Investigating structural inequities in the culture of medicine

2020 ◽  
Vol 54 (4) ◽  
pp. 278-279
Author(s):  
Rebecca L. Volpe ◽  
Margaret Hopkins
Keyword(s):  
Culture Of Medicine ◽  
Structural Inequities

scholarly journals Klamath Tribal Response to the Pandemic of COVID-19 Among Klamath Tribal Community in Oregon, USA

2021 ◽  
Vol 10 ◽  
pp. 216495612110344
Author(s):  
Obinna Oleribe ◽  
Rachel Miller ◽  
Misty Wadzeck ◽  
Nikowa Mendez ◽  
Joseph Tibay ◽  
...  
Keyword(s):  
Social Services ◽  
American Indians ◽  
Alaska Native ◽  
Incident Management ◽  
Tribal Community ◽  
Family Services ◽  
Minimal Impact ◽  
Income Disparities ◽  
Testing Center ◽  
Structural Inequities

Introduction Socially-disadvantaged populations are more at risk of contracting COVID-19 than those with access to better medical facilities. We looked at responses of Klamath Tribes in Oregon, USA to mitigate spread of COVID-19 in a community with a higher incidence of obesity, diabetes and coronary heart disease, compared to the general US population. This study reports on Klamath Tribes response to COVID-19 March -September 2020. Methods Klamath Tribes Tribal Health and Family Services established a COVID-19 Incident Management Team (IMT), instituting creative programs including a Walk-In Testing Center, implementing strict infection control protocols and regular sharing of information on the pandemic and prevalence of COVID-19 amongst Klamath Tribes. All COVID-19 tests were documented with positive cases isolated and people with high risk exposures quarantined and provided with wrap-around medical and social services until recovered or past quarantine time period. Results A total of 888 (12%) tribal members were tested for COVID1-19 between March to September 2020; 50 were found positive for COVID-19, giving a test positivity rate of 5.6% (Male – 6.3%; Female – 5.2%). No deaths have been reported amongst the local Klamath Tribes and other American Indians/Alaska Native (AI/AN) population served by the tribe. Conclusion Despite the fact that structural inequities including income disparities have shaped racial and ethnic impact of epidemics around the world, the timely response, establishment of partnerships and proactive control of the epidemic resulted in minimal impact among the Klamath Tribal and other AI/AN populations served by the tribal facilities.

scholarly journals Discrimination and Protective Factors to Cognitive Health: Testing NIA’s Health Disparities Framework

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 672-672
Author(s):  
Ernest Gonzales ◽  
Cliff Whetung ◽  
Jane Lee ◽  
Yi Wang
Keyword(s):  
Health Disparities ◽  
Protective Factors ◽  
Cognitive Functioning ◽  
Mixed Models ◽  
Ethnically Diverse ◽  
Cognitive Health ◽  
Factors Associated ◽  
Health Trajectories ◽  
Structural Inequities ◽  
Everyday Discrimination

Abstract Cognitive impairment is a worldwide epidemic. Informed by NIA’s Health Disparities Framework, this study investigated interpersonal, behavioral, and sociocultural risk and protective factors associated with cognitive health trajectories. Mixed models examined factors associated with cognitive health with data from the Health and Retirement Study among Whites, Blacks, and Hispanics (2008-2014, N=4,511). A majority of respondents who experienced everyday discrimination attributed it to ageism among this racially and ethnically diverse sample. Stratified mixed models of everyday discrimination by attribution (racism or ageism) revealed worse cognitive functioning. Major lifetime discrimination was not statistically associated with cognitive functioning. Economic factors (education, income, assets) and religious activity protected cognitive functioning and were particularly salient for Blacks and Hispanics. Strategies that bolster individual resilience as well as social policies that address discrimination and structural inequities will likely reduce health disparities and improve population health.

