Paediatric palliative care and the social determinants of health: Mitigating the impact of urban poverty on children with life-limiting illnesses

ABSTRACT Objectives: to analyze the impact of the Colombian Peace Agreement on the structural social determinants of health. Methods: a descriptive, ecological study, based on documentary data from 2008 to 2018. The records of victims, epidemiological indicators, and structural social determinants of health in Colombia were analyzed. Results: there was a correlation between the period in which the Peace Agreement process was developed and the indicators of structural determinants in health with p<0.05. With the Poisson regression analysis, the favorable correlations between the peace process and the determinants were confirmed, besides allowing the understanding of the changes in these indicators before the Peace Agreement. Conclusions: the implementation of the peace process has a positive impact on structural social determinants of health, which is observed by the beginning of the decrease of economic, educational, health, and social inequalities and inequities, a fact that offers the possibility of living in peace.

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How can social enterprises impact health and well-being?

International Journal of Entrepreneurial Behaviour & Research ◽

10.1108/ijebr-01-2017-0022 ◽

2018 ◽

Vol 24 (3) ◽

pp. 697-713 ◽

Cited By ~ 8

Author(s):

Katy Gordon ◽

Juliette Wilson ◽

Andrea Tonner ◽

Eleanor Shaw

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

Social Enterprise ◽

Well Being ◽

Social Enterprises ◽

Determinants Of Health ◽

Content Type ◽

The Social ◽

The Impact ◽

Health And Well Being

Purpose The purpose of this paper is to examine the impacts of social enterprise on individual and community health and well-being. It focusses on community food initiatives, their impact on the social determinants of health and the influence of structure on their outcomes. Design/methodology/approach Using an interpretive qualitative approach through case studies focussed on two community food social enterprises, the research team conducted observations, interviews and ad hoc conversations. Findings Researchers found that social enterprises impacted all layers of the social determinants of health model but that there was greater impact on individual lifestyle factors and social and community networks. Impact at the higher socio-economic, cultural and environmental layer was more constrained. There was also evidence of the structural factors both enabling and constraining impact at all levels. Practical implications This study helps to facilitate understanding on the role of social enterprises as a key way for individuals and communities to work together to build their capabilities and resilience when facing health inequalities. Building upon previous work, it provides insight into the practices, limitations and challenges of those engaged in encouraging and supporting behavioural changes. Originality/value The paper contributes to a deeper insight of the use, motivation and understanding of social enterprise as an operating model by community food initiatives. It provides evidence of the impact of such social enterprises on the social determinants of health and uses structuration theory (Giddens, 1984) to explore how structure both influences and constrains the impact of these enterprises.

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Social Forces and Their Impact on Health

10.1093/oso/9780190662455.003.0005 ◽

2017 ◽

Author(s):

Joia S. Mukherjee

Keyword(s):

Social Determinants Of Health ◽

Health Equity ◽

Social Determinants ◽

Premature Death ◽

Social Medicine ◽

Determinants Of Health ◽

Biomedical Science ◽

Adverse Health Effects ◽

The Social ◽

The Impact

This chapter focuses on the social determinants of health. The phrase—the social determinants of health—is used to describe the factors and forces in society that cause ill health and premature death. To achieve health equity, it is important to understand the impact of social determinants and work to mitigate their adverse health effects. The practice of social medicine uses a biosocial approach that merges biomedical science with social analysis to design programs that strive for health equity. Because of the historical and geopolitical forces that have shaped global inequities, social medicine and a biosocial approach are important in global health and health equity and are addressed in this chapter.

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Mobile Health Interventions to Support Caregivers of Older Adults: An Equity-Focused Systematic Review (Preprint)

10.2196/preprints.33085 ◽

2021 ◽

Author(s):

Anna Garnett ◽

Melissa Northwood ◽

Justine Ting ◽

Ruheena Sangrar

Keyword(s):

