Measuring and Combatting Health-Related Inequalities

2021 ◽  
pp. 184-204
Author(s):  
James Wilson
Keyword(s):  
Public Health ◽  
Lived Experience ◽  
Health Systems ◽  
Health Equity ◽  
Power Structures ◽  
Health Related ◽  
Break Up ◽  
Pluralist Approach

This chapter examines how health systems should measure, and respond to, health-related inequalities. Health equity is often taken to be a core goal of public health, but what exactly health equity requires is more difficult to specify. There are indefinitely many health-related variables that can be measured, and variation in each of these variables can be measured in a number of different ways. Given the systemic interconnections between variables, making a situation more equal in some respects will tend to make it less equal in others. The chapter argues for a pluralist approach to health equity measurement, which takes its cue from the lived experience of individuals’ lives. Reflection on the deepest and most resilient causes of health-related inequalities shows that they are often the result of intersecting structural concentrations of power—structures which it is vital, but very difficult, to break up.

scholarly journals Health Equity Lens Embedded in the Public Health Policies of Saudi Arabia: A Qualitative Document Analysis

SAGE Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 215824402096277
Author(s):  
Leena Eklund Karlsson ◽  
Anne Leena Ikonen ◽  
Kothar Mohammed Alqahtani ◽  
Pernille Tanggaard Andersen ◽  
Subash Thapa
Keyword(s):  
Public Health ◽  
Saudi Arabia ◽  
Health Equity ◽  
Policy Development ◽  
Health Policies ◽  
Future Health ◽  
Public Health Policies ◽  
The People ◽  
The Social ◽  
Health Related

In the Kingdom of Saudi Arabia (KSA), no studies have been documented to analyze the equity aspects of public health policies. The aims of the study were to identify policy documents in the KSA relevant to public health and to explore whether these include an equity approach. Twenty health-related documents were identified from various ministries’ websites and analyzed through directed content analysis. The results showed that the term “equity” was neither defined nor explained in the documents and suggestions on how to tackle health inequities were lacking. None of the suggested measures communicated an explicit focus on promoting health equity or the social gradient. Several upstream, midstream, and downstream measures were suggested to improve justice and public health for the people. The study reveals that there is a need for an in-depth assessment of the policy measures across sectors and their influence on health equity to inform future health policy development and action in the KSA.

scholarly journals “The health equity curse”: ethical tensions in promoting health equity

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bernie Pauly ◽  
Tina Revai ◽  
Lenora Marcellus ◽  
Wanda Martin ◽  
Kathy Easton ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Health Equity ◽  
Ethical Challenges ◽  
Services Research ◽  
Ethical Concerns ◽  
Ethical Frameworks ◽  
Ph Values ◽  
Constant Comparative Analysis ◽  
Health Agenda

Abstract Background Public health (PH) practitioners have a strong moral commitment to health equity and social justice. However, PH values often do not align with health systems values, making it challenging for PH practitioners to promote health equity. In spite of a growing range of PH ethics frameworks and theories, little is known about ethical concerns related to promotion of health equity in PH practice. The purpose of this paper is to examine the ethical concerns of PH practitioners in promoting health equity in the context of mental health promotion and prevention of harms of substance use. Methods As part of a broader program of public health systems and services research, we interviewed 32 PH practitioners. Results Using constant comparative analysis, we identified four systemic ethical tensions: [1] biomedical versus social determinants of health agenda; [2] systems driven agendas versus situational care; [3] stigma and discrimination versus respect for persons; and [4] trust and autonomy versus surveillance and social control. Conclusions Naming these tensions provides insights into the daily ethical challenges of PH practitioners and an opportunity to reflect on the relevance of PH frameworks. These findings highlight the value of relational ethics as a promising approach for developing ethical frameworks for PH practice.

scholarly journals “The Health Equity Curse”: Ethical Tensions in Promoting Health Equity

2020 ◽  
Author(s):  
Bernie Pauly ◽  
Tina Revai ◽  
Lenora Marcellus ◽  
Wanda Martin ◽  
Kathy Easton ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Health Equity ◽  
Ethical Challenges ◽  
Services Research ◽  
Ethical Concerns ◽  
Ethical Frameworks ◽  
Ph Values ◽  
Constant Comparative Analysis ◽  
Health Agenda

Abstract Background: Public health (PH) practitioners have a strong moral commitment to health equity and social justice. However, PH values often do not align with health systems values, making it challenging for PH practitioners to promote health equity. In spite of a growing range of PH ethics frameworks and theories, little is known about ethical concerns related to promotion of health equity in PH practice. The purpose of this paper is to examine the ethical concerns of PH practitioners in promoting health equity in the context of mental health promotion and prevention of harms of substance use.Methods: As part of a broader program of public health systems and services research, we interviewed 32 PH practitioners. Results: Using constant comparative analysis, we identified four systemic ethical tensions: [1] biomedical versus social determinants of health agenda; [2] systems driven agendas versus situational care; [3] stigma and discrimination versus respect for persons; and [4] trust and autonomy versus surveillance and social control.Conclusions: Naming these tensions provides insights into the daily ethical challenges of PH practitioners and an opportunity to reflect on the relevance of PH frameworks. These findings highlight the value of relational ethics as a promising approach for developing ethical frameworks for PH practice.

