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1.
Mayara Fontes Marx Leslie London Alex Müller 《BMC international health and human rights》2018,18(1):33
Background
Despite 20 years of democracy, South Africa still suffers from profound health inequalities. Gender roles and norms are associated with individuals’ vulnerability that lead to ill-health. For instance, gender inequality influences women’s access to health care and women’s agency to make health-related decisions. This paper explores gender-awareness and inclusivity in organisations that advocate for the right to health in South Africa, and analyses how this knowledge impacts their work?Methods
In total, 10 in-depth interviews were conducted with members of The Learning Network for Health and Human Rights (LN), a network of universities and Civil Society Organisations (CSOs) which is explicitly committed to advancing the right to health, but not explicitly gendered in its orientation.Results
The results show that there is a discrepancy in knowledge around gender and gendered power relations between LN members. This discrepancy in understanding gendered power relations suggests that gender is ‘rendered invisible’ within the LN, which impacts the way the LN advocates for the right to health.Conclusions
Even organizations that work on health rights of women might be unaware of the possibility of gender invisibility within their organisational structures.2.
A. McAllister S. Fritzell M. Almroth L. Harber-Aschan S. Larsson B. Burström 《International journal for equity in health》2018,17(1):180
Background
In Europe and elsewhere there is rising concern about inequality in health and increased prevalence of mental ill-health. Structural determinants such as welfare state arrangements may impact on levels of mental health and social inequalities. This systematic review aims to assess the current evidence on whether structural determinants are associated with inequalities in mental health outcomes.Methods
We conducted a systematic review of quantitative studies published between 1996 and 2017 based on search results from the following databases Medline, Embase, PsychInfo, Web of Science, Sociological Abstracts and Eric. Studies were included if they focused on inequalities (measured by socio-economic position and gender), structural determinants (i.e. public policies affecting the whole population) and showed a change or comparison in mental health status in one (or more) of the Organisation for Economic Cooperation and Development (OECD) countries. All studies were assessed for inclusion and study quality by two independent reviewers. Data were extracted and synthesised using narrative analysis.Results
Twenty-one articles (17 studies) met the inclusion criteria. Studies were heterogeneous with regards to methodology, mental health outcomes and policy settings. More comprehensive and gender inclusive welfare states (e.g. Nordic welfare states) had better mental health outcomes, especially for women, and less gender-related inequality. Nordic welfare regimes may also decrease inequalities between lone and couple mothers. A strong welfare state does not buffer against socio-economic inequalities in mental health outcomes. Austerity measures tended to worsen mental health and increase inequalities. Area-based initiatives and educational policy are understudied.Conclusion
Although the literature on structural determinants and inequalities in mental health is limited, our review shows some evidence supporting the causal effects of structural determinants on mental health inequalities. The lack of evidence should not be interpreted as lack of effect. Future studies should apply innovative methods to overcome the inherent methodological challenges in this area, as structural determinants potentially affect both levels of mental health and social inequalities.3.
N. Otaki N. Tanino M. Yokoro M. Yano M. Akita H. Uemura M. Maeda Keisuke Fukuo 《The journal of nutrition, health & aging》2018,22(6):695-699
Objectives
The purpose of this study was to assess the relationship between economic security and self-rated health for elderly Japanese residents living alone.Design
A secondary analysis of a cross-sectional study.Setting
N City, H. Prefecture, Japan.Participants
Survey questionnaires were distributed to 2,985 elderly residents living alone, aged ≥70 years, of which, 1,939 (65.0%) were returned and treated as valid responses.Measurements
The survey included questions about gender, age, number of years spent in N City, self-rated health, economic security, number of years spent living alone, reason for living alone, life satisfaction, cooking frequency, frequency of seeing a doctor, long-term care service usage, as well as whether they enjoyed their lives, participated in social organizations.Results
Of the respondents, 1,563 (80.6%) reported that they were economically secure, and 376 (19.4%) responded that they were insecure. The odds ratio predicting poor self-rated health for the economically insecure participants was significantly high (odds ratio: 3.19, 95%, Confidence Interval (CI): 2.53?4.02, and P < 0.001). Similarly, the adjusted odds ratio for poor self-rated health was significantly high for the economically insecure participants in multivariate analyses controlling for factors such as age, gender, cooking frequency, and social participation (adjusted odds ratio: 2.21, 95%, CI: 1.70?2.88, and P < 0.001). Furthermore, a similar trend was observed in stratified analyses based on gender and age groups.Conclusion
Economic security predicted self-rated health independently of confounders, including social participation and cooking frequency, among the elderly Japanese living alone in communities.4.
