Search

What are the leadership development needs of so-called 'Global South' humanitarian professionals? The humanitarian professionalisation agenda begun in the 1990s has evolved to include short courses and accredited programmes specifically aiming to build leadership skills. This paper explores how humanitarian professionals from the Global South understand the current context of leadership development, including its barriers of access, and potential for change to be more relevant to their lives and work. Using thematic analysis of eleven key informant interviews, the paper finds three levels of consideration: global politics and inequality, personal and professional enrichment, and practical support. The findings suggest that while humanitarian leadership training can be better tailored and made available to Global South leaders at all career stages, there is a wider, more crucial need to address systemic imbalances. This paper contributes to wider discussion on localisation and inequality in the humanitarian aid sector, and more specifically contributes to the literature on how systemic factors shape the limits of both professionalisation and expansion of humanitarian education initiatives. [ABSTRACT FROM AUTHOR]

The World Health Organization has designated vaccine hesitancy and vaccine confidence among the most pressing issues in global health. The COVID-19 pandemic has made vaccine hesitancy and vaccine confidence particularly salient and urgent. The purpose of this special issue is to highlight a broad range of perspectives on these critical issues. We have included a total of 30 papers that address issues related to vaccine hesitancy and vaccine confidence across multiple levels of the Socio-Ecological Model. We have organized the empirical papers into the following sections: individual-level beliefs, minority health and health disparities, social media and conspiracy beliefs, and interventions. In addition to the empirical papers, three commentaries are included in this special issue. [ABSTRACT FROM AUTHOR]

Interdisciplinary study in neurobiology, liberation psychology, and social work highlight the ways in which the brain is related to various cognitive, personality, and behavioral characteristics within a cultural context by blurring lines between dimensions, such as nature and nurture, person and environment, and micro and macro. This paper considers study findings that generate potential clinical social work strategies that are particularly relevant for communities of color experiencing ethno-racial trauma. The purpose of this paper is to support clinical practitioners' efforts to use holistic approaches and practices by incorporating the "bio" component of the biopsychosocial paradigm as it relates to racism. There are at least three pathways by which racism may produce neurobiological consequences that affect the biopsychosocial functioning of populations of color: (a) socio-structural/environmental, (b) stress and/or trauma, and (c) epigenetics. The Flint, Michigan water crisis—wherein the local government allowed lead to contaminate the city's drinking water causing negative health (brain and body) consequences for Flint residents, a predominantly Black and Brown community—presents an example of the intersecting pathways and autopoietic nature of racism that infects relationships, institutions and systems; causes dehumanizing affects; and produces ill effects as evidenced by racial health inequities. The issues, such as racial health inequities, that social workers struggle to resolve tend to be complex and multi-dimensional. Therefore, comprehensive practice is needed to support healthy biopsychosocial functioning. As such, this paper offers Critical Clinical Social Work Practice (CCSWP) informed by the Critical Transformative Potential Development (CTPD) framework. CTPD centers a trauma-informed and healing-centered approach to CCSWP by transforming consciousness into action to change self, relationships, and environment; ideally, working cyclically from the molecular to the macro. Given the field's enduring commitment to social justice, the biopsychosocial model, and the person-in-environment perspective, social work is in a unique position to critically consider how brain health (bio) is affected by trauma (psycho) stemming from racism (social). These multi-level (molecular to macro) considerations empower clinical social workers to innovate integrated strategies that can overcome complex challenges perpetuating racial health inequities. [ABSTRACT FROM AUTHOR]

Purpose: During the COVID-19 pandemic, the NZ COVID Tracer App (NZCTA) was released as a digital intervention to support contact tracing processes in Aotearoa New Zealand. This paper examines whether NZCTA met the data governance requirements of the Indigenous Māori people. Māori are an interesting case study as they have unique Treaty and data sovereignty rights, and a higher risk of COVID-related mortality. Methods: The NZCTA was assessed against 24 criteria drawn from the Māori Data Governance Model. The assessment drew on documentary sources and the authors' knowledge of NZCTA and contact tracing process. Each criteria was assessed as 'met', 'partially met' or 'not met'. Results: Our retrospective assessment showed a mixed performance against the Māori Data Governance Model, with NZCTA only fulfilling seven of the 24 model criteria and failing to meet nine. Conclusion: There is significant room for improvement in future digital health interventions for Māori. Much work remains to be done in the Aotearoa public sector to uphold Māori data sovereignty and address systemic barriers to genuine partnership with Māori. [ABSTRACT FROM AUTHOR]

Machine learning is frequently being leveraged to tackle problems in the health sector including utilization for clinical decision-support. Its use has historically been focused on single modal data. Attempts to improve prediction and mimic the multimodal nature of clinical expert decision-making has been met in the biomedical field of machine learning by fusing disparate data. This review was conducted to summarize the current studies in this field and identify topics ripe for future research. We conducted this review in accordance with the PRISMA extension for Scoping Reviews to characterize multi-modal data fusion in health. Search strings were established and used in databases: PubMed, Google Scholar, and IEEEXplore from 2011 to 2021. A final set of 128 articles were included in the analysis. The most common health areas utilizing multi-modal methods were neurology and oncology. Early fusion was the most common data merging strategy. Notably, there was an improvement in predictive performance when using data fusion. Lacking from the papers were clear clinical deployment strategies, FDA-approval, and analysis of how using multimodal approaches from diverse sub-populations may improve biases and healthcare disparities. These findings provide a summary on multimodal data fusion as applied to health diagnosis/prognosis problems. Few papers compared the outputs of a multimodal approach with a unimodal prediction. However, those that did achieved an average increase of 6.4% in predictive accuracy. Multi-modal machine learning, while more robust in its estimations over unimodal methods, has drawbacks in its scalability and the time-consuming nature of information concatenation. [ABSTRACT FROM AUTHOR]

The growing prevalence of cardiovascular diseases in the United States (US) has disproportionately affected minority populations more than their white counterparts. A population that is often overlooked is the Asian American population, particularly Southeastern Asian immigrants. Despite having relatively favorable socioeconomic indicators compared to the general US population, Asian Americans, specifically Southeast Asian individuals, face a significant burden of traditional cardiovascular risk factors and are considered a high cardiovascular disease risk group. In addition, most studies have aggregated Asian populations into one major racial group rather than analyzing the different ethnicities among the Asian categorization. While some studies suggest that the acculturation process has some degree of impact on cardiovascular health, there has not been a widely-used tool to measure or ascertain the totality of acculturation. Instead, multiple proxies have been used to measure acculturation, and prior studies have argued for more culturally-tailored acculturation proxies. This paper aims to assess the implications of different acculturation measures on cardiovascular health among Asian Americans, particularly Southeastern Asian immigrants. The following proxies were expanded on in this paper: English spoken at home, length of stay in the US, religiosity and spirituality, and admixed family structures. Previous studies showed that as the length of stay in the US increases, the burden of cardiovascular risk factors increases. However, the impact of English spoken at home, religiosity, and admixed family structure are still inconclusive given the extent of current studies. While most studies suggest that an increase in acculturation increases the risk of cardiovascular disease, it is critical to note that acculturation is a multifaceted process. Therefore, more studies are necessary to appropriately examine the implications of various acculturation processes on cardiovascular risk factors in Asians, specifically Southeastern Asian individuals in the US. [ABSTRACT FROM AUTHOR]