scholarly journals Addressing Health Inequities in Environmental Public Health in Alberta

2019 ◽  
Vol 62 (4) ◽  
pp. 121-124
Author(s):  
Michelle Kilborn ◽  
Jason Cabaj ◽  
Lynn Navratil ◽  
Angela Torry ◽  
Richelle Schindler
Keyword(s):  
Public Health ◽  
Health Equity ◽  
Structural Determinants ◽  
Group Project ◽  
Environmental Public Health ◽  
Marginalized Groups ◽  
The Social ◽  
Health Related ◽  
Alberta Health

Environmental health related inequities can occur when environmental hazards or disasters disproportionally impact vulnerable populations, when environmental protection activities place a disproportionate burden on marginalized groups through a lack of inclusion or representation, and through creation of policies or programs that address only the immediate environment rather than the broader structural determinants that have created it ( Gore and Anita, 2013 ). Environmental public health (EPH) practitioners are well positioned to reduce inequities when they are empowered to include an equity lens in their work and identify opportunities to act on the social determinants of health (SDH). This focus group project identified ways in which public health inspectors in Alberta Health Services Calgary zone understand the concepts of equity and SDH as relevant to their work, revealed gaps in understanding and practice, and generated ideas to operationalize the integration of an equity lens into EPH practice. This project helps reinforce the importance of providing health equity education and opportunities for collaboration as a catalyst for action to integrate SDH and health equity into professional competencies and address organizational/operational barriers. Sharing these results will be helpful in moving towards fulfilling the key inequity-reducing role of EPH practice.

scholarly journals Values are not enough: qualitative study identifying critical elements for prioritization of health equity in health systems

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Thea van Roode ◽  
Bernadette M. Pauly ◽  
Lenora Marcellus ◽  
Heather Wilson Strosher ◽  
Sana Shahram ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
Health Equity ◽  
Health Inequities ◽  
System Capacity ◽  
Comparative Approach ◽  
Structural Level ◽  
Critical Elements ◽  
Health Authorities

Abstract Background Health system policies and programs that reduce health inequities and improve health outcomes are essential to address unjust social gradients in health. Prioritization of health equity is fundamental to addressing health inequities but challenging to enact in health systems. Strategies are needed to support effective prioritization of health equity. Methods Following provincial policy recommendations to apply a health equity lens in all public health programs, we examined health equity prioritization within British Columbia health authorities during early implementation. We conducted semi-structured qualitative interviews and focus groups with 55 senior executives, public health directors, regional directors, and medical health officers from six health authorities and the Ministry of Health. We used an inductive constant comparative approach to analysis guided by complexity theory to determine critical elements for prioritization. Results We identified seven critical elements necessary for two fundamental shifts within health systems. 1) Prioritization through informal organization includes creating a systems value for health equity and engaging health equity champions. 2) Prioritization through formal organization requires explicit naming of health equity as a priority, designating resources for health equity, requiring health equity in decision making, building capacity and competency, and coordinating a comprehensive approach across levels of the health system and government. Conclusions Although creating a shared value for health equity is essential, health equity - underpinned by social justice - needs to be embedded at the structural level to support effective prioritization. Prioritization within government and ministries is necessary to facilitate prioritization at other levels. All levels within health systems should be accountable for explicitly including health equity in strategic plans and goals. Dedicated resources are needed for health equity initiatives including adequate resourcing of public health infrastructure, training, and hiring of staff with equity expertise to develop competencies and system capacity.

scholarly journals 10 Best resources on… intersectionality with an emphasis on low- and middle-income countries

2016 ◽  
Vol 31 (8) ◽  
pp. 964-969 ◽  
Author(s):  
Elizabeth Larson ◽  
Asha George ◽  
Rosemary Morgan ◽  
Tonia Poteat
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Social Stratification ◽  
Health It ◽  
Power Structures ◽  
Middle Income ◽  
Middle Income Countries ◽  
Intersectionality Theory ◽  
Systems Research ◽  
Low And Middle Income