Background
There is a growing understanding of the role social determinants such as poverty, gender discrimination, racial prejudice, and economic inequality play on health and illness. While these determinants and effects may be challenging to identify in parts of high-income countries, they are patently obvious in many other areas of the world. How we react to these determinants and effects depends on what historical, cultural, ideological, and psychological characteristics we bring to our encounters with inequity, as well as how our feelings and thoughts inform our values and actions.Discussion
To address these issues, we share a series of questions we have asked ourselves—United States’ citizens with experience living and working in Central America—in relation to our encounters with inequity. We offer a conceptual framework for contemplating responses in hopes of promoting among educators and practitioners in medicine and public health an engaged awareness of how our every day work either perpetuates or breaks down barriers of social difference. We review key moments in our own experiences as global health practitioners to provide context for these questions.Summary
Introspective reflection can help professionals in global medicine and public health recognize the dynamic roles that they play in the world. Such reflection can bring us closer to appreciating the forces that have worked both for and in opposition to global health, human rights, and well-being. It can help us recognize how place, time, environment, and context form the social determination of health. It is from this holistic perspective of social relations that we can work to effect fair, equitable, and protective environments as they relate to global medicine and public health.5.
Background
Chronic conditions contribute to over 70 % of Australia’s total disease burden, and this is set to increase to 80 % by 2020. Women’s greater longevity means that they are more likely than men to live with disability and have unique health concerns related to their gender based roles in society. Cultural and social issues can impact on women's health and are important to consider in health services planning and research. In this study, we aimed to identify barriers and facilitators to providing a gender-based approach to chronic conditions and women's health in an eastern metropolitan region of Australia.Methods
Focus groups were used to engage both community-dwelling women who had chronic conditions and relevant professional stakeholders in the target area. Recorded proceedings underwent thematic analysis.Results
Five focus groups were conducted with professional stakeholders and women community members in February and March 2014. Resultant themes included: women’s disempowerment through interactions with health systems; social and economic constraints and caregiving roles act to exclude women from participating in self-care and society; and empowerment can be achieved through integrated models of care that facilitate voice and enable communication and engagement.Conclusions
This study underscores the importance of including perspectives of sex and gender in health care services planning. Tailoring services to socio-demographic and cultural groups is critical in promoting access to health care services. Unique epidemiological trends, particularly the ageing of women and new migrant groups, require particular attention.6.
Background
Despite various policy interventions that have targeted reductions in socio-economic inequalities in health and health care in post-Apartheid South Africa, evidence suggests that not much has really changed. In particular, health inequalities, which are strongly linked to social determinants of health (SDH), persist. This study, thus, examines how changes in the SDH have impacted health inequalities over the last decade, the second since the end of Apartheid.Methods
Data come from information collected on social determinants of health (SDH) and on health status in the 2004, 2010 and 2014 questionnaires of the South African General Household Surveys (GHSs). The health indicators considered include ill-health status and disability. Concentration indices and Oaxaca-Blinder decomposition of change in a concentration index methods were employed to unravel changes in socio-economic health inequalities and their key social drivers over the studied time period.Results
The results show that inequalities in ill-health are consistently explained by socio-economic inequalities relating to employment status and provincial differences, which narrowed considerably over the studied periods. Relatedly, disability inequalities are largely explained by shrinking socio-economic inequalities relating to racial groups, educational attainment and provincial differences.Conclusion
The extent of employment, location and education inequalities suggests the need for improved health care management and further delivery of education and job opportunities; greater effort in this regard is likely to be more beneficial in some way.7.