Systematic Review ◽

Older Adults ◽

Social Determinants Of Health ◽

Mobile Health ◽

Social Determinants ◽

Determinants Of Health ◽

Health Technologies ◽

Health And Wellbeing ◽

The Social ◽

The Impact

BACKGROUND Caregivers provide crucial support to older adults so they can remain safely in their homes as they age. Over time, caregivers’ own health can be negatively impacted by their caregiving role. The social determinants of health, such as gender and socioeconomic status, can influence assuming a caregiving role as well as the impacts of caregiving on the caregiver. While programs exist to support caregivers, uptake of these services does not match the need for services expressed by caregivers. Research suggests that supportive interventions offered via mobile health technologies have the potential to increase caregiver accessibility of supportive services. However, a knowledge gap exists regarding the extent to which the social determinants of health are considered in the design, implementation, and evaluation of mobile health (mHealth) interventions intended to support caregivers of older adults. Furthermore, a comprehensive review of the impact of mHealth interventions in this population does not exist. OBJECTIVE To conduct a systematic review to: (1) determine how health inequities are considered in the design, implementation, and evaluation of mHealth interventions for caregivers of older adults using Cochrane-Equity's PROGRESS-Plus framework; and (2) synthesize evidence of the impacts of caregiver-focused mHealth interventions. METHODS A systematic review was conducted in five databases and articles published between January 2010 and June 2021 were included if they evaluated or explored the impacts of mHealth interventions on the health and wellbeing of informal caregivers of older adults. mHealth interventions were defined as those that caregivers of older adults accessed via mobile or wireless devices. RESULTS A total of 28 articles met the inclusion criteria and were included in the systematic review. The interventions evaluated by the included studies sought to help caregivers make connections with services, facilitate the caregiving process, and promote the caregivers’ health and wellbeing. The PROGRESS-Plus framework factors were mainly considered in the results, discussion, and limitations sections of included studies. Some PROGRESS-Plus factors such as sexual orientation, religion and occupation, received little to no consideration in all phases of intervention design, implementation, or evaluation. Overall, findings of this review suggest that mHealth interventions were positively received by users. Such interventions may have the potential to reduce caregiver burden and positively impact caregivers’ physical and mental health while supporting them in their caregiving role. Study findings highlight the importance of available supports to help facilitate caregivers’ use of mHealth interventions particularly early on as well as the use of appropriate language and text. CONCLUSIONS Successful uptake and spread of mHealth interventions to support caregivers of older adults will depend on creating opportunities for inclusive involvement of a broad range of stakeholders at all stages of design, implementation, and assessment. CLINICALTRIAL PROSPERO CRD42021239584; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239584

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Designing and implementing equity-based pandemic preparedness and response learning modules: Lessons from a multi-country short-course

10.21203/rs.3.rs-908739/v1 ◽

2021 ◽

Author(s):

Anatole Manzi ◽

Phaedra Henley ◽

Hannah Lieberman ◽

Langley Topper ◽

Bernice Wuethrich ◽

...

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

The United States ◽

Determinants Of Health ◽

Average Score ◽

Pandemic Preparedness ◽

Short Course ◽

The Social ◽

Pandemic Response ◽

The Impact

Abstract BackgroundThe COVID-19 pandemic has had disproportionate impacts across race, social class, and geography. Insufficient attention has been paid to addressing the massive inequities worsened by COVID-19. In July 2020, Partners In Health (PIH) and the University of Global Health Equity (UGHE) designed a four-module short course, “An Equity Approach to Pandemic Preparedness and Response: Emerging Insights from COVID-19 Global Response Leaders.” We describe the design and use of a case-based, short-course education model to transfer knowledge and skills in equity approaches to pandemic preparedness and response.MethodsThis course used case studies of Massachusetts and Navajo Nation in the U.S, and Rwanda to highlight examples of equity-centered pandemic response. A post-session assessment survey was completed by course participants after each of the four modules. A mixed-method analysis was conducted to understand knowledge acquisition on key topics and assess participants’ experience and satisfaction with the course. Additionally, a landscape analysis was conducted to identify other equity-centered courses for pandemic response offered previously and to compare the content, audience, and intended outcomes.Results Forty-four percent of participants identified, “Immediate need for skills and information to address COVID-19” as their primary reason for attending the course. Participants reported that they are very likely (4.75 out of 5) to use the information, tools, or skills from the course in their work. The average score for content related questions answered correctly was 82-88% for each session. Participants (~70-90%) said their understanding was Excellent or Very Good for each session. Participants expressed a deepened understanding of the importance of prioritizing vulnerable communities and built global solidarity.ConclusionParticipants viewed the training as highly relevant, well-presented, actionable, shareable, and contributed to a new level of understanding of the social determinants of health and equity issues surrounding pandemic preparedness, crisis response, and long-term population recovery. This course offered a clear analysis of the impact of racism on the pandemic in the United States, the intersection of racism and wealth inequality; the role of the social determinants of health in pandemic preparedness, outcomes and response; and the impacts of neocolonialism on pandemic response in low- and middle-income countries.