Purpose: An intersectionality framework has been increasingly incorporated into quantitative study of health inequity, to incorporate social power in meaningful ways. Researchers have identified "person-centered" methods that cluster within-individual characteristics as appropriate to intersectionality. We aimed to review their use and match with theory. Methods: We conducted a multidisciplinary systematic review of English-language quantitative studies wherein authors explicitly stated an intersectional approach, and used clustering methods. We extracted study characteristics and applications of intersectionality. Results: 782 studies with quantitative applications of intersectionality were identified, of which 16 were eligible: eight using latent class analysis, two latent profile analysis, and six clustering methods. Papers used cross-sectional data (100.0%) primarily had U.S. lead authors (68.8%) and were published within psychology, social sciences, and health journals. While 87.5% of papers defined intersectionality and 93.8% cited foundational authors, engagement with intersectionality method literature was more limited. Clustering variables were based on social identities/positions (e.g., gender), dimensions of identity (e.g., race centrality), or processes (e.g., stigma). Results most commonly included four classes/clusters (60.0%), which were frequently used in additional analyses. These described sociodemographic differences across classes/clusters, or used classes/clusters as an exposure variable to predict outcomes in regression analysis, structural equation modeling, mediation, or survival analysis. Author rationales for method choice included both theoretical/intersectional and statistical arguments. Conclusion: Latent variable and clustering methods were used in varied ways in intersectional approaches, and reflected differing matches between theory and methods. We highlight situations in which these methods may be advantageous, and missed opportunities for additional uses. [ABSTRACT FROM AUTHOR]

Background: Diversity, equity, and inclusion have been an intentional focus for SAGES well before the COVID-19 pandemic and the coincident societal recognition of social injustices and racism. Longstanding inequities within our society, healthcare, and the surgery profession have come to light in the aftermath of events that rose to attention around the time of Covid. In so doing, they have brought into focus disparities, injustices, and inequalities that have long been present in the field of surgery, selectively affecting the most vulnerable. Methods: This White paper examines the current state of diversity within the field of surgery and SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) approach and effort to pave the way forward to meaningful change. We delineate the imperative for diversity, equity, and inclusion for all. By all, we mean to be inclusive of the diversity of gender and sexual orientation, race, ethnicity, geography, sex, and disability in the field of surgery. Results: SAGES is an organization that lives at the intersection of education and innovation. It has a vital role in assisting the surgical profession in addressing these issues and needs and being a force alongside others for sustained and necessary change. SAGES can only realize these goals through a commitment across all aspects of the organization to embed diversity, equity, and inclusion into our very fabric. Conclusion: True diversity, equity, and inclusion within a surgical organization is vital for its longevity, growth, relevance, and impact. Unfortunately, the absence of DEI limits opportunity, robs the organization of collective intelligence in an environment in which its presence is critical, contributes to health inequities, and impoverishes all within the society and its value to all with whom it interfaces. SAGES is an organization that lives at the intersection of education and innovation. It has a vital role in assisting the surgical profession in addressing these issues and needs and being a force alongside others for sustained and necessary change. SAGES can only realize these goals through a commitment across all aspects of the organization to embed diversity, equity, and inclusion into our very fabric. Strategies like those highlighted in this White Paper, may be within our grasp and we can learn yet more if we remain in a place of humility and teachability in the future. [ABSTRACT FROM AUTHOR]

In June 2022, the NIH Office of Disease Prevention (ODP) issued a Call for Papers for a Supplemental Issue to Prevention Science on Design and Analytic Methods to Evaluate Multilevel Interventions to Reduce Health Disparities. ODP sought to bring together current thinking and new ideas about design and analytic methods for studies aimed at reducing health disparities, including strategies for balancing methodological rigor with design feasibility, acceptability, and ethical considerations. ODP was particularly interested in papers on design and analytic methods for parallel group- or cluster-randomized trials (GRTs), stepped-wedge GRTs, group-level regression discontinuity trials, and other methods appropriate for evaluating multilevel interventions. In this issue, we include 12 papers that report new methods, provide examples of strong applications of existing methods, or provide guidance on developing multilevel interventions to reduce health disparities. These papers provide examples showing that rigorous methods are available for the design and analysis of multilevel interventions to reduce health disparities. [ABSTRACT FROM AUTHOR]

There is growing interest in extending the evaluative space of the quality-adjusted life-year framework beyond health. Using a critical interpretive synthesis approach, the objective was to review peer-reviewed literature that has discussed non-health outcomes within the context of quality-adjusted life-years and synthesise information into a thematic framework. Papers were identified through searches conducted in Web of Science, using forward citation searching. A critical interpretive synthesis allows for the development of interpretations (synthetic constructs) that go beyond those offered in the original sources. The final output of a critical interpretive synthesis is the synthesising argument, which integrates evidence from across studies into a coherent thematic framework. A concept map was developed to show the relationships between different types of non-health benefits. The critical interpretive synthesis was based on 99 papers. The thematic framework was constructed around four themes: (1) benefits affecting well-being (subjective well-being, psychological well-being, capability and empowerment); (2) benefits derived from the process of healthcare delivery; (3) benefits beyond the recipient of care (spillover effects, externalities, option value and distributional benefits); and (4) benefits beyond the healthcare sector. There is a wealth of research concerning non-health benefits and the evaluative space of the quality-adjusted life-year. Further dialogue and debate are necessary to address conceptual and normative challenges, to explore the societal willingness to sacrifice health for benefits beyond health and to consider the equity implications of different courses of action. [ABSTRACT FROM AUTHOR]

This paper reviews major structural drivers of place-based health disparities in the context of Canada, an industrialized nation with a strong public health system. Likelihood that the COVID-19 pandemic will facilitate rejuvenation of Canada's northern and remote areas through remote working, advances in online teaching and learning, and the increased use of telemedicine are also examined. The paper concludes by identifying some common themes to address healthcare disparities for northern and remote Canadian residents. [ABSTRACT FROM AUTHOR]

In fact, the analysis holds even if income inequality has no direct effect on health and the only effect runs from income to health, this is sometimes referred to as the absolute income hypothesis [[2]]. Stark highlights that the Gini coefficient is a relative measure of income inequality, so if all incomes increase by the same proportion the Gini coefficient will remain constant. This is not due to any direct income inequality effect but due the fact that low-income individuals may have a larger marginal product of income with respect to health outputs than high income individuals. [Extracted from the article]

COVID-19 has dramatically affected financial markets, economies, and societies worldwide and exposed pre-existing inequalities in cities. This work aims to understand the inequalities in some cities worldwide, their reasons and circumstances, and impacts to drive lessons for future prevention, intervention, and post-catastrophe/ hazard plans such as COVID-19 that would raise resilience and decrease damages. Six major cities were included in the analysis and contrasted based on specific assessment criteria. The study included the impact of the pandemic on the economy and the government's responses global crisis. Additionally, newfound measures and technologies developed to control the hazard, including the community's response and cooperation to solving the issue were explored. The outcomes of this work shed a light on problems to be addressed in the future towards enhances the resilience of cities pre- and post- global crisis. Through the comparisons made in this paper, conclusions regarding the cities' successful combat against COVID-19 were drawn. According to the comparative analysis, it became apparent that poverty, culture, and governance are primary factors that control the success of states under emergency. Moreover, it is understood that technology is a significant factor in combating pandemics and health emergencies as large as COVID-19, especially for tracking and monitoring. [ABSTRACT FROM AUTHOR]

