scholarly journals COVID-19 Medical Vulnerability Indicators: A Local Data Model for Equity in Public Health Decision-Making

2020 ◽  
Author(s):  
Paul M. Ong ◽  
Chhandara Pech ◽  
Nataly Rios Gutierrez ◽  
Vickie Mays
Keyword(s):  
Decision Making ◽  
Los Angeles ◽  
Built Environment ◽  
Low Income ◽  
Social Vulnerability ◽  
Local Data ◽  
California Department ◽  
Public Health Decision ◽  
Medical Needs ◽  
Vulnerability Indicators

AbstractObjectiveTo develop indicators of vulnerability for coronavirus disease 2019 (covid-19) infection in Los Angeles County (LAC) by race and neighborhood characteristics.DesignDevelopment of indicators that combines pre-existing medical vulnerabilities with social and built-environment data by zip code tabulation areas (ZCTAs).SettingNeighborhoods in LAC categorized by race/ethnicity ranked into quintiles by relative vulnerability: Non-Hispanic white; Black; Latinx; Cambodians, Hmong and Laotians combined (CHL); and Other Asians.Data SourcesAskCHIS Neighborhood Edition, American Community Survey 2014-2018, and California Department of Parks and Recreation.Main Outcome Measures1) Pre-Existing Health Condition, 2) Barriers to Accessing Healthcare, 3) Built Environment Risk, and 4) CDC’s Social Vulnerability.ResultsNeighborhoods most vulnerable to COVID-19 are characterized by significant clustering of racial minorities, low income households and unmet medical needs. An overwhelming 73% of Blacks reside in the neighborhoods with the two highest quintiles of pre-existing health conditions, followed by Latinx (70%) and CHL (60%), while 60% of whites reside in low or the lowest vulnerable neighborhoods. For the Barriers to Accessing Healthcare indicator, 40% of Latinx reside in the highest vulnerability places followed by Blacks, CHL and other Asians (29%, 22%, and 16% respectively), compared with only 7% of Whites reside in such neighborhoods. The Built Environment Indicator finds CHL (63%) followed by Latinx (55%) and Blacks (53%) reside in the neighborhoods designated as high or the highest vulnerability compared to 32% of Whites residing in these neighborhoods. The Social Vulnerability Indicator finds 42% of Blacks and Latinx and 38% of CHL residing in neighborhoods of high vulnerability compared with only 8% of Whites residing these neighborhoods.ConclusionsVulnerability to covid-19 infections differs by neighborhood and racial/ethnic groups. Our vulnerability indicators when utilized in decision-making of re-openings or resource distribution such as testing, vaccine distribution, hotel rooms for quarantine and other covid-19-related resources can provide an equity driven data approach for the most vulnerable.

scholarly journals COVID-19 Medical Vulnerability Indicators: A Predictive, Local Data Model for Equity in Public Health Decision Making

2021 ◽  
Vol 18 (9) ◽  
pp. 4829
Author(s):  
Paul M. Ong ◽  
Chhandara Pech ◽  
Nataly Rios Gutierrez ◽  
Vickie M. Mays
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Los Angeles ◽  
Built Environment ◽  
Social Vulnerability ◽  
Health Condition ◽  
Local Data ◽  
Public Health Decision ◽  
Care Indicator ◽  
Vulnerability Indicators

This article reports the outcome of a project to develop and assess a predictive model of vulnerability indicators for COVID-19 infection in Los Angeles County. Multiple data sources were used to construct four indicators for zip code tabulation areas: (1) pre-existing health condition, (2) barriers to accessing health care, (3) built environment risk, and (4) the CDC’s social vulnerability. The assessment of the indicators finds that the most vulnerable neighborhoods are characterized by significant clustering of racial minorities. An overwhelming 73% of Blacks reside in the neighborhoods with the two highest levels of pre-existing health conditions. For the barriers to accessing health care indicator, 40% of Latinx reside in the highest vulnerability places. The built environment indicator finds that selected Asian ethnic groups (63%), Latinx (55%), and Blacks (53%) reside in the neighborhoods designated as high or the highest vulnerability. The social vulnerability indicator finds 42% of Blacks and Latinx and 38% of selected Asian ethnic group residing in neighborhoods of high vulnerability. The vulnerability indicators can be adopted nationally to respond to COVID-19. The metrics can be utilized in data-driven decision making of re-openings or resource distribution such as testing, vaccine distribution and other pandemic-related resources to ensure equity for the most vulnerable.