Dianne Currier Jane Pirkis John Carlin Louisa Degenhardt Shyamali C. Dharmage Billie Giles-Corti Ian Gordon Lyle Gurrin Jane Hocking Anne Kavanagh Louise A. Keogh Rachel Koelmeyer Anthony D. LaMontagne Marisa Schlichthorst George Patton Lena Sanci Matthew J. Spittal David M. Studdert Joanne Williams Dallas R. English 《BMC public health》2016,16(3):1030
Background
The Australian Longitudinal Study on Male Health (Ten to Men) was established in 2011 to build the evidence base on male health to inform policy and program development.Methods
Ten to Men is a national longitudinal study with a stratified multi-stage cluster random sample design and oversampling in rural and regional areas. Household recruitment was conducted from October 2013 to July 2014. Males who were aged 10 to 55 years residing in private dwellings were eligible to participate. Data were collected via self-completion paper questionnaires (participants aged 15 to 55) and by computer-assisted personal interview (boys aged 10 to 14). Household and proxy health data for boys were collected from a parent via a self-completion paper-based questionnaire. Questions covered socio-demographics, health status, mental health and wellbeing, health behaviours, social determinants, and health knowledge and service use.Results
A cohort of 15,988 males aged between 10 and 55 years was recruited representing a response fraction of 35 %.Conclusion
Ten to Men is a unique resource for investigating male health and wellbeing. Wave 1 data are available for approved research projects.8.
André Hajek C. Brettschneider H. van den Bussche H. Kaduszkiewicz A. Oey B. Wiese S. Weyerer J. Werle A. Fuchs M. Pentzek J. Stein T. Luck H. Bickel E. Mösch K. Heser M. Bleckwenn M. Scherer S. G. Riedel-Heller W. Maier H.-H. König AgeCoDe & AgeQualiDe Study Groups 《The journal of nutrition, health & aging》2018,22(6):689-694
Objectives
The aim of this study was to identify determinants of outpatient health care utilization among the oldest old in Germany longitudinally.Design
Multicenter prospective cohort “Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)” (AgeQualiDe).Setting
Individuals in very old age were recruited via GP offices at six study centers in Germany. The course of outpatient health care was observed over 10 months (two waves).Participants
Primary care patients aged 85 years and over (at baseline: n=861, with mean age of 89.0 years±2.9 years; 85–100 years).Measurements
Self-reported numbers of outpatient visits to general practitioners (GP) and specialists in the past three months were used as dependent variables. Widely used scales were used to quantify explanatory variables (e.g., Geriatric Depression Scale, Instrumental Activities of Daily Living Scale, or Global Deterioration Scale).Results
Fixed effects regressions showed that increases in GP visits were associated with increases in cognitive impairment, whereas they were not associated with changes in marital status, functional decline, increasing number of chronic conditions, increasing age, and changes in social network. Increases in specialist visits were not associated with changes in the explanatory variables.Conclusion
Our findings underline the importance of cognitive impairment for GP visits. Creating strategies to postpone cognitive decline might be beneficial for the health care system.9.