Abstract Intersectionality has emerged as an important framework for understanding and responding to health inequities by making visible the fluid and interconnected structures of power that create them. It promotes an understanding of the dynamic nature of the privileges and disadvantages that permeate health systems and affect health. It considers the interaction of different social stratifiers (e.g. ‘race’/ethnicity, indigeneity, gender, class, sexuality, geography, age, disability/ability, migration status, religion) and the power structures that underpin them at multiple levels. In doing so, it is a departure from previous health inequalities research that looked at these forms of social stratification in isolation from one another or in an additive manner. Despite its potential use and long history in other disciplines, intersectionality is uncommonly used in health systems research in low- and middle-income countries (LMICs). To orient readers to intersectionality theory and research, we first define intersectionality and describe its role in public health, and then we review resources on intersectionality. We found that applications in public health mostly increased after 2009, with only 14 out of 86 articles focused on LMICs. To arrive at 10 best resources, we selected articles based on the proportion of the article that was devoted to intersectionality, the strength of the intersectionality analysis, and its relevance to LMICs. The first four resources explain intersectionality as a methodology. The subsequent six articles apply intersectionality to research in LMIC with quantitative and qualitative analysis. We provide examples from India, Swaziland, Uganda and Mexico. Topics for the studies range from HIV, violence and sexual abuse to immunization and the use of health entitlements. Through these 10 resources, we hope to spark interest and open a needed conversation on the importance and use of intersectional analysis in LMICs as part of understanding people-centred health systems.

Climate change glossary for public health practice: from vulnerability to climate justice

2020 ◽  
pp. jech-2020-213889
Author(s):  
Chris G Buse ◽  
Rebecca Patrick
Keyword(s):  
Public Health ◽  
Climate Change ◽  
Health Equity ◽  
Public Health Practice ◽  
Climate Justice ◽  
Intersectoral Collaboration ◽  
Local Health ◽  
Health Community ◽  
Health Related Research ◽  
Health Related

Climate change is an emerging and growing field of practice for the international public health community. As practitioners, researchers and policy-makers grapple with the local health impacts of climate change, there is an increasing need to clarify key terminology to support public health actors engage and respond in ways that promote intersectoral collaboration. This contribution introduces the public health discourse on climate change, with a particular focus on its implications for health equity. After defining key terms and existing adaptation practices, climate justice and assets-oriented inquiry into the intersectional determinants of health are discussed as future opportunities for addressing health equity in climate and health-related research and practice.

Trend of Parental Refusal or Delay of Childhood Vaccinations

2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Meagan Marie Daoust
Keyword(s):  
Public Health ◽  
Social Media ◽  
Healthcare System ◽  
Educational Context ◽  
Health Consequences ◽  
Missed Opportunities ◽  
The Public ◽  
Health Related ◽  
Parental Refusal

The healthcare trend of parental refusal or delay of childhood vaccinations will be investigated through a complex Cynefin Framework component in an economic and educational context, allowing patterns to emerge that suggest recommendations of change for the RN role and healthcare system. As a major contributing factor adding complexity to this trend, social media is heavily used for health related knowledge, making it is difficult to determine which information is most trustworthy. Missed opportunities for immunization can result, leading to economic and health consequences for the healthcare system and population. Through analysis of the powerful impact social media has on this evolving trend and public health, an upstream recommendation for RNs to respond with is to utilize reliable social media to the parents’ advantage within practice. The healthcare system should focus on incorporating vaccine-related education into existing programs and classes offered to parents, and implementing new vaccine classes for the public.

Advocacy in pediatric neurosurgery: results from a 2017 survey of the American Society of Pediatric Neurosurgeons

2019 ◽  
Vol 24 (3) ◽  
pp. 338-342 ◽  
Author(s):  
Melissa LoPresti ◽  
Sandi Lam ◽  
Katie Orrico ◽  
Samuel R. Browd ◽  
Richard G. Ellenbogen ◽  
...  
Keyword(s):  
Public Health ◽  
Pediatric Neurosurgery ◽  
Clinical Issues ◽  
Economic Issues ◽  
Advocacy Effort ◽  
Health Related ◽  
Key Issues ◽  
American Society ◽  
Advocacy Program

OBJECTIVEPediatric neurosurgeons are unswerving advocates for public health–related issues in children, with most providers participating in local, regional, national, or international efforts. Collective advocacy efforts by organized pediatric neurosurgeons have not been undertaken to date.METHODSA 10-item survey was administered to members of the American Society of Pediatric Neurosurgeons (ASPN) in order to evaluate attitudes and opinions regarding the development of a formal advocacy effort by the organization.RESULTSSeventy-nine of 178 registered members of the ASPN (44.38%) participated in the survey. Participants were 82.61% male, with age, stage of career, and practice type varied. Although there was unequivocal support for participation in organized advocacy, respondents were divided on methods and topics for advocacy. In this survey, the ASPN membership prioritized public health and clinical issues over economic issues that affected children.CONCLUSIONSMost respondents favored the drafting of position statements on key issues and partnerships with larger organizations to pursue an advocacy agenda. The survey provides data regarding pediatric neurosurgeons’ attitudes that may assist with the design of a successful advocacy program.

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