scholarly journals Importance of Local Data and Resource Allocation for Effective Successful Public Health Interventions to Reduce COVID-19 Transmission: Commentary on COVID-19 Medical Vulnerability Indicators: A Predictive Local Data Model for Equity in Public Health Decision-Making

2021 ◽  
Vol 18 (10) ◽  
pp. 5454
Author(s):  
Edward Sondik ◽  
Jonathan Fielding
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Los Angeles ◽  
Data Model ◽  
Public Healthcare ◽  
Local Data ◽  
Public Health Decision ◽  
Health Decision Making ◽  
Vulnerability Indicators ◽  
Health Decision

The article, COVID-19 Medical Vulnerability Indicators: Predictive Local Data Model for Equity in Public Health Decision-Making (2021), is an important contribution to identifying and prioritizing the needs of Los Angeles’ public healthcare in responding to the COVID-19 pandemic crisis [...]

scholarly journals The NCCMT’s dynamic model for evidence-informed public health

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Clark ◽  
S Neil-Sztramko ◽  
M Dobbins
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Research Evidence ◽  
Decision Makers ◽  
Local Data ◽  
Public Health Decision ◽  
Health Decision Making ◽  
Political Preferences ◽  
Health Decision ◽  
Structured Approach

Abstract Issue It is well accepted that public health decision makers should use the best available research evidence in their decision-making process. However, research evidence alone is insufficient to inform public health decision making. Description of the problem As new challenges to public health emerge, there can be a paucity of high quality research evidence to inform decisions on new topics. Public health decision makers must combine various sources of evidence with their public health expertise to make evidence-informed decisions. The National Collaborating Centre for Methods and Tools (NCCMT) has developed a model which combines research evidence with other critical sources of evidence that can help guide decision makers in evidence-informed decision making. Results The NCCMT's model for evidence-informed public health combines findings from research evidence with local data and context, community and political preferences and actions and evidence on available resources. The model has been widely used across Canada and worldwide, and has been integrated into many public health organizations' decision-making processes. The model is also used for teaching an evidence-informed public health approach in Masters of Public Health programs around the globe. The model provides a structured approach to integrating evidence from several critical sources into public health decision making. Use of the model helps ensure that important research, contextual and preference information is sought and incorporated. Lessons Next steps for the model include development of a tool to facilitate synthesis of evidence across all four domains. Although Indigenous knowledges are relevant for public health decision making and should be considered as part of a complete assessment the current model does not capture Indigenous knowledges. Key messages Decision making in public health requires integrating the best available evidence, including research findings, local data and context, community and political preferences and available resources. The NCCMT’s model for evidence-informed public health provides a structured approach to integrating evidence from several critical sources into public health decision making.

scholarly journals Pandemic Injustice: Spatial and Social Distributions of COVID-19 in the US Epicenter

2021 ◽  
pp. 2150007
Author(s):  
Timon McPhearson ◽  
Zbigniew Grabowski ◽  
Pablo Herreros-Cantis ◽  
Ahmed Mustafa ◽  
Luis Ortiz ◽  
...  
Keyword(s):  
New York ◽  
Low Income ◽  
Social Vulnerability ◽  
Urban Areas ◽  
Social Dynamics ◽  
Negative Relationship ◽  
Policy Debate ◽  
The Social ◽  
Vulnerability Indicators ◽  
The U.S

