A price to pay: The impact of user charges in ashanti-akim district,Ghana

In present constrained economic circumstances, many governments have introduced or increased user charges for health services. This has been advocated by the World Bank, justified by reference to the raising of revenue, efficiency and, controversially, even the promotion of equity. This paper examines the impact of user charges on utilisation in the Ashanti-Akim district of Ghana since the introduction of charges in 1985. In many ways, user charges have been a success: in recovering fees and maintaining urban utilisation. However some advantages have not materialised because the health infrastructure has not changed adequately. More importantly, equity and affordability have been problematical. For some of the population, services are no longer affordable.     

Loops and Building Blocks: a Knowledge co-Production Framework for Equitable Urban Health

This paper sets out a structured process for the co-production of knowledge between researchers and societal partners and illustrates its application in an urban health equity project in Accra, Ghana. The main insight of this approach is that research and knowledge co-production is always partial, both in the sense of being incomplete, as well as being circumscribed by the interests of participating researchers and societal partners. A second insight is that project-bound societal engagement takes place in a broader context of public and policy debate. The approach to co-production described here is formed of three recursive processes: co-designing, co-analysing, and co-creating knowledge. These ‘co-production loops’ are themselves iterative, each representing a stage of knowledge production. Each loop is operationalized through a series of research and engagement practices, which we call building blocks. Building blocks are activities and interaction-based methods aimed at bringing together a range of participants involved in joint knowledge production. In practice, recursive iterations within loops may be limited due of constraints on time, resources, or attention. We suggest that co-production loops and building blocks are deployed flexibly.     

Evolving Beyond the World Foods Course: Creating Racially and Ethnically Inclusive Educational Spaces for Dietetics Students

Only 13.1% of US registered dietitian nutritionists and 27.8% of students enrolled in US dietetics education programs identify as racially/ethnically diverse individuals. National demographic trends show increasing percentages of racially/ethnically diverse individuals within the broader US and college student populations; however, these changes have not been mirrored within dietetics. Dietetics educators have an ethical and professional mandate to address diversity, equity, and inclusion within their programs. This paper reviews key terminology related to diversity, equity, and inclusion in the context of dietetics education, and describes a new framework to transform dietetics education based on the principles of cultural humility and culturally sustaining teaching. Strategies are presented to facilitate recruitment, admissions, retention, and mentorship for racially/ethnically diverse students and faculty, and to improve diversity, equity, and inclusion within curricula and classrooms. Lastly, this paper provides clear practice applications, including recommendations for program policy change and training/skill building activities for dietetics students, educators, and preceptors.     

2014年—2018年内蒙古社区卫生资源配置现状及公平性研究

目的 分析2014—2018年内蒙古社区卫生资源配置现状及公平性情况,为进一步优化社区卫生资源配置提供依据。 方法 采用洛伦兹曲线和基尼系数评价内蒙古社区卫生资源配置公平性。 结果 内蒙古地区社区卫生资源配置按地区分布存在“中间高,两边低”的现象。2014年至2018年内蒙古地区卫生资源总量在不断增长;整体看在国内生产总值维度上各项社区卫生资源洛伦兹曲线弯曲程度最小,地理面积维度上各项社区卫生资源洛伦兹曲线弯曲程度最大。 结论 内蒙古社区卫生资源总量不断增长,但人均不足;执业（助理）医师和注册护士人才稀缺;按常住人口和国内生产总值配置的卫生资源比较公平,按地理面积配置的卫生资源差距悬殊。     

广东省专业公共卫生机构卫生资源配置公平性分析

目的 分析广东省专业公共卫生机构卫生资源配置现状及其公平性,为后续研究和公共卫生服务资源的优化配置提供数据支撑。方法 对广东省专业公共卫生机构卫生资源配置情况进行描述性分析;通过卫生资源集聚度（HRAD）分析其配置的可及性和公平性。 结果 广东省专业公共卫生机构数呈负增长,为- 10.13%,而公共卫生人力资源总量逐年递增,年均增速在3.0%以上。2019年各地市公共卫生资源配置的公平性差异显著。2013—2019年东翼地区公共卫生人力资源基于人口分布的公平性较差,而西翼和山区公共卫生资源基于地理分布的可及性较差。结论 广东省专业公共卫生机构卫生人力资源配置总量逐年增长,但增速尚需提高。区域间、区域内卫生资源配置的可及性、公平性差异显著,公共卫生资源分布不均衡的状况仍然存在,人才短缺的情况仍是短板。应持续推动优质公共卫生资源扩容和区域均衡布局,稳定和发展公共卫生人才队伍,提高现有公共卫生资源的配置效率和利用效率。     