Women Garment Workers Face Huge Inequities in Global Supply Chain Factories Made Worse by COVID-19

2021 ◽  
pp. 104829112110116
Author(s):  
Garrett D. Brown
Keyword(s):  
Supply Chain ◽  
Women Workers ◽  
Health And Safety ◽  
Professional Associations ◽  
Gender Based Violence ◽  
Garment Workers ◽  
Gender Based ◽  
Structural Inequities ◽  
Corporate Social ◽  
The Impact

Women make up the large majority of workers in global supply chains, especially factories in the apparel supply chain. These workers face significant inequalities in wages, workplace hazards, and a special burden of gender-based violence and harassment. These “normal” conditions have been compounded by the impact of the COVID-19 pandemic, which has exacerbated long-standing structural inequities. Decades of well-financed “corporate social responsibility” programs have failed because they do not address the underlying causes of illegal and abusive working conditions. New initiatives in the past half-decade offer promise in putting the needs and rights of workers front and center. Occupational health and safety professionals can assist in the global effort to improve working and social conditions, and respect for the rights and dignity of women workers, through advocacy and action on the job, in their professional associations, and in society at large.

scholarly journals Structural inequities in seasonal influenza vaccination rates

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lara I. Brewer ◽  
Mark J. Ommerborn ◽  
Augustina Le Nguyen ◽  
Cheryl R. Clark
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
American Indian ◽  
Low Socioeconomic Status ◽  
Behavioral Risk ◽  
Vaccination Rates ◽  
Access To Primary Care ◽  
Structural Inequities

Abstract Background Influenza immunization is a highly effective method of reducing illness, hospitalization and mortality from this disease. However, influenza vaccination rates in the U.S. remain below public health targets and persistent structural inequities reduce the likelihood that Black, American Indian and Alaska Native, Latina/o, Asian groups, and populations of low socioeconomic status will receive the influenza vaccine. Methods We analyzed correlates of influenza vaccination rates using the 2019 Behavioral Risk Factor Surveillance System (BRFSS) in the year 2020. Our analysis compared influenza vaccination as the outcome of interest with the variables age, sex, race, education, income, geographic location, health insurance status, access to primary care, history of delaying care due to cost, and comorbidities such as: asthma, cardiovascular disease, hypertension, body mass index, cancer and diabetes. Results Non-Hispanic White (46.5%) and Asian (44.1%) participants are more likely to receive the influenza vaccine compared to Non-Hispanic Black (36.7%), Hispanic (33.9%), American Indian/Alaskan Native (36.6%), and Native Hawaiian/Other Pacific Islander (37.9%) participants. We found persistent structural inequities that predict influenza vaccination, within and across racial and ethnic groups, including not having health insurance [OR: 0.51 (0.47–0.55)], not having regular access to primary care [OR: 0.50 (0.48–0.52)], and the need to delay medical care due to cost [OR: 0.75 (0.71–0.79)]. Conclusion As COVID-19 vaccination efforts evolve, it is important for physicians and policymakers to identify the structural impediments to equitable U.S. influenza vaccination so that future vaccination campaigns are not impeded by these barriers to immunization.

scholarly journals The Impact of Macroeconomic Policies on Healthcare Delivery in Kenya: An Analysis of the National Sexual Violence Prevention and Care Response

2020 ◽  
pp. 0272684X2098259
Author(s):  
Leso Munala ◽  
Emily Welle ◽  
Nene Okunna ◽  
Emily Hohenshell
Keyword(s):  
Health Care ◽  
Sexual Violence ◽  
Healthcare Delivery ◽  
Health Economy ◽  
Economic Policies ◽  
Macroeconomic Policies ◽  
Complex Needs ◽  
Study Results ◽  
Structural Inequities ◽  
The Impact

Sexual violence is one of the most common forms of violence against women in Kenya. This study documents the care of sexual violence survivors from the perspective of health care practitioners based on an analytic framework developed in studies of the political-economy of health to examine the effects of International Financial Institutions’ conditionalities on the allocation of national fiscal resources. The study documented the working conditions of practitioners and myriad challenges that they experience in providing quality services to sexual violence survivors. The issues reflected in the results are grounded in social structural inequities driven by the global political economic policies that perpetuate poverty and dependency throughout Africa and the developing world. Macro-level variables associated with health care provision are assessed with a focus on global macroeconomic policies established by the International Monetary Fund and World