We examine the uneven social and spatial distributions of COVID-19 and their relationships with indicators of social vulnerability in the U.S. epicenter, New York City (NYC). As of July 17th, 2020, NYC, despite having only 2.5% of the U.S. population, has [Formula: see text]6% of all confirmed cases, and [Formula: see text]16% of all deaths, making it a key learning ground for the social dynamics of the disease. Our analysis focuses on the multiple potential social, economic, and demographic drivers of disproportionate impacts in COVID-19 cases and deaths, as well as population rates of testing. Findings show that immediate impacts of COVID-19 largely fall along lines of race and class. Indicators of poverty, race, disability, language isolation, rent burden, unemployment, lack of health insurance, and housing crowding all significantly drive spatial patterns in prevalence of COVID-19 testing, confirmed cases, death rates, and severity. Income in particular has a consistent negative relationship with rates of death and disease severity. The largest differences in social vulnerability indicators are also driven by populations of people of color, poverty, housing crowding, and rates of disability. Results highlight the need for targeted responses to address injustice of COVID-19 cases and deaths, importance of recovery strategies that account for differential vulnerability, and provide an analytical approach for advancing research to examine potential similar injustice of COVID-19 in other U.S. cities. Significance Statement Communities around the world have variable success in mitigating the social impacts of COVID-19, with many urban areas being hit particularly hard. Analysis of social vulnerability to COVID-19 in the NYC, the U.S. national epicenter, shows strongly disproportionate impacts of the pandemic on low income populations and communities of color. Results highlight the class and racial inequities of the coronavirus pandemic in NYC, and the need to unpack the drivers of social vulnerability. To that aim, we provide a replicable framework for examining patterns of uneven social vulnerability to COVID-19- using publicly available data which can be readily applied in other study regions, especially within the U.S.A. This study is important to inform public and policy debate over strategies for short- and long-term responses that address the injustice of disproportionate impacts of COVID-19. Although similar studies examining social vulnerability and equity dimensions of the COVID-19 outbreak in cities across the U.S. have been conducted (Cordes and Castro 2020, Kim and Bostwick 2002, Gaynor and Wilson 2020; Wang et al. 2020; Choi and Unwin 2020), this study provides a more comprehensive analysis in NYC that extends previous contributions to use the highest resolution spatial units for data aggregation (ZCTAs). We also include mortality and severity rates as key indicators and provide a replicable framework that draws from the Centers for Disease Control and Prevention’s Social Vulnerability indicators for communities in NYC.

scholarly journals Voices of Experience: What Do Low-Income Older Adults Tell Us About Mobility, Technology, and Social Participation?

2021 ◽  
pp. 073346482110125
Author(s):  
Haley B. Gallo ◽  
Lia W. Marshall ◽  
Lené Levy-Storms ◽  
Kathleen H. Wilber ◽  
Anastasia Loukaitou-Sideris
Keyword(s):  
Older Adults ◽  
Los Angeles ◽  
Qualitative Study ◽  
Thematic Analysis ◽  
Social Participation ◽  
Low Income ◽  
Technology Use ◽  
Diverse Group ◽  
Senior Center ◽  
Perceived Safety

Mobility and technology can facilitate in-person and virtual social participation to help reduce social isolation, but issues exist regarding older adults’ access, feasibility, and motivation to use various forms of mobility and technology. This qualitative study explores how a diverse group of low-income, urban-living older adults use mobility and technology for social participation. We conducted six focus groups ( N = 48), two each in English, Spanish, and Korean at a Los Angeles senior center. Three major themes emerged from thematic analysis: using technology for mobility; links between mobility and social participation; and technology-mediated social participation. Cost, perceived safety, (dis)ability, and support from family and friends were related to mobility and technology use. This study demonstrates the range of mobility and technology uses among older adults and associated barriers. The findings can help establish a pre-COVID-19 baseline on how to make mobility and technology more accessible for older adults at risk of isolation.

scholarly journals Healthy eating: a matter of prioritisation by households or policymakers?

2021 ◽  
pp. 1-3
Author(s):  
Joreintje Dingena Mackenbach
Keyword(s):  
Decision Making ◽  
Healthy Eating ◽  
Low Income ◽  
Fruits And Vegetables ◽  
Food System ◽  
Vegetable Consumption ◽  
Fruit And Vegetable Consumption ◽  
Healthy Foods ◽  
Fruit And Vegetable ◽  
Decision Making Processes

Abstract I reflect upon the potential reasons why American low-income households do not spend an optimal proportion of their food budgets on fruits and vegetables, even though this would allow them to meet the recommended levels of fruit and vegetable consumption. Other priorities than health, automatic decision-making processes and access to healthy foods play a role, but solutions for the persistent socio-economic inequalities in diet should be sought in the wider food system which promotes cheap, mass-produced foods. I argue that, ultimately, healthy eating is not a matter of prioritisation by individual households but by policymakers.

scholarly journals Improving Tanzanian childbirth service quality

2018 ◽  
Vol 31 (3) ◽  
pp. 190-202 ◽  
Author(s):  
Jennie Jaribu ◽  
Suzanne Penfold ◽  
Cathy Green ◽  
Fatuma Manzi ◽  
Joanna Schellenberg
Keyword(s):  
Health Facility ◽  
Low Income ◽  
Healthcare Providers ◽  
Health Facilities ◽  
Rural District ◽  
Local Data ◽  
Content Type ◽  
Primary Health ◽  
Primary Health Facilities ◽  
Childbirth Care