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Globalization, Trade, and Health Economics

Oxford Research Encyclopedia of Economics and Finance ◽

10.1093/acrefore/9780190625979.013.35 ◽

2018 ◽

Author(s):

Richard Smith ◽

Johanna Hanefeld

Keyword(s):

Social Determinants Of Health ◽

Trade Liberalization ◽

Social Determinants ◽

Determinants Of Health ◽

Trade Patterns ◽

Late 20Th Century ◽

Potential Health ◽

Goods And Services ◽

The Social ◽

The Impact

Global trade—the movement of goods, services, people, and capital between countries—is at the center of modern globalization. Since the late 20th century trade has also become established as a critical determinant of public health. As the raison d’être of trade is to increase both wealth and the availability of goods and services, changing trade patterns will inevitably impact many of the known determinants of health, including employment, nutrition, environmental factors, social capital, and education. Trade will also impact the health sector itself, most clearly through direct trade in health-related goods and services (such as pharmaceuticals, health workers, foreign direct investment in health services, and mobile patients), but also more broadly in determining tax receipts and thus overall public expenditures. It is also the case that trade—especially rapid and widespread movement of people, animals, and goods—may facilitate the rapid and widespread spread of disease. Trade, and associated policies governing and responding to that trade, has thus become increasingly recognized as a critical driver of health issues. The design of trade policies that reduce the potential health risks associated with freer trade while maximizing the positive impact of trade liberalization on the social determinants of health is still in its infancy. There remains a lack of sound empirical evidence demonstrating how trade liberalization links directly and indirectly to health. Even though the positive link between increased trade, poverty reduction, and economic growth is widely accepted, evidence regarding the impact of trade liberalization on the social determinants of health varies from one national context to another. Hence, adapting trade liberalization to national conditions is important in ensuring desired outcomes. Yet although evidence is necessary, it is not sufficient to ensure that health is more integrated in trade negotiations and decision-making. There is a substantive requirement for those with a health remit to engage in negotiation with those from other sectors and from other geographic locations.

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The impact of gender and the social determinants of health on the clinical course of people living with HIV in Myanmar: an observational study

AIDS Research and Therapy ◽

10.1186/s12981-021-00364-w ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Phyo Pyae Nyein ◽

Eithandee Aung ◽

Ne Myo Aung ◽

Mar Mar Kyi ◽

Mark Boyd ◽

...

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

Clinical Course ◽

Determinants Of Health ◽

People Living With Hiv ◽

Poor Outcome ◽

The Social ◽

Living With Hiv ◽

The Impact

Abstract Background There is a growing recognition of the impact of gender and the social determinants of health on the clinical course of people living with HIV (PLHIV). However, the relative contribution of these factors to clinical outcomes of PLHIV is incompletely defined in many countries. This study was performed to gain a greater understanding of the non-clinical determinants of prognosis of PLHIV in Myanmar. Methods Selected demographic, behavioural and socioeconomic characteristics of outpatients at two specialist HIV hospitals and one general hospital in Yangon, Myanmar were correlated with their subsequent clinical course; a poor outcome was defined as death, hospitalisation, loss to follow-up or a detectable viral load at 6 months of follow-up. Results 221 consecutive individuals with advanced HIV commencing anti-retroviral therapy (ART) were enrolled in the study; their median CD4 T-cell count was 92 (44–158) cells/mm3, 138 (62.4%) were male. Socioeconomic disadvantage was common: the median (interquartile range (IQR) monthly per-capita income in the cohort was US$48 (31–77); 153 (69.9%) had not completed high school. However, in a multivariate analysis that considered demographic, behavioural, clinical factors and social determinants of health, male gender was the only predictor of a poor outcome: odds ratio (95% confidence interval): 2.33 (1.26–4.32, p = 0.007). All eight of the deaths and hospitalisations in the cohort occurred in males (p = 0.03). Conclusions Men starting ART in Myanmar have a poorer prognosis than women. Expanded implementation of gender-specific management strategies is likely to be necessary to improve outcomes.