Arezoo Yari Saharnaz Nedjat Mohsen Asadi-Lari Reza Majdzadeh 《BMC international health and human rights》2017,17(1):24
Background
Evidence shows ethnic-inequality is a very effective variable in the Community and individual health associated outcomes. This study focused on gaining a deeper understanding of people’s perception on inequality of health in Iranian-Kurds and its determinants.Methods
The study was conducted in the three cities of Marivan, Sanandaj (capital of Kurdistan province in Iran) and Tehran (capital of the country). The study was conducted through 34 in-depth interviews and ten focus group discussions with health services users, academic graduates and health delivery service personnel.Results
Consensus on social, mental and physical health inequality did not exist within the study participants. However, there were concerns about differences in healthcare access and utilization. Several participants believed that access to health services and socio-cultural differences of Kurds affected the healthcare utilization.Conclusions
Since, people perceived ethnic-inequality in healthcare access and utilization, ethnicity must be considered as a mandatory stratifier in monitoring health status and a concern during planning health interventions. People’s awareness, resources management and allocation are factors requiring more consideration when choosing policy options.10.
Background
In previous public health surveys large differences in health have been shown between citizens living in different neighbourhoods in the Örebro municipality, which has about 125000 inhabitants. The aim of this study was to investigate the determinants of health with an emphasis on the importance of neighbourhood characteristics such as the influence of neighbourhood social cohesion and social capital. The point of departure in this study was a conceptual model inspired by the work of Carpiano, where different factors related to the neighbourhood have been used to find associations to individual self-rated health.Methods
We used data from the survey 'Life &; Health 2004' sent to inhabitants aged 18-84 years in Örebro municipality, Sweden. The respondents (n = 2346) answered a postal questionnaire about living conditions, housing conditions, health risk factors and individual health. The outcome variable was self-rated health. In the analysis we applied logistic regression modelling in various model steps following a conceptual model.Results
The results show that poor self-rated health was associated with social capital, such as lack of personal support and no experience of being made proud even after controlling for strong factors related to health, such as age, disability pension, ethnicity and economic stress. Also the neighbourhood factors, housing area and residential stability were associated with self-rated health. Poor self-rated health was more common among people living in areas with predominately large blocks of flats or areas outside the city centre. Moreover, people who had lived in the same area 1-5 years reported poor health more frequently than those who had lived there longer.Conclusions
The importance of the neighbourhood and social capital for individual health is confirmed in this study. The neighbourhoods could be emphasized as settings for health promotion. They can be constructed to promote social interaction which in turn supports the development of social networks, social support and social capital - all important determinants of health.11.
Background
The new Prevention Law includes important starting points to strengthen and to further develop occupational health promotion and prevention practices in Germany. A major impetus lies in the encouragement of specific and better collaboration of social insurance and other health policy players, in establishing corresponding structures and in the rearrangement of the financial basis.Aims
The Prevention Law strengthens the development of health insurance services with respect to content and systematic orientation and evaluation.Results
Opportunties for systematic development of different approaches and services in health promotion and prevention are fostered through the Prevention Law. It covers rules for intersectoral cooperation with the occupational safety and health system, which have been long overdue; finally, it aims at reducing gender inequality with regard to health promotion and prevention.12.
Jens-Oliver Bock Dirk Heider Herbert Matschinger Hermann Brenner Kai-Uwe Saum Walter E. Haefeli Hans-Helmut König 《The European journal of health economics》2016,17(2):149-158
Introduction
All elderly Germans are legally obliged to have health insurance. About 90 % of this population are members of social health insurances (SHI) whose premiums are generally income-related and independent of health status. For most of these members, holding social health insurance is mandatory. As a consequence, genuine information about preferences for health insurance is not available. The aim of this study was therefore to determine and analyze the willingness to pay (WTP) for health insurance among elderly Germans.Methods
Data from a population-based 8-year follow-up of a large cohort study conducted in the Saarland, Germany was used. Participants aged 57–84 years passed a geriatric assessment and responded to a health economic questionnaire. Individuals’ WTP was elicited based on a contingent valuation method with a payment card.Results
Mean monthly WTP per capita for health insurance amounted to €260. This corresponded to about 20 % of individual disposable income. Regression analyses showed that WTP increased significantly with higher income, male gender, higher educational level, and privately insured status. In contrast, neither increasing morbidity level nor higher individual health care costs influenced WTP significantly.Discussion
The relatively large extent of average WTP for health insurance indicates that the elderly would probably accept higher contributions to SHI rather than policy efforts to reduce contributions. The identified determinants of WTP might indicate that elderly generally approve the principle of solidarity of the SHI with contributions depending on income rather than morbidity.13.