Monitoring health is key for identifying priorities in public health planning and improving healthcare services. Life expectancy has conventionally been regarded as a valuable indicator to compare the health status of different populations. However, this measure is simply the mean of the distribution of the length of life and, as such, neglects individual disparities in health outcomes. In this paper, we use life tables from the UN World Population Prospects to develop the most comprehensive dataset of lifespan inequality and polarization for 258 countries and areas for the period 1950–2021. These extensive series on lifespan distributions provide access to crucial information for researchers, practitioners, and the general public, thus contributing to a better understanding of health differences within and between nations. [ABSTRACT FROM AUTHOR]

Purpose: The Child Friendly Cities Initiative (CFCI) is a UNICEF framework based on the UN Convention on the Rights of the Child (CRC). CFCI was launched globally in 1996 to protect children's rights throughout the world. There are child friendly cities in over 44 countries around the globe, but none presently in the United States. The purpose was to establish a Child Friendly City in the United States. Description: Child friendly cities are a child-rights and equity-based approach designed to ensure all children in a community reach their full potential for optimal health, development, and well-being. The paper discusses the development of the guiding principles of the CFCI-Minneapolis Model as well as a community needs assessment. Assessment: The assessment consisted of a digital survey of 60 questions on the SurveyMonkey platform. The sample included 173 Minneapolis youth 10-18 years of age and 85 parents with children less than five years of age. The participants were drawn from four of the 83 Minneapolis neighborhoods that had the highest concentration of children and youth, communities of color, and immigrant families that have historically been under resourced. Conclusion: The results of the community assessment guided the development of four programmatic initiatives. These included child rights learning & awareness, emergency preparedness & planning, community safety, and youth participation in decision making. The paper concludes with the lesson learned to date in the implementation of the CFCI-Minneapolis Model. These include partnership, dedication, leadership, community engagement, coalition building, and celebrating success. CFCI-Minneapolis received full designation from UNICEF USA as a child friendly city in February 2024. [ABSTRACT FROM AUTHOR]

Background: The concept of Positive Health (PH) has gained increasing attention as a way of measuring individuals' ability to adapt in the face of contextual challenges. However, a suitable measurement instrument for PH that encompasses contextual factors has not yet been developed. This paper responds to this need by developing a Context-specific Positive Health (CPH) measurement instrument that aligns with the Capability Approach (CA). Methods: The measurement instrument was developed and tested among a representative sample of 1002 Dutch internet survey panel members with diverse sociodemographic backgrounds. The instrument was developed in two stages: a preparation phase consisting of focus groups and expert consultations, and a validation among a representative panel of Dutch citizens. The goal of the preparation phase, was to pilot test and refine previously proposed Positive Health questionnaires into an initial version of the CPHQ. The validation phase aimed to examine the initial CPHQ's factorial validity using Factor Analysis, and its concurrent validity using Multivariate Regression Analysis. Results: The developed questionnaire demonstrated adequate factorial and concurrent validity. Furthermore, it explicitly includes an assessment of resilience, this being a key component of PH. Conclusions: The introduced measurement tool, the CPHQ, comprises 11 dimensions that we have labeled as follows: relaxation, autonomy, fitness, perceived environmental safety, exclusion, social support, financial resources, political representation, health literacy, resilience, and enjoyment. In this article, we present four major contributions. Firstly, we embedded the measurement in a theoretical framework. Secondly, we focused the questionnaire on a key concept of Positive Health - the "ability to adapt." Thirdly, we addressed issues of health inequality by considering contextual factors. Finally, we facilitated the development of more understandable measurement items. [ABSTRACT FROM AUTHOR]

This paper peruses one of the most challenging healthcare concerns related to human organ transplantation. In this regard, a medical system's health-economic objectives are investigated to (1) achieve a desirable level of health equity in offering healthcare services to patients who are differentiated in terms of medical conditions, and (2) minimize total costs incurred across managing the inventory. This paper presents the first-ever operational research study to manage processed corneal tissue (PCT). Besides, hybrid demand-oriented policies have been proposed to equitably issue and assign specific inventories to demands with distinct medical urgent levels (ULs). In this regard, a practical multi-objective mixed-integer linear programming (MOMILP) model is proposed for a system with multiple products that can be substituted with each other according to medical priorities. A goal programming (GP) approach is utilized to find the optimum solution. The applicability of the model is validated through a real case study. Finally, several sensitivity analyses are conducted to examine the effect of critical parameters on the solutions to gain useful managerial insights. The results show that the proposed health-economic trade-off is well performed and can efficiently handle the real case. [ABSTRACT FROM AUTHOR]

Roma communities across Europe still remain a neglected population group by way of the social and economic disadvantage that largely characterizes their lives. Roma communities continue to experience structural socioeconomic health inequalities on the grounds of their ethnic origin, alarmingly unveiling a pattern of systematic discrimination and ethnic marginalization. Without any doubt, such a highly worrying situation calls for States to incorporate Roma health rights within their law and policy agendas in a manner consistent with right to health requirements. Against this background, this paper seeks to identify an operational human rights framework for States as a driver for better informed policies and implementation as well as for Roma engagement in the deliberations about their life prospects. The paper argues that continuing, concerted, and proactive State engagement is required for effectively addressing the structural obstacles impeding Roma socioeconomic health rights realization and maximizing Roma opportunities for well-being. [ABSTRACT FROM AUTHOR]

Introduction: Avoidable mortality is widely used by public health researchers to measure population health, and many related methodologies have been proposed for doing so. This scoping review presents a comprehensive view of global peer-reviewed and grey literature exploring the association between socioeconomic status (SES) and avoidable mortality. Methods: We searched Ovid Medline, Scopus, and Web of Science to find articles that investigated SES inequalities in avoidable mortality. We limited our review to articles in English published between 2000 and 2020. For grey literature, we searched leading global and Canadian health information websites. We extracted data on different study characteristics, avoidable mortality definition, SES indicator, method of analysis of the association between avoidable mortality and SES, and main findings of the studies. Results: We identified 34 articles to review, including 29 scientific papers and 5 grey literature documents. The findings of the selected articles consistently indicate a negative association between SES and avoidable mortality rates. Studies have not all used the same definitions of avoidable mortality or SES nor operationalized them in the same way. Conclusion: Our review highlights the absence of a globally standard definition in avoidable mortality health equity research. Additional work to establish a standardized definition is crucial for supporting global comparability. [ABSTRACT FROM AUTHOR]

