Reducing Socio-economic Inequalities in Health: The Role of Simulation Modeling in Evaluating the Impact of Population Health Interventions

Abstract Within-country social inequalities in health have widened while global health inequalities have (with some exceptions) narrowed since the Second World War. On commonly accepted prioritarian and sufficientist views of justice and health, these two trends together would be acceptable: the wealthiest of the wealthy are pulling ahead, but the worst off are catching up and more are achieving sufficiency. Such commitments to priority or sufficiency are compatible with a common “development” narrative about economic and social changes that accompany changes (“transitions”) in population health. I set out a very simple version of health egalitarianism (without commitment to any particular current theory of justice) and focus on two common objections to egalitarianism. Priority and sufficiency both address the levelling down and formalism objections, but these objections are distinct: giving content to equality (I argue here) places in question the claimed normative superiority of priority and sufficiency. Using examples of the role of antimicrobials in both these trends – and the future role of AMR – I clarify (first) the multiple forms and dimensions of justice at play in health, and (second) the different mechanisms at work in generating the two current patterns (seen in life course narratives and narratives of political economy). The “accelerated transition” that narrowed global health inequalities is fed by anti-microbials (among other technology transfers). It did not accelerate but replaced the causal processes by which current HICs achieved the transition (growing and shared economic prosperity and widening political franchise). The impact of AMR on widening social inequalities in health in HICs will be complex: inequality has been fed in part by tertiary care enabled by antimicrobials; AMR might erode the solidarity underlying universal health systems as the well-off seek to maintain current expectations of curative and rehabilitative surgery and chemotherapy while AMR mounts. In light of both speculations about the impact of AMR on social and global health inequalities, I close with practical and with theoretical reflection. I briefly indicate the practical importance of understanding AMR from the perspective of health justice for policy response. Then, from a broader perspective, I argue that the content by which I meet the formalism objection demonstrates that the two trends (broadening within-country inequality and narrowing global inequality) are selective and biased samples of a centuries-long pattern of widening social inequalities in health. We are not in the midst of a process of “catching up”. In light of the long-term pattern described here, is the pursuit of sufficiency or priority morally superior to the pursuit of equality as a response to concrete suffering – or do they rationalize a process more objectively described as the best-off continuing to take the largest share of one of the most important benefits of economic development?

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The Role of the Pathologist in Population Health

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0223-cp ◽

2018 ◽

Vol 143 (5) ◽

pp. 610-620 ◽

Cited By ~ 2

Author(s):

David J. Gross ◽

Mary Kennedy ◽

Tarush Kothari ◽

David O. Scamurra ◽

Myra L. Wilkerson ◽

...

Keyword(s):

Population Health ◽

Health Management ◽

Laboratory Data ◽

Value Added ◽

Medical Laboratory ◽

Population Health Management ◽

Semistructured Interviews ◽

Value Based Care ◽

The Impact

Context.— As part of its value-based care initiative, the College of American Pathologists has pursued research to better understand the role pathologists can have in population health. Objectives.— To answer the following questions: (1) what is the impact of population health and population health management on pathologists; (2) what roles are pathologists playing in population health management; (3) is population health something that pathologists in both larger and smaller settings can engage in; (4) are pathologists in a position to analyze laboratory data for population health, and, if so, what are the key information sources those pathologists must access; and (5) what steps can a pathologist take to become involved in population health? Design.— We conducted 10 semistructured interviews with pathologists and other medical laboratory leaders who have been active in population health. These interviews were supplemented with a review of the medical literature. Results.— Pathologists have demonstrated that laboratory data can provide unique value-added contributions to improving the health of populations. These contributions are not limited to pathologists in large, integrated settings. However, pathologists need to be proactive to contribute to health systems' population health efforts and may need to both enhance their own skills and the quality of their data to maximize the value of their contributions. Conclusions.— Although not necessarily a definitive summary of the roles that pathologists are playing in population health, this article identifies some of the promising and innovative activities occurring among pathologists and laboratorians.