Objective
To explore the relationships among ethnicity/race, gender, demographics, age-group and dietary health in a nationally representative sample of older adults.Design
Cross-sectional study.Setting
Data for this study were collected by interview in the mobile examination centers from the National Health and Nutrition Examination Surveys, 2011 - 2012.Participants
U.S. representative sample of adults aged 55 years and older (N = 1860) from five ethnic/racial groups. All participants read, understood, and signed informed consent forms under data collection procedures by trained individuals.Measurements
Sociodemographics were collected by trained interviewers using a general questionnaire. Food groups were determined by 24-hour recall using the validated USDA Automated Multiple-Pass Method. Data were presented by cross-tabulation and logistic regression to investigate relationships among race/ethnicity, gender, and age groups.Results
Over 70% of older adults failed to consume 2.75 cups of combined fruits and vegetables. Other Hispanics (Hispanics excluding Mexican Americans) had higher Odds of sugar-containing food consumption compared to non-Hispanic Whites (adjusted model). Being older and female were protective factors for over-consumption of sugar.Conclusion
Older Americans are not meeting dietary guidelines and there are differences by gender and ethnicity. Since diet has been associated with quality of life and medical costs, public health interventions can benefit by knowing age-, gender- and racial/ethnic- specific dietary behaviors.14.
Background
Gender issues remain a neglected area in most approaches to health workforce policy, planning and research. There is an accumulating body of evidence on gender differences in health workers' employment patterns and pay, but inequalities in access to non-pecuniary benefits between men and women have received little attention. This study investigates empirically whether gender differences can be observed in health workers' access to non-pecuniary benefits across six low- and middle-income countries.Methods
The analysis draws on cross-nationally comparable data from health facility surveys conducted in Chad, Côte d'Ivoire, Jamaica, Mozambique, Sri Lanka and Zimbabwe. Probit regression models are used to investigate whether female and male physicians, nurses and midwives enjoy the same access to housing allowance, paid vacations, in-service training and other benefits, controlling for other individual and facility-level characteristics.Results
While the analysis did not uncover any consistent pattern of gender imbalance in access to non-monetary benefits, some important differences were revealed. Notably, female nursing and midwifery personnel (the majority of the sample) are found significantly less likely than their male counterparts to have accessed in-service training, identified not only as an incentive to attract and retain workers but also essential for strengthening workforce quality.Conclusion
This study sought to mainstream gender considerations by exploring and documenting sex differences in selected employment indicators across health labour markets. Strengthening the global evidence base about the extent to which gender is independently associated with health workforce performance requires improved generation and dissemination of sex-disaggregated data and research with particular attention to gender dimensions.15.
Ellen Van de Poel Ahmad Reza Hosseinpoor Caroline Jehu-Appiah Jeanette Vega Niko Speybroeck 《International journal for equity in health》2007,6(1):21
Background
Malnutrition is a major public health and development concern in the developing world and in poor communities within these regions. Understanding the nature and determinants of socioeconomic inequality in malnutrition is essential in contemplating the health of populations in developing countries and in targeting resources appropriately to raise the health of the poor and most vulnerable groups.Methods
This paper uses a concentration index to summarize inequality in children's height-for-age z-scores in Ghana across the entire socioeconomic distribution and decomposes this inequality into different contributing factors. Data is used from the Ghana 2003 Demographic and Health Survey.Results
The results show that malnutrition is related to poverty, maternal education, health care and family planning and regional characteristics. Socioeconomic inequality in malnutrition is mainly associated with poverty, health care use and regional disparities. Although average malnutrition is higher using the new growth standards recently released by the World Health Organization, socioeconomic inequality and the associated factors are robust to the change of reference population.Conclusion
Child malnutrition in Ghana is a multisectoral problem. The factors associated with average malnutrition rates are not necessarily the same as those associated with socioeconomic inequality in malnutrition.16.