This paper investigates the effects of health insurance enrollment on health disparities among different racial groups in the United States. Two models were constructed and estimated empirically where a health insurance disparity model was nested in the health disparity model. The Blinder-Oaxaca decomposition method was used to measure potential racial discrimination in health status. The racial gap in health disparities was broken down by endowment and treatment effects. The results show that the health status gap can be explained by potential discrimination in health insurance enrollment between Blacks and Whites. Overall, health insurance enrollment plays a critical role in explaining racial disparities and a racial disparity in the healthcare industry explains a nontrivial portion of the differences in health status. [ABSTRACT FROM AUTHOR]

Current definitions of migraine that are based mainly on clinical characteristics do not account for other patient's features such as those related to an impaired quality of life, due to loss of social life and productivity, and the differences related to the geographical distribution of the disease and cultural misconceptions which tend to underestimate migraine as a psychosocial rather than neurobiological disorder. Global differences definition, care access, and health equity for headache disorders, especially migraine are reported in this paper from a collaborative group of the editorial board members of the Journal of Headache and Pain. Other components that affect patients with migraine, in addition to the impact promoted by the migraine symptoms such as stigma and social determinants, are also reported. [ABSTRACT FROM AUTHOR]

The current paper serves as an introduction to this special issue, Advancing Health Equity among Black Communities, in which we provide an overview of the papers included. Specifically, we summarize the papers covered in the special issue and highlight some of the common themes. The impetus for this special issue originated from a culmination of the COVID-19 pandemic, continued murders of Black people by police officers, and an unsettling political climate (e.g., Galea & Abdalla, 2020). While the impact of individual racism has been studied extensively, the insidious and pervasive impact of structural racism is less understood. Structural racism is a system in which embedded values, practices and policies facilitate and perpetrate the continued differential treatment of people based on race and becomes an almost hidden influence on the way an institution functions. For this special issue, prevention scientists were invited to submit conceptual and empirical research reflecting their understandings of structural racism as it operates in U.S. systems (e.g., education, justice, housing, workforce) and contributes to health inequities in the lives of Black Americans. The submissions also demonstrate how prevention scientists can leverage translational science to impact policies, practices, and procedures to promote equitable and sustainable change for Black communities. [ABSTRACT FROM AUTHOR]

Individuals with mental illness often face barriers to voting. One of the primary barriers is not being registered to vote. This paper describes voter support activities (VSAs) provided to hospitalized adults on the acute inpatient psychiatric units at Pennsylvania Psychiatric Institute. During the six weeks preceding the 2020 general election, adult inpatients were offered six VSAs and an optional survey examining previous voting behaviors and barriers encountered to voting. VSAs included checking voter registration status and polling location, completing a paper or electronic voter registration application, and requesting a mail-in ballot. Of 189 patients approached, 119 individuals participated in the survey and 60 individuals utilized at least one VSA. This project demonstrates that VSAs are a welcome and feasible resource for psychiatrically hospitalized adults. Psychiatric providers can serve an important role in promoting access to voting-related activities for their patients. [ABSTRACT FROM AUTHOR]

Introduction: Atopic dermatitis (AD) is a chronic, pruritic skin disease caused by a mixture of genetic, immunological, and environmental factors, characterized by periods of inflammation and remission. In Latin America (LA), the prevalence of AD ranges up to 25% in children and 1–3% in adults. The natural history of the disease for most patients is that AD goes into remission in adolescence and adult life. Only 10–30% of patients continue to have symptoms of the disease in adulthood. There are patients (3–4%) who have the onset of AD during adolescence or after adulthood. Those with limited access to healthcare services, such as diagnosis and treatment, have increased difficulties coping with AD. Healthcare disparities are a complex topic that include social, political, racial/ethnic, and geographical factors. Publications about healthcare disparities in AD in LA are scarce. As a result, recognizing and resolving healthcare inequalities is critical to improving the treatment and quality of life (QoL) of individuals with AD. Methods: A panel of Latin American experts in dermatology and allergies was provided with a series of relevant questions to address before a multiday conference. During this conference, the entire group discussed and edited each narrative through numerous drafts and rounds of discussion until they reached a consensus. Results: This paper examines the barriers to equal access to care and recommends realistic actions to overcome them. Inadequate disease knowledge, cultural and linguistic barriers, stigmatization, maldistribution of resources, absence of local clinical practice guidelines, arduous patient journey, and limited consultation time were identified as causes of health inequality. Conclusions: Among the suggested solutions are enhanced education for healthcare professionals, patients, and the general public, a focus on underprivileged communities, telemedicine and telementoring, translators, multidisciplinary teams, and local living clinical practice guidelines. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, focused protection strategies including selective lockdowns of the elderly were proposed as alternatives to general lockdowns. These selective restrictions would consist of isolating only those most at risk of COVID-19 hospitalization and subsequent use of healthcare resources. The proposal seems to have troubling implications, including the permissibility of selective lockdown on the basis of characteristics such as ethnicity, sex, disability, or BMI. Like age, these factors also correlated with an increased risk of hospitalization from COVID-19. In this paper, we argue that age has meaningful differences as a morally relevant characteristic in the justification for selective restrictions of liberty. Thus, it might justify selective freedom restrictions in a way in which other factors might not. We offer four moral domains that separate age from other proxies: empiricism, operationality, discrimination, and disparity. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has been one of the most acute global crises in recent history, which profoundly impacted the world across many dimensions. During this period, racism manifested in ways specifically related to the pandemic, including xenophobic sentiments, racial attacks, discriminatory policies, and disparate outcomes across racial/ethnic groups. This paper examines some of the pressing questions about pandemic racism and inequity. We review what research has revealed about the nature and manifestations of racism, the entrenchment of structural racism, and trajectories of racism during COVID-19. [ABSTRACT FROM AUTHOR]

Solidarity between more and less vulnerable groups is fundamental to an effective public health response to a global pandemic. Yet in the case of COVID-19, a focus on deciding who can and who cannot be protected from harm has shaped the pandemic experience and continues to determine the post-pandemic trajectory of life with SARS-CoV-2. In this paper I discuss how this has affected our understanding and acceptance of solidarity. [ABSTRACT FROM AUTHOR]

Introduction: Tooth decay remains the most prevalent chronic disease in children and adults, even though it is largely preventable. Studies show that mothers' oral and overall health is linked to children's oral health and pregnancy outcomes. This paper examines achievements during the last 20 years, assesses current challenges, and discusses future priorities. Oral health status: Data show a modest improvement in children's oral health during the last 20 years; however, tooth decay still affects more than half of adolescents. According to national survey data, about 26% of working-age adults had untreated tooth decay. Overall, significant oral health disparities by race/ethnicity and income persist. Dental service utilization: The annual dental visit rate for children in the 2015 Medical Expenditure Panel Survey was 48%. Among children enrolled in Medicaid, dental visit rates increased from 18% in 1993 to nearly 50% in 2018. About 46% of women are estimated to receive teeth cleaning during pregnancy. Over the years, race or ethnicity and income-level differences in dental visits observed in the early 2000s have narrowed substantially in children but not among pregnant women. Discussion: Many effective interventions are available at the community and individual levels but are underutilized. Lack of integration of oral health into the overall health care system and programs, community conditions, poverty, and limited health literacy make it difficult for families to engage in healthy habits, use preventive interventions, and access treatment promptly. Conclusion: To further improve oral health, policy and system reforms are needed to address the factors mentioned above. Therefore, we urge the federal Maternal and Child Health Bureau to take steps to convene a workshop to develop a framework for future actions. Significance: What is already known on this subject? Existing publications discuss the extent to which women, children, and adolescents experience oral health problems, effective policies and programs, and the need to integrate oral health care into the overall health care system. What does this study add? This manuscript provides a historical perspective on efforts and progress made to address the causes of high oral disease rates, unmet oral health treatment needs, and profound oral health disparities. It also discusses challenges that four major programs have encountered in working to achieve better oral health outcomes. In addition, it makes recommendations for improving oral health and calls for a national workshop to develop a framework for future actions. [ABSTRACT FROM AUTHOR]