“十三五”以来广西村卫生室卫生资源配置公平性分析

目的 评价广西“十三五”以来村卫生室卫生资源配置公平性,为优化村卫生室卫生资源配置提供依据。方法 运用洛伦兹曲线、基尼系数、泰尔指数,从人口和地理两个角度,分析2016—2019年广西村卫生室卫生资源配置状况及公平性。结果 2016—2019年,广西村卫生室卫生资源数量逐年减少并低于同期全国、东部、中部和西部平均水平。桂北与桂东地区卫生资源拥有量较高,桂西地区较少。各卫生资源指标的基尼系数按人口分布在0.113 2～0.484 3之间;按按地理分布在0.371 7～0.652 6之间。总泰尔指数在0.225 2～0.791 6之间,区域内的泰尔指数贡献率大于区域间。结论 广西村卫生室卫生资源总量不足,分布存在地区差异;卫生资源配置按人口分布的公平性优于按地理分布;卫生资源配置的不公平性主要受区域内差异的影响。     

中国中老年人失能状况公平性与影响因素

目的 分析中国50岁及以上中老年人失能状况和失能状况公平性,并探究中老年人失能状况不公平的主要影响因素。方法 利用全球老龄化与成人健康研究(Study on Global Ageing and Adult Health,SAGE)中国2007—2010年第一轮调查数据,计算集中指数和集中曲线,并对集中指数进行分解。结果 中国中老年人失能评估量表平均分为7.32,中老年男性平均分为6.37,女性平均分为8.21。中老年人失能状况集中指数为-0.190 9,中老年男性为-0.184 4,中老年女性为-0.196 1。对集中指数进行分解后,社会经济地位对中老年人失能状况不公平的贡献较高,包括经济水平、受教育程度和工作类型,贡献率分别为66.41%、16.45%和13.10%。与社会结构因素相比,中老年人吸烟、饮酒和身体活动情况等个人生活方式因素的贡献率较低。结论 中国存在中老年人失能状况不公平,较好的健康状况集中在经济水平较好的中老年人群中。中老年男性失能状况较女性更轻,且失能状况不公平程度更小。经济水平、受教育程度和工作类型是对中国中老年人失能状况不公平贡献率较高的主要因素,提示仅通过促进中老年人健康生活方式不能够有效减少失能状况在经济水平较好和较差的中老年人群中的差异。政府需要在重视促进中老年人健康的基础上,进一步加强和完善适宜的社会和医疗保障措施,将减少中老年人健康不公平作为政策重点,尤其应该向发展相对滞后、中老年人相对聚集的地区重点分配医疗卫生和其他相关社会资源,同时应该加大对中老年人健康和健康公平相关研究的支持,为积极应对人口老龄化和制定政策收集证据。     

关于改善我国卫生服务公平性的思考

卫生服务公平性问题是我国深化卫生改革中关注的焦点问题之一.该文从卫生服务公平性的概念及衡量出发,探讨目前我国卫生服务公平性低下的现状及其主要原因,并提出了相应的对策与建议.     

卫生服务公平的逻辑分析与政策选择

卫生服务公平的内涵是指在同等健康与疾病状况下接受卫生服务的权利公平,并且基本卫生服务需要应该完全平等.卫生服务公平原则的实现需要有相应的社会经济条件作为基础,在当前情况下只能通过建立医疗保障制度,提高卫生服务可得性和可及性,以及补贴基本卫生服务等措施,达到基本卫生需要完全均等的标准.     

In-situ at a distance? challenges and opportunities for health and place research methods in a post-COVID-19 world

In-situ methodologies, including go-along and photo-elicited interviews, are ideal for harnessing people's lived experiences of place and their meanings for health and health equity. Their immersive nature means that the COVID-19 pandemic has impacted their use. Physical distancing measures combined to anxiety over the sharing of physical space have created ethical and practical challenges to the conduct of in-person in-situ methodologies. However, in-situ methodologies are precisely needed to gain deeper understandings of people's changing relationships to place post-COVID-19. In this commentary we discuss emerging challenges, highlight questions researchers should ask before engaging in these methods in the future, and explore adaptations and alternatives to traditional in-person in-situ methodologies.