident stroke hospitalisations and deaths, after adjustment for confounding. After DAG adjustment, low education explained 38.8% (95% Confidence Interval 26.0% to 49.4%, area deprivation (as measured by the Scottish Index of Multiple Deprivation) 34.9% (95% CI 26.4 to 42.4%), occupational social class differences 30.3% (95% CI 19.4% to 39.8%), high systolic blood pressure 29.6% (95% CI 20.6% to 37.6%), smoking 25.6% (95% CI 17.9% to 32.6%) and area deprivation (as measured by the Carstairs area deprivation Index) 23.5% (95% CI 14.4% to 31.7%), of incident strokes in Scotland after adjustment.ConclusionThis study provides evidence for prioritising interventions that tackle socioeconomic inequalities as a means of achieving the greatest reduction in avoidable strokes in Scotland. Future work to disentangle the proportion of the effect of deprivation transmitted through intermediate mediators on the pathway between socioeconomic inequalities and stroke may offer additional opportunities to reduce the incidence of stroke in Scotland.

Quantifying the fatal and non-fatal burden of Stroke and its modifiable determinants using routine Scottish healthcare datasets

ABSTRACT&#x0D; ObjectivesThe gap between a population’s actual and ideal health can be quantified by Disability-Adjusted Life Years (DALY). This metric combines the Years Lived with Disability (YLD) and Years of Life Lost (YLL). When supplemented by a Comparative Risk Assessment (CRA) it can depict the magnitude of disease burden and the effect that modifiable exposures contribute. We aim to utilise routine healthcare records to quantify the burden and potential reduction in DALY caused by stroke.&#x0D; ApproachHospital stays involving a stroke diagnosis (ICD-9: 430-431, 433-34, 436; ICD-10: I60-61, I63-64) were identified through secondary care primary diagnoses from 1981-2013 and used to derive the incidence of acute stroke and the point-prevalence of chronic stroke. Disability weights for each health state of stroke sequelae were sourced from the Global Burden of Disease 2013 study and used to derive YLD. YLL for each death was calculated using Scotland-specific life tables for deaths where stroke was the underlying cause.&#x0D; Eight waves of the Scottish Health Survey (SHES) from 1995-2012 were linked to secondary care and mortality records. Risk factors were identified from SHES then mapped to levels in the Dahlgren and Whitehead model and Population Attributable Fractions (PAFs) were calculated for each risk factor that was a significant casual risk of stroke from a Cox-proportional hazard regression model.&#x0D; ResultsStroke was responsible for 47,836 DALY in Scotland during 2013 which was a reduction of 33.3% from 2000. The proportion of YLD contributing to DALY was 7.6% in 2000 rising to 14.4% in 2013. The main reasons for the changing profile of DALY are due to the large reduction in mortality and influence of the rising prevalence of chronic stroke. Stroke mortality reduced 34.3% during the period 2000-2013 from 7,013 deaths in 2000 to 4,610 in 2013, whilst chronic prevalence increased from 46,184 in 2000 to 59,367 in 2013.&#x0D; Between 23.5 to 38.8% of excess first stroke incidence can be explained by education, social class and area deprivation, which were all significant predictors of stroke after adjusting for confounding. Altering the exposure distribution for each independent risk factor to its theoretical minimum risk exposure level could potentially reduce the DALY by between 9,615 to 15,882 in 2013.&#x0D; ConclusionThis study highlights the benefit of using linked administrative health records to quantify the burden of stroke on the population and how public health interventions to tackle inequalities would be a method of reducing strokes in Scotland.

Eco-social and behavioural determinants of diarrhoea in under-five children of Nepal: a framework analysis of the existing literature.

BackgroundWhile diarrhoea is the second major killer among the under-five children in the world with an estimation of 760,000 deaths annually, it stands as a major killer in Nepal with an annual incidence of 500 per 1000 under-five children with diarrhoea. Diarrhoea is responsible for a wide range of morbidity and mortality among children in Nepal. The objective of this review work is to identify the eco-social and behavioural determinants of diarrhoea among the under-five children of Nepal.MethodsA literature review was conducted using the Dahlgren and Whitehead model (1991) between June and October 2015. PubMed, Nepal Journals online and Google Scholar were used to search for literature published between 1989 and July 2015 using defined keywords.ResultsChildren of age group 6–23 months are at higher risk, as supplementary diets are introduced to the children from the age of 6 months. Male children have better access to healthcare services. Malnourished children also have a higher chance of developing persistent diarrhoea. Provision of safe water and sanitation has direct link with the prevention and control of diarrhoea. Male gender with high income positively influences the treatment-seeking behaviour. Mother’s education and hand-washing practice have direct influence in child health. Hand-washing practices with soap which are protective are influenced by the cultural beliefs. Involvement of community health volunteers increases the access to the health system, thereby reducing the diarrhoeal burden in the community.ConclusionAge, gender, hand-washing behaviour, nutritional status of children, education of mothers, water and sanitation, healthcare services, cultural and societal values and income of the household were identified determinants for diarrhoea in under-five children of Nepal.