Background: A growing gap in exclusive breastfeeding across racial/ethnic groups in the United States includes a very low proportion of African American/Black women, with only 17.4% breastfeeding exclusively in 2015. While many quantitative studies examine these disparities, few qualitative studies have examined the overall experience of breastfeeding for Black women. Objective: The aim of this study is to evaluate the existing qualitative literature on experiences of African American/Black women who breastfeed to gain insight on barriers and facilitators unique to this population. Methods: This scoping review included studies that had a focus on any qualitative study design. Evidence was identified by searching electronic databases (PubMed, CINAHL, and PsychINFO). Results: Thirteen papers met the inclusion criteria for this review. Each study was summarized and then analyzed for content to produce a synthesis. Seven themes that influence Black women's experience with breastfeeding were identified: influence of interpersonal relationship on intention to and sustained breastfeeding experiences, influence of institutional systems on initiating and sustaining infant feeding decision, influence of personal beliefs on breastfeeding decisions and experience, material barriers and facilitators to breastfeeding experience, traditional stigma of breastfeeding, historical stigma of breastfeeding influences feeding choice in Black women, and negative impacts of body image. Conclusion: The breastfeeding experience for Black women is unique and poses additional areas for intervention based on cultural and historical stigma. Incorporating the identified factors into intervention design is key to creating more effective policies for improving breastfeeding rates in the Black women and closing the gap across racial/ethnic demographics in the United States. Still, more qualitative research with culturally relevant theories needs to be done to investigate the full scope and complexities of breastfeeding as a Black woman to develop messaging to encourage the behavior. Significance: What is Already Known on this Subject? Many barriers hinder women from breastfeeding, and disproportionately impact Black women, leading to growing disparities in breastfeeding rates. What does this study add? This scoping review synthesizes the findings from prior qualitative studies on the breastfeeding experiences of Black women, exploring the presence of current well-documented themes across studies, with additional attention to themes that may be unique for Black women to further investigate Black women's experiences with breastfeeding. [ABSTRACT FROM AUTHOR]

Purpose: Basic science research is critical for understanding biological mechanisms essential to advances in cancer prevention, diagnoses and treatment. However, most of this research is conducted outside of the purview of community observation or input, leaving these research processes mysterious and subsequent findings disconnected from the communities they intend to benefit. This paper discusses strategies to build capacity for collaborations between basic scientists and Hispanic community members at the University of Arizona Cancer Center (UACC). Methods: Through partnership of the Cancer Biology Program and Office of Community Outreach and Engagement both at UACC, the Research Outreach for Southern Arizona (ROSA) program was developed as a way to forward the following strategies to build capacity for collaboration: forming a community working group, launching a community and student ambassador program, hosting scientific cafés and developing a community-based survey. Results: The strategies underpinning the ROSA program have been integral in bridging dialogue between basic scientists and the community and fostering bidirectional learning opportunities. Each of the strategies presented have documented successes and based on the lessons learned, they have evolved into productive and integral parts of UACC's overall strategy of bridging scientific research and communities. Conclusion: While the strategies discussed are evolving, they help foster dialogue and exchange between basic scientists and community members that demystifies basic science research and facilitates culturally tailored approaches to address health disparities of vulnerable communities. These strategies also have the potential to shift cancer research into a paradigm that is more collaborative and transformative. [ABSTRACT FROM AUTHOR]

American Indian women experience cervical cancer disparities, including later-stage diagnosis and a higher cervical cancer mortality rate. These disparities are interconnected and linked to cervical cancer screening disparities. Cervical cancer when identified early is highly treatable. Individual- and health system-level factors often contribute to gaps in cervical cancer screening. To better understand the source of these inequities experienced by American Indian women, specifically Zuni women, this paper examines how knowledge about cervical cancer and related risk factors is linked to cervical cancer screening for Zuni women using primary data gathered by the Zuni Health Initiative in 2020 and 2021. We find that of the women who completed the survey (n = 171), women with greater cervical cancer knowledge are statistically significantly more likely to have received cervical cancer screening. Closer examination of knowledge on the specific risk factors for cervical cancer provides evidence upon which to develop a cervical cancer education intervention. [ABSTRACT FROM AUTHOR]

The identification of territorial clusters where the population suffers from worse health conditions is an important topic in social epidemiology, in order to identify health inequalities in cities and provide health policy interventions. This objective is particularly challenging because of the mechanism of self-selection of individuals into neighborhoods, which causes selection bias. The aim of this paper consists in the identification of neighborhood clusters where elderly people living in Turin, a city in north-western Italy, are exposed to an increased risk of hospitalized fractures. The study is based on administrative data and is a retrospective, observational cohort study. It is composed by a first phase, in which the individual confounding variables are balanced across neighborhoods in order to make them comparable, and a second phase in which the neighborhoods are aggregated into clusters characterized by significantly higher health risk. In the first phase we exploited a balancing technique based on partially ordered sets (poset), called Matching on poset based Average Rank for Multiple Treatments (MARMoT). On the balanced dataset, we used a spatial scan to identify the presence of clusters and we checked whether the risk of fracture is significantly higher in some contiguous areas. The combination of both MARMoT procedure and spatial scan makes it possible to highlight two clusters of neighborhoods in Turin where the risk of incurring hospitalized fractures for elderly people is significantly higher than the mean. These results could have important implications for the implementation of health policies. [ABSTRACT FROM AUTHOR]

Background: Achieving equity in healthcare services has been a global priority. According to the literature, a slew of initiatives aimed at increasing household equity in healthcare financing have exacerbated the problem, making it hard for most developing countries to understand the real cause of the problem. Method: The non-experimental research design has been used to explore the Tanzania Panel Survey (NPS) data 2019/2020, to investigate equity differential in household healthcare financing in Tanzania by the use of conventional instrumental variable methods of Two-stage and Three-stage least square methods Results: Despite the global agenda of universal health coverage, this paper reveals that 86 percent of Tanzania lacks health insurance with a high degree of inequitable distribution of health facilities as 71.54 percent of the population is in rural areas, yet these areas have poor health systems compared to urban ones. These disparities increase pressure on household healthcare financing and widen the inequity and equality gaps simultaneously. Additionally, a household's income, education, health care waivers, out-of-pocket expenditure, and user fees have been found to have a significant impact on household equity in healthcare financing. Conclusion: To reverse the situation and increase equity in household healthcare financing in most developing countries, this paper suggests that an adequate pooling system should be used to allow more people to be covered by medical prepayment programs, and the donor-funded programs in developing countries should focus on health sector infrastructure development and not the capacity building. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic drew attention to health disparities and racism in healthcare. The first step in addressing racial disparities in healthcare is acknowledgement that there is a problem. Palliative care teams have an obligation to recognize how racism shows up in healthcare and in turn how it affects racially marginalized patients. Clinicians must engage in self-reflection by assessing their own conscious and unconscious biases that impact the clinician/patient dyad, by understanding their social location, and by using assessments and interventions that are grounded in cultural humility and awareness of racial trauma. This paper examines racism in healthcare, the psychological impact of racism when working patients, techniques for clinicians in palliative care to address their own biases, and implications for clinical practice. It includes a composite case study of a patient navigating pain management, illustrating how racism can impact the care of BIPOC and AAPI patients. [ABSTRACT FROM AUTHOR]