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Introduction to Public Health in Pharmacy

10.1093/med/9780190238308.001.0001 ◽

2018 ◽

Keyword(s):

Public Health ◽

Population Health ◽

Pharmacy Practice ◽

The United States ◽

Pharmacy Education ◽

Health Care Outcomes ◽

Disease States ◽

Care Outcomes ◽

The Impact

The need for texts that blend the areas of pharmacy and public health has continued to expand. Introduction to Public Health in Pharmacy (second edition), builds upon the Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes report, which emphasizes public health in the domains of Foundational Knowledge and Essentials of Pharmacy Practice and Care, focusing on both patient and population health care outcomes. This second edition has (a) a strong pharmacy-relevant emphasis on the foundations of public health in pharmacy and (b) an increased emphasis on the impact of pharmacy on disease states important in public health and pharmacy in the United States and internationally. This text can be adopted for pharmacy and public health courses but would also be a valuable resource to those teaching therapeutics, patient care, disease prevention, and community engagement. In addition, it is an invaluable resource and handbook for practitioners. The focus is on the role of pharmacy in population health.

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Modeling the Impact of Social Determinants of Health on HIV

AIDS and Behavior ◽

10.1007/s10461-021-03399-2 ◽

2021 ◽

Author(s):

Joseph W. Hogan ◽

Noya Galai ◽

Wendy W. Davis

Keyword(s):

Social Determinants Of Health ◽

Population Health ◽

Social Services ◽

Social Determinants ◽

Critical Role ◽

Individual Characteristics ◽

Determinants Of Health ◽

Modeling Approaches ◽

The Impact

AbstractThere is growing evidence for the key role of social determinants of health (SDOH) in understanding morbidity and mortality outcomes globally. Factors such as stigma, racism, poverty or access to health and social services represent complex constructs that affect population health via intricate relationships to individual characteristics, behaviors and disease prevention and treatment outcomes. Modeling the role of SDOH is both critically important and inherently complex. Here we describe different modeling approaches and their use in assessing the impact of SDOH on HIV/AIDS. The discussion is thematically divided into mechanistic models and statistical models, while recognizing the overlap between them. To illustrate mechanistic approaches, we use examples of compartmental models and agent-based models; to illustrate statistical approaches, we use regression and statistical causal models. We describe model structure, data sources required, and the scope of possible inferences, highlighting similarities and differences in formulation, implementation, and interpretation of different modeling approaches. We also indicate further needed research on representing and quantifying the effect of SDOH in the context of models for HIV and other health outcomes in recognition of the critical role of SDOH in achieving the goal of ending the HIV epidemic and improving overall population health.

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The role of connectivity on COVID-19 preventive approaches

10.1101/2021.03.11.21253348 ◽

2021 ◽

Author(s):

V. Miró Pina ◽

J. Nava-Trejo ◽

A. Tóbiás ◽

E. Nzabarushimana ◽

A. Gonzalez-Casanova ◽

...

Keyword(s):

Public Health ◽

Contact Structure ◽

Vaccination Strategy ◽

Demographic Characteristics ◽

Health Interventions ◽

Public Health Interventions ◽

The Impact ◽

Modelling Approaches

AbstractPreventive and modelling approaches to address the COVID-19 pandemic have been primarily based on the age or occupation, and often disregard the importance of the population contact structure and individual connectivity. To address this gap, we developed models that first incorporate the role of heterogeneity and connectivity and then can be expanded to make assumptions about demographic characteristics. Results demonstrate that variations in the number of connections of individuals within a population modify the impact of public health interventions such vaccination approaches. We conclude that the most effective vaccination strategy will vary depending on the underlying contact structure of individuals within a population and on timing of the interventions.

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Intergroup Threat and Outgroup Attitudes

Social Psychology ◽

10.1027/1864-9335/a000127 ◽

2013 ◽

Vol 44 (5) ◽

pp. 311-319 ◽

Cited By ~ 12

Author(s):

Marco Brambilla ◽

David A. Butz

Keyword(s):

Gay Men ◽

Social Group ◽

Welfare Recipients ◽

Intergroup Attitudes ◽

Social Policies ◽

Intergroup Threat ◽

Economic Threat ◽

The Impact ◽

General Climate

Two studies examined the impact of macrolevel symbolic threat on intergroup attitudes. In Study 1 (N = 71), participants exposed to a macrosymbolic threat (vs. nonsymbolic threat and neutral topic) reported less support toward social policies concerning gay men, an outgroup whose stereotypes implies a threat to values, but not toward welfare recipients, a social group whose stereotypes do not imply a threat to values. Study 2 (N = 78) showed that, whereas macrolevel symbolic threat led to less favorable attitudes toward gay men, macroeconomic threat led to less favorable attitudes toward Asians, an outgroup whose stereotypes imply an economic threat. These findings are discussed in terms of their implications for understanding the role of a general climate of threat in shaping intergroup attitudes.

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