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

scholarly journals A participatory modelling approach for investigating the spread of COVID-19 in countries of the Eastern Mediterranean Region to support public health decision-making

2021 ◽  
Vol 6 (3) ◽  
pp. e005207
Author(s):  
Keyrellous Adib ◽  
Penelope A Hancock ◽  
Aysel Rahimli ◽  
Bridget Mugisa ◽  
Fayez Abdulrazeq ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Mediterranean Region ◽  
Eastern Mediterranean ◽  
Eastern Mediterranean Region ◽  
Epidemiological Data ◽  
Regional Office ◽  
Participatory Modelling ◽  
Public Health Decision ◽  
Epidemiological Modelling

Early on in the COVID-19 pandemic, the WHO Eastern Mediterranean Regional Office recognised the importance of epidemiological modelling to forecast the progression of the COVID-19 pandemic to support decisions guiding the implementation of response measures. We established a modelling support team to facilitate the application of epidemiological modelling analyses in the Eastern Mediterranean Region (EMR) countries. Here, we present an innovative, stepwise approach to participatory modelling of the COVID-19 pandemic that engaged decision-makers and public health professionals from countries throughout all stages of the modelling process. Our approach consisted of first identifying the relevant policy questions, collecting country-specific data and interpreting model findings from a decision-maker’s perspective, as well as communicating model uncertainty. We used a simple modelling methodology that was adaptable to the shortage of epidemiological data, and the limited modelling capacity, in our region. We discuss the benefits of using models to produce rapid decision-making guidance for COVID-19 control in the WHO EMR, as well as challenges that we have experienced regarding conveying uncertainty associated with model results, synthesising and comparing results across multiple modelling approaches, and modelling fragile and conflict-affected states.

scholarly journals Housing Programs for the Poor in Addis Ababa: Urban Commons as a Bridge between Spatial and Social

2021 ◽  
pp. 009614422198997
Author(s):  
Marianna Charitonidou
Keyword(s):  
Decision Making ◽  
Urban Planning ◽  
Low Income ◽  
Addis Ababa ◽  
Low Cost ◽  
Development Program ◽  
Housing Program ◽  
Cultural Aspects ◽  
The Poor ◽  
The Government

The article presents the reasons for which the issue of providing housing to low-income citizens has been a real challenge in Addis Ababa during the recent years and will continue to be, given that its population is growing extremely fast. It examines the tensions between the universal aspirations and the local realities in the case of some of Ethiopia’s most ambitious mass pro-poor housing schemes, such as the “Addis Ababa Grand Housing Program” (AAGHP), which was launched in 2004 and was integrated in the “Integrated Housing Development Program” (IHDP) in 2006. The article argues that the quotidian practices of communities and their socio-economic and cultural characteristics are related to the spatial attributes of co-housing practices. Drawing upon the idea that there is a mutual correspondence between social and spatial structures, it places particular emphasis on the analysis of the IHDP and aims to show that to shape strategies that take into account the social and cultural aspects of daily life of the poor citizens of Addis Ababa, it is pivotal to invite them to take part in the decision-making processes regarding their resettlement. Departing from the fact that a large percentage of the housing supply in Addis Ababa consists of informal unplanned housing, the article also compares the commoning practices in kebele houses and condominium units. The former refers to the legal informal housing units owned by the government and rented to their dwellers, whereas the latter concerns the housing blocks built in the framework of the IHDP for the resettlement of the kebele dwellers. The article analyzes these processes of resettlement, shedding light of the fact that kebele houses were located at the inner city, whereas the condominiums are located in the suburbs. Despite the fact that the living conditions in the condominium units are of a much higher quality than those in the kebele houses, their design underestimated or even neglected the role of the commoning practices. The article highlights the advantages of commoning practices in architecture and urban planning, and how the implementation of participation-oriented solutions can respond to the difficulties of providing housing. It argues that understanding the significance of the endeavors that take into account the opinions of dwellers during the phase of decision-making goes hand in hand with considering commoning practices as a source of architecture and urban planning frameworks for low-cost housing in this specific context. The key argument of the article is that urban planning and architecture solutions in Addis Ababa should be based on the principles of the so-called “negotiated planning” approach, which implies a close analysis of the interconnections between planning, infrastructure, and land.

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