Task Force on 'Clinical Algorithms for Fracture Risk' commissioned by the American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee has recommended that FRAX® models in the US do not include adjustment for race and ethnicity. This position paper finds that an agnostic model would unfairly discriminate against the Black, Asian and Hispanic communities and recommends the retention of ethnic and race-specific FRAX models for the US, preferably with updated data on fracture and death hazards. In contrast, the use of intervention thresholds based on a fixed bone mineral density unfairly discriminates against the Black, Asian and Hispanic communities in the US. This position of the Working Group on Epidemiology and Quality of Life of the International Osteoporosis Foundation (IOF) is endorsed both by the IOF and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). [ABSTRACT FROM AUTHOR]

Purpose: Co-creation of a citizen-science research initiative with a collaborative team of community members and university-based scientists to address regional disparities in maternal and fetal health outcomes for Black birthing people. Description: Citizen scientist-led projects, where community members actively contribute to each discovery step, from setting a research agenda to collecting data and disseminating results, can extend community participatory research initiatives and help reconceptualize traditional research processes. The Pregnancy Collaborative is a citizen-science research initiative and one of nine scientific committees of The Pittsburgh Study—a longitudinal, community-partnered study designed to bring together collaborators to improve child thriving. Assessment: Ten community members and five university-based scientists participated during all phases of developing a citizen-scientist collaboration over an initial two-and-a-half-year period. Phases include forming the Pregnancy Collaborative and group research ethics training; co-creating a research agenda grounded in shared principles; and community-partnered data collection, analysis, and dissemination. These phases produced three key co-designed products: (1) a mission and vision statement of the Pregnancy Collaborative, (2) a Collaborative-endorsed research agenda, and (3) a citizen-scientist-executed research survey. Conclusion: Lessons learned from the formation of the Pregnancy Collaborative highlight the importance of equitable power distribution through bidirectional knowledge sharing and by centering intellectual effort, lived experience, and tools and resources of those affected by health inequities. Using a citizen science approach to co-designing and executing research helps us move maternal health inequity work from "research on" to "research with." Significance: Persistent disparities characterize maternal and child health outcomes in the United States. These disparities, mediated by poverty, racism, and place-based social and structural determinants of health, are the biggest threats to Black maternal health. Recently, community-engaged efforts to improve Black maternal health disparities have moved towards cross-sector approaches that center the lived experiences of Black birthing people. Despite these comprehensive approaches, community members rarely participate throughout the research lifecycle. Citizen science-led projects like those described in this paper are one way to acknowledge and commit to bidirectional community-partnered research and action. [ABSTRACT FROM AUTHOR]

The disparity in the distribution of COVID-19 vaccine has been recorded with more than 70% vaccination rate for high-income countries as compared to less than 40% for low-income countries. The low affordability of vaccines for the majority of low-income group invites the need for redistribution of vaccines. The disproportionate donation of vaccines across the globe motivates us to explore the incentive for the high-income group to redistribute. An exploratory analysis of cross-country COVID-19 vaccination distribution data shows that the countries which have received vaccines as donation has also contributed to vaccine wastage. This paper intends to provide a theoretical background for this counterintuitive observation using welfare analysis. We find that the market mechanism leads to a negative impact on global welfare due to redistribution. Only an invention with a defined redistribution mechanism may ensure an increase in global welfare. It is found that a critical value of redistribution mechanism reinforced by a minimum threshold level of income is essential to enhance welfare. The reduced form from the theoretical predictions is empirically validated with cross-country data on COVID-19 vaccination for all countries. As identified in theory, the internal support variables like political stability, government effectiveness, and health expenditure at the country level will impact global welfare. Therefore, when global cooperation is essential during a health crisis like COVID-19, improved internal coordination and intentions cannot be ignored. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate disparities in urine drug testing (UDT) during perinatal care at a single academic medical center. This retrospective cohort study included patients who had a live birth and received prenatal care at our institution between 10/1/2015 and 9/30/2020. The primary outcomes were maternal UDT during pregnancy (UDTPN) and UDT only at delivery (UDTDEL). Secondary outcomes included the number of UDTs (UDTNUM) and the association between a positive UDT test result and race/ethnicity. Mixed model logistic regression and negative binomial regression with clustering based on prenatal care locations were used to control for confounders. Of 6,240 live births, 2,265 (36.3%) and 167 (2.7%) received UDTPN and UDTDEL, respectively. Black (OR 2.09, 95% CI 1.54–2.84) and individuals of Other races (OR 1.64, 95% CI 1.03–2.64) had greater odds of UDTPN compared to non-Hispanic White individuals. Black (beta = 1.12, p < 0.001) and Hispanic individuals (beta = 0.78, p < 0.001) also had a positive relationship with UDTNUM. Compared to individuals with non-Medicaid insurance, those insured by Medicaid had greater odds of UDTPN (OR 1.66, 95% CI 1.11–2.49) and had a positive relationship with UDTNUM (beta = 0.89, p < 0.001). No significant associations were found for UDTDEL and race/ethnicity. Despite receiving more UDT, Black individuals were not more likely to have a positive test result compared to non-Hispanic White individuals (OR 0.95, 95% CI 0.72–1.25). Our findings demonstrate persistent disparities in substance use testing during the perinatal period. Significance: What is already known on this subject?: Prior literature has shown evidence of racial disparities in urine drug testing during pregnancy-related hospital admissions and at delivery. What this study adds?: This paper found that disparities in urine drug testing also exist during the prenatal care period at an urban academic institution. We also found a positive relationship between the number of tests received and being of Black or Hispanic race/ethnicity. Future research should investigate health care system-related interventions to mitigate disparities in urine drug testing. [ABSTRACT FROM AUTHOR]

The increasing health inequity and injustice of the COVID-19 pandemic rendered visible the inadequacy of global health governance, and exposed the self-interested decision-making of states and pharmaceutical companies. This research explores the advocacy activities of humanitarian and development international non-governmental organizations (INGOs) in responding to this inequality and investigates how they framed alternatives for global health justice. It reviews 47 organizational documents and 43 media articles of five INGOs (ActionAid, Médecins Sans Frontières, Oxfam, Save the Children, and World Vision) and points to the importance of understanding advocacy frames in analyzing how these organizations prioritize agendas and advocacy strategies. The dominance of the 'human rights' frame, sometimes in combination with 'scientific evidence' and 'security' frames, reflects the identities, mandates, and histories of campaigning and collaboration of these INGOs. This paper contends that the advocacy of humanitarian and development INGOs highlights both deontological and teleological ethics, promoting the voices of people in lower-income countries, clarifying duty bearers and their accountabilities, and addressing structural barriers from a human rights perspective in a global health agenda setting. [ABSTRACT FROM AUTHOR]