Determinantes sociais da saúde do idoso

A saúde é afetada ao longo da vida pelas características do contexto social, que geram desigualdades nas exposições e vulnerabilidades. Esses determinantes sociais interferem no bem-estar, independência funcional e qualidade de vida dos idosos, mas geralmente são desconsiderados nas intervenções e políticas. Diante disso, objetivou-se sistematizar os conhecimentos acerca dos determinantes sociais da saúde do idoso, adotando-se como marco conceitual o modelo de Dahlgren e Whitehead. No nível estrutural, abordaram-se os efeitos das mudanças demográficas no processo de envelhecimento e perfil de morbidade; no nível intermediário, as condições de vida e trabalho com impacto na saúde atual e futura e o papel da coesão social; no nível proximal, os comportamentos e estilos de vida de maior risco. Evidenciou-se que a equidade em saúde requer ação sobre os determinantes sociais no curso da vida para minimizar as doenças crônicas e deficiências do idoso que refletem as suas posições sociais no passado.

Tackling health inequalities in Norway: applying linear and non-linear models in the policy-making process

This article follows the Norwegian policy-making process on social inequalities in health applying models for policy development with focus on linear and non-linear movements. The focus is process-oriented following the introduction of a comprehensive, cross-sectoral strategy to tackle socioeconomic health inequalities in Norway. A case study design was selected and two theoretical frameworks have guided the research. Whitehead's model for health inequality intervention (2007) follows a linear theory-based logic, underpinning the idea that implicit or explicit theories or formulation of a distinct problem causally predicts design and outcome of policy programmes. The second approach is based on Kingdon's (2003) perception that policy-making often occurs unpredictably within independent streams of the policy formulation process. The model focuses on the non-linearity of the flow and timing of policy action. The present case suggests that both linear and non-linear models are necessary for understanding of the Norwegian policy-making process on social inequalities in health. Whitehead's model is a conceptual model focussing on the linear structure of the policy process, useful for identifying the different entry points for choice of direction in policy-making. Kingdon's multiple streams model is useful for gaining insight into the agenda-setting process that may be predictable, but may also be unpredictable and steer non-linear movements. The model identifies components necessary for a problem to rise on the political agenda with a particular focus on the role of policy entrepreneurs.

Antipredator behaviour of hatchling snakes: effects of incubation temperature and simulated predators

All animals that are exposed to predators must distinguish dangerous from nondangerous threats and respond correctly. In reptiles, emerging hatchlings are vulnerable to a wide range of predators, particularly if they emerge during daylight. In these experiments I tested the response of pine snake,Pituophis melanoleucus, hatchlings incubated at 22–23, 27–28, or 32–33°C to visual and vibratory stimuli to examine antipredator behaviour. Emerging hatchlings were exposed to one of five conditions: (1) hawk model, (2) white head model with no facial features, (3) white head model with black eyes, (4) a person, or (5) a vibration without a visual stimulus. I tested the null hypotheses of no differences in response as a function of predator type or incubation temperature. Emergence behaviour when undisturbed was affected by incubating temperature, and antipredatory behaviour was affected by both predator type and incubation temperature. Pine snake hatchlings responded more protectively (withdrawal into tunnels) than defensively (striking), responded with less intensity to a vibration compared with visual predator stimuli, and required longer to respond to a head model without eyes than to all other predator types. Given the relatively small size of hatchlings, it is adaptive for them to withdraw into the nest rather than attack a predator. Hatchlings from eggs that were incubated at medium temperatures required less time to emerge from their underground nests when undisturbed, and had stronger protective responses than snakes incubated at other temperatures. These results suggest that hatchlings incubated at medium temperatures are generally less vulnerable to predators than hatchlings incubated at higher or lower temperatures.