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Teaching the social determinants of health through medical legal partnerships: a systematic review

BMC Medical Education ◽

10.1186/s12909-021-02729-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kristian Welch ◽

Benjamin Robinson ◽

Michaela Lieberman Martin ◽

Amy Salerno ◽

Drew Harris

Keyword(s):

Systematic Review ◽

Medical Education ◽

Social Determinants Of Health ◽

Graduate Medical Education ◽

Social Determinants ◽

Determinants Of Health ◽

Graduate Medical ◽

The Social ◽

The Impact ◽

Future Practice

Abstract Background Undergraduate and graduate medical education often includes the social determinants of health, but questions remain regarding how best to ensure that trainees become empowered to take action on the social determinants of health in their future practice. The authors conducted a systematic review to better define the impact that educational programs centered on medical legal partnerships have on trainees’ knowledge, attitudes and future practice. The authors sourced data from PubMed, Web of Science, Index to Legal Periodicals, LegalTrac, Google Scholar, Academic Search Complete, Business Source Complete, SocINDEX, SSRN, and Proquest Social Sciences. Selected studies included those centered on Medical Legal Partnerships in undergraduate or graduate medical education and that measured outcomes of the participating trainees. Two abstractors independently extracted information about the study population, setting, design, intervention and outcomes. Results Six out of 483 studies met the inclusion criteria. One study highlighted four different MLPs, thus nine total MLP programs were included. Trainees included medical students as well as interns and residents from pediatrics, family medicine and internal medicine. Interventions ranged from didactic sessions, to advocacy projects, to hands-on community-based learning, to poverty simulation trainings. Benefits to trainees were wide in scope but all programs showed improvements in participants’ understanding, comfort, confidence, and/or abilities in identifying and intervening on the social determinants of health in their patients. Conclusion As medical schools and residency programs are increasingly considering how to effectively teach trainees to understand and address the social determinants of health, the findings in this systematic review suggest that inclusion of Medical Legal Partnerships into training programs is an effective approach.

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Impact of COVID-19 on Latinos: A Social Determinants of Health Model and Scoping Review of the Literature

Hispanic Journal of Behavioral Sciences ◽

10.1177/07399863211041214 ◽

2021 ◽

pp. 073998632110412

Author(s):

Velia Nelly Salgado de Snyder ◽

Marisol McDaniel ◽

Amado M. Padilla ◽

Deborah Parra-Medina

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

Scoping Review ◽

Limited English Proficiency ◽

Living Conditions ◽

Determinants Of Health ◽

Primary Data ◽

Review Of The Literature ◽

The Social ◽

The Impact

The purpose of this scoping review of the literature was to analyze the impact of the COVID-19 pandemic on the living conditions of Latinos (Hispanics) in the U.S. from a social determinants of health perspective. We developed a conceptual model based on the social determinants of health framework to guide the search, extraction, analysis, and interpretation of the bibliographic material. A systematic review of peer reviewed literature published in 2020 in scientific journals in the social, health, and behavioral sciences was conducted. A total of 37 articles met the selection criteria, 12 were original investigations with primary data collection, and 25 were studies reporting results of secondary data analysis using public or private databases. The representation of Latinos in the study samples ranged from 5% to 40%. The results of our review are compelling in terms of the overrepresentation of Latinos in SARSCoV-2 positivity and COVID-19 morbidity and mortality rates. The risk factors identified include working in a job considered essential, living in a geographic area with a high population density of Latinos and blacks, overcrowded living conditions in the household, limited English proficiency, and being unable to systematically carry out preventive behaviors known to be effective for infection avoidance. Existing national surveys and registries suffer from assumptions and omissions regarding variables relevant to Latinos. New studies must be guided by inquiries on the usual social determinants of health, but also those relevant for Latinos, such as national group, generational status, and language, among others.

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Exploring civil society leadership to advance action on the social determinants of health

PsycEXTRA Dataset ◽

10.1037/e515722013-001 ◽

2008 ◽

Author(s):

Susan McCunn

Keyword(s):

Civil Society ◽

Social Determinants Of Health ◽

Social Determinants ◽

Determinants Of Health ◽

The Social

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