Multilevel interventions (MLIs) are appropriate to reduce health disparities among Indigenous peoples because of their ability to address these communities' diverse histories, dynamics, cultures, politics, and environments. Intervention science has highlighted the importance of context-sensitive MLIs in Indigenous communities that can prioritize Indigenous and local knowledge systems and emphasize the collective versus the individual. This paradigm shift away from individual-level focus interventions to community-level focus interventions underscores the need for community engagement and diverse partnerships in MLI design, implementation, and evaluation. In this paper, we discuss three case studies addressing how Indigenous partners collaborated with researchers in each stage of the design, implementation, and evaluation of MLIs to reduce health disparities impacting their communities. We highlight the following: (1) collaborations with multiple, diverse tribal partners to carry out MLIs which require iterative, consistent conversations over time; (2) inclusion of qualitative and Indigenous research methods in MLIs as a way to honor Indigenous and local knowledge systems as well as a way to understand a health disparity phenomenon in a community; and (3) relationship building, maintenance, and mutual respect among MLI partners to reconcile past research abuses, prevent extractive research practices, decolonize research processes, and generate co-created knowledge between Indigenous and academic communities. [ABSTRACT FROM AUTHOR]

In this paper, we introduce an analytic approach for assessing effects of multilevel interventions on disparity in health outcomes and health-related decision outcomes (i.e., a treatment decision made by a healthcare provider). We outline common challenges that are encountered in interventional health disparity research, including issues of effect scale and interpretation, choice of covariates for adjustment and its impact on effect magnitude, and the methodological challenges involved with studying decision-based outcomes. To address these challenges, we introduce total effects of interventions on disparity for the entire sample and the treated sample, and corresponding direct effects that are relevant for decision-based outcomes. We provide weighting and g-computation estimators in the presence of study attrition and sketch a simulation-based procedure for sample size determinations based on precision (e.g., confidence interval width). We validate our proposed methods through a brief simulation study and apply our approach to evaluate the RICH LIFE intervention, a multilevel healthcare intervention designed to reduce racial and ethnic disparities in hypertension control. [ABSTRACT FROM AUTHOR]

Systemic racism is pervasive in US society and disproportionately limits opportunities for education, work, and health for historically marginalized and minoritized racial and ethnic groups, making it an urgent issue of social justice. Because systemic racism is a social determinant of health prevalent across multiple social and institutional structures, it requires multilevel intervention approaches using effective designs and analytic methods to measure and evaluate outcomes. Racism is a fundamental cause of poor health outcomes, including mental health outcomes; thus, mental health services and programs that address racism and discrimination are key to promoting positive mental health of racial and ethnic minority youth. While multilevel interventions are well-suited for improving outcomes like youth mental health disparities, their evaluation poses unique methodological challenges, requiring specialized design and analytic approaches. There has been limited methodological guidance provided to researchers on how to test multilevel interventions using approaches that balance methodological rigor, practicality, and acceptability across stakeholder groups, especially within communities most affected by systemic racism. This paper addresses this gap by providing an example of how to rigorously evaluate a hypothetical, theoretically based, multilevel intervention promoting mental health equity in three US school systems using an anti-racist approach intervening at the macro- (i.e., school system), meso- (i.e., school), and micro- (i.e., family and student) levels to improve mental health in adolescents. We describe the design, sample size considerations, and analytic methods to comprehensively evaluate its effectiveness while exploring the extent to which the components interact synergistically to improve outcomes. The methodological approach proposed can be adapted to other multilevel interventions that include strategies addressing macro-, meso-, and micro-levels of influence. [ABSTRACT FROM AUTHOR]

Background: Evaluating healthcare interventions for their impacts beyond health outcomes may result in recognition of changes in human capital, income level, tax revenue, and government spending, which could affect economic growth and population health. In this paper, we document instances where current health technology assessment (HTA) practices fail to account for the impacts of healthcare interventions on broader society beyond the healthcare sector. Methods: We propose a novel conceptual framework, highlighting its three components (distributional cost-effectiveness analysis [DCEA], input-output model, and voting scheme) and their contributions to capturing the economic and societal ripple effects of healthcare interventions. This manuscript also outlines a case study in which the framework is applied to the reassessment of a previously evaluated digital health therapeutic for the treatment of opioid use disorder (OUD) compared with standard of care, demonstrating its practical application. Results: The DCEA health value metric indicates that digital therapeutic is more equitable, favoring socioeconomically disadvantaged groups, while standard of care exacerbates health inequality by benefiting the already advantaged. Additionally, digital therapeutic shows potential for boosting productivity, raising income, and creating jobs, supporting its consideration by employer-sponsored health plans to optimize resource allocation for treating OUD. Conclusion: The conceptual framework provides insights for enhancing HTAs to incorporate the broader economic and societal impacts of healthcare interventions. By integrating DCEA, extended HTA analysis with input-output modeling, and a voting scheme, decision makers can make informed choices aligned with societal priorities, although further research and validation are necessary for practical implementation across diverse healthcare contexts. [ABSTRACT FROM AUTHOR]

To emphasize to learners how factors outside individual control impact health, scholars introduced the concept of structural competency. Structural competency refers to the development of analytical skills that reveal the larger societal context beyond the patient-clinician interaction that shapes health outcomes. The growing adoption of structural competency curricula, however, has revealed that prelicensure and early career health professionals can feel overwhelmed by the mismatch between the wide scale of entrenched problems and the limited scope of their therapeutic skills. In this Reflections paper, I draw on theories from Giddens, Bourdieu, and Foucault to restore a role for individual agency in promoting health. Conceiving of structure and agency as mutually constituting suggests that structures are human-made and can be vulnerable to challenge. Structures, however, disperse power to such an extent that people internalize their rules and discipline themselves to follow them without explicit enforcement. It is precisely in those local sites of power that health professions learners and educators can intervene to interrupt the reproduction of structures harmful to health. As I demonstrate with an example from a reproductive health emergency, being structurally competent may also include contesting agreed upon norms at the level of the learning and clinical environments rather than only macro-level societal forces. Rewriting norms within health professions education and clinical practice is not necessarily a simpler task, but it provides learners and educators with more accessible targets for action. [ABSTRACT FROM AUTHOR]

Crowdfunding is emerging as an alternative form of funding for medical purposes, with capital being raised directly from a broader and more diverse audience of investors. In this paper, we have systematically researched and reviewed the literature on medical crowdfunding to determine how crowdfunding connects with the health care industry. The health care industry has been struggling to develop sustainable research and business models for economic systems and investors alike, especially in pharmaceuticals. The research results have revealed a wealth of evidence concerning the way crowdfunding is applied in real life. Patients and caregivers utilize web platform–based campaigns all over the world to fund their medical expenses, generally on a spot basis, using donation-based or even reward-based schemes, regardless of the health care system archetype (public, private insurance-based or hybrid). Academics have also focused on funding campaigns and the predictors of success (which range from social behaviour and environment to the basic demographics of the campaigners and their diseases) and on social and regulatory concerns, including heightened social inequality and stigma. While equity crowdfunding is disrupting the way many ventures/businesses seek capital in the market, our research indicates that there are no relevant or consistent data on the practice of medical equity crowdfunding in health care, apart from a few anecdotal cases. [ABSTRACT FROM AUTHOR]

Policymakers, researchers, and public health practitioners have long sought not only to improve overall population health but also to reduce or eliminate differences in health based on geography, race/ethnicity, socioeconomic status, and other social factors. Italian healthcare authorities and health policy makers are called to help to both solve existing inequities in accessing healthcare and remove barriers to healthcare. In this context, COVID-19 has highlighted the aspect of inequalities. Our paper proposes an overview of different methods of measuring health inequalities and their applications, both in regional and national contexts, in absolute and relative scales. The first involves an application on accessibility to an obstetrics clinic in a district of Marche region, connected to the educational level of the female population. The second, calculates the indices on inequalities in the infant mortality rate in the Italian regions in relation to income. Finally, the three indices are calculated considering the rate of self-perceived health in relation with the GDP per capita. To achieve this goal, we use the Kuznets index, the slope index of inequality and the concentration index as measures of social inequalities. The measurement of health inequities is an excitingly multidisciplinary endeavor. Its development requires interdisciplinary integration of advances from relevant disciplines. The proposed approach is one such effort and stimulates cross-disciplinary dialogues, specifically, about conceptual and empirical significance of definitions of health inequities. [ABSTRACT FROM AUTHOR]

Background: Although many studies have assessed the socioeconomic inequalities caused by COVID-19 in several health outcomes, there are numerous issues that have been poorly addressed. For instance, have socioeconomic inequalities in mortality from COVID-19 increased? What impact has the pandemic had on inequalities in specific causes of mortality other than COVID-19? Are the inequalities in COVID-19 mortality different from other causes? In this paper we have attempted to answer these questions for the case of Spain. Methods: We used a mixed longitudinal ecological design in which we observed mortality from 2005 to 2020 in the 54 provinces into which Spain is divided. We considered mortality from all causes, not excluding, and excluding mortality from COVID-19; and cause-specific mortality. We were interested in analysing the trend of the outcome variables according to inequality, controlling for both observed and unobserved confounders. Results: Our main finding was that the increased risk of dying in 2020 was greater in the Spanish provinces with greater inequality. In addition, we have found that: (i) the pandemic has exacerbated socioeconomic inequalities in mortality, (ii) COVID-19 has led to gender differences in the variations in risk of dying (higher in the case of women) and (iii) only in cardiovascular diseases and Alzheimer did the increased risk of dying differ between the most and least unequal provinces. The increase in the risk of dying was different by gender (greater in women) for cardiovascular diseases and cancer. Conclusion: Our results can be used to help health authorities know where and in which population groups future pandemics will have the greatest impact and, therefore, be able to take appropriate measures to prevent such effects. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) youth experience significant risk for negative health outcomes, yet few studies exist that address TGD youth's experiences of health care. This paper explores the equitable access and utilization of health care in a sample of TGD youth of diverse gender and racial/ethnic identities. Data for this analysis are from the TGD subsample (n = 1415) of the 2018 Survey of Today's Adolescent Relationships and Transitions (START) Project. We assessed five health care experiences: being insured, having a current health care provider, being out to one's provider, believing your provider was knowledgeable about transgender issues, and barriers to accessing care due to gender identity/expression. We examined the proportion of TGD youth who reported each of these outcomes and within-group differences by gender identity and race/ethnicity using descriptive statistics, logistic regression, and predicted probabilities. When differences were examined by gender identity, barriers to equitable care were consistently more present among transgender females than youth of other gender identities. There were few significant differences by race/ethnicity; however, dual referent models demonstrated barriers to equitable care were particularly evident among Black and Hispanic transgender women. We discuss these findings through the lens of intersectionality and highlight the importance of research and intervention work focused on reducing barriers to equitable care for TGD youth. [ABSTRACT FROM AUTHOR]

Purpose: In Aotearoa me Te Waipounamu (New Zealand; NZ) there are considerable inequities in health status and outcomes for Māori, the Indigenous peoples of NZ. It is therefore important that the health status and preferences of Māori are specifically considered in healthcare policy and decision making. This paper describes the health-related quality of life of 390 Māori adults who took part in the NZ EQ-5D-5L valuation study. Methods: Responses on the five dimensions of the EQ-5D-5L were dichotomised into "no problems" and "any problems", summarised and disaggregated by age group. Mean preference weights were reported by age group and overall. Mean utility values (calculated by applying each participant's preference weights to their EQ-5D-5L profile) were summed and respective means and standard deviations reported by age, chronic disease status and disability. Results: The EQ-5D-5L dimensions with the highest proportion of participants reporting any problems were pain/discomfort (61.5%) and anxiety/depression (50%). The most commonly-reported chronic disease was mental illness/distress (24.6%). Anxiety/depression ranked as the most important dimension, with usual activities, the least important. The mean utility value was 0.83 with the lowest value (0.79) found in the 18–24 and 45–54 age groups. For participants with at least one chronic disease the mean utility value was 0.76 compared to 0.91 for those with none. Conclusion: To reduce inequities experienced by Māori it is crucial that the health status of Māori and the values Māori place on health-related quality of life are properly understood. This can only be achieved using Māori-specific data. [ABSTRACT FROM AUTHOR]

Background: Quality-adjusted life expectancy (QALE) combines mortality risk and multidimensional health-related quality of life (HRQoL) information to measure healthy life expectancy in terms of quality-adjusted life years (QALYs). This paper estimates the relative importance of individual quality of life dimensions in explaining inequalities in QALE. Methods: We combined EQ-5D-5L data from the Health Survey for England for 2017 and 2018 (N = 14,412) with full population mortality data from the Office for National Statistics to calculate QALE by age, sex and deprivation quintile. The effect of HRQoL dimensions on the socioeconomic gradient in QALE was decomposed using an iterative imputation approach, in which inequalities associated with socioeconomic status in each domain were removed by imputing the response distribution of the richest quintile for all participants. Sampling uncertainty in the HRQoL data was evaluated using bootstrapping. Results: People in the least deprived fifth of neighbourhoods in England can expect to live 7.0 years longer and experience 11.1 more QALYs than those in the most deprived fifth. Inequalities in HRQoL accounted for 28.0% and 45.7% of QALE inequalities for males and females, respectively. Pain/discomfort, anxiety/depression and mobility were the most influential HRQoL domains. Discussion: Our results identify the extent of inequalities associated with socioeconomic status in lifetime health and the relative importance of inequalities by mortality and HRQoL. The contributions of the individual dimensions of HRQoL towards lifetime inequalities vary substantially by sex. Our findings can help to identify the types of interventions most likely to alleviate health inequalities, which may be different for males and females. [ABSTRACT FROM AUTHOR]