Michelle DiGiacomo Anna Green Patricia Delaney John Delaney Patrick Patradoon-Ho Patricia Mary Davidson Penelope Abbott 《BMC family practice》2017,18(1):96
Background
Australian parents/carers of a person with a disability experience higher rates of depression, more financial stress, and are twice as likely to be in poor physical health than the general population. Aboriginal and Torres Strait Islander peoples experience worse health, social and economic outcomes than other Australians, and those with a disability face ‘double disadvantage’. This study aimed to better understand the experiences and needs of parents/carers/families of Aboriginal children with a disability.Methods
Semi-structured in-depth interviews were conducted with parents or primary carers of Aboriginal children aged zero-eight with disability. Interviews were analysed using thematic analysis.Results
Nineteen women (sixteen mothers and three grandmothers) were interviewed. More than half were lone carers (without a partner or spouse). Participants described their experiences, including challenges and facilitators, to providing and accessing care, impacts on their health and wellbeing, and associated economic and non-economic costs of caregiving. Financial strain and social isolation was particularly prominent for lone carers.Conclusions
Tailoring services to the needs of carers of Aboriginal children with a disability means supporting kinship caregiving, facilitating engagement with other Aboriginal families, and streamlining services and systems to mitigate costs. The experiences described by our participants depict an intersection of race, socio-economic status, gender, disability, and caregiving. Services and funding initiatives should incorporate such intersecting determinants in planning and delivery of holistic care.17.
Background
Multicultural families and foreign residents are rapidly increasing in Korea. Thus, the proportion of children and adolescents from minority racial/ethnic groups are also increasing, and there are concerns about adolescents who fail to adapt to school and show low academic achievement and poor health status.Objective
This study aimed to investigate influencing factors related to academic achievement among Korean multicultural adolescents.Methods
Cross-sectional data from 2234 Korean multicultural adolescent participants from the 2010–2014 Korea Youth Risk Behavior Web-based Survey were analyzed using multiple regression.Results
Perceived economic status and breakfast frequency affected academic achievement, regardless of gender. Family affluence, satisfaction with sleep time, and lifetime smoking were additional factors in males. For females, depression and frequency of physical school activities were additional factors.Conclusion
The present study suggests that diverse individual factors should be considered, including economic status, health status, and health-related behaviors, to improve multicultural adolescents’ academic achievement.18.
Health status in a transitional society: urban-rural disparities from a dynamic perspective in China
Background
The phenomenon of urban-rural segmentation has emerged and is remarkable, and the health disparities between rural and urban China should be stressed.Methods
Based on data from the Chinese General Social Survey from 2005 to 2013, this study not only explored the net age, period, and cohort effects of self-rated health, but compared these effects between rural and urban China from a dynamic perspective through hierarchical age-period-cohort-cross-classified random effects model.Results
Urban-rural disparities, as well as work status and gender disparities in health increased with age, in line with the cumulative advantage/disadvantage effects theory, while marital status disparities in health declining with age was in line with the age-as-leveler effects theory. The war cohort, famine cohort, later cultural revolution cohort, and early reform cohort had poorer health than did those in the early China cohort, economic recovery cohort, and later reform cohort. The economic crisis period, war cohort, baby boomer, and early cultural revolution cohort encountered larger urban-rural health disparities, while the early China cohort and early reform cohort experienced smaller urban-rural disparities in health.Conclusions
Population health is closely related to social context and health care development. It is necessary to keep economic development stable and boost medical technology improvements and the construction of the health care system.19.
Léonard?Fourn Slim?Haddad Pierre?Fournier Roméo?Gansey 《BMC international health and human rights》2009,9(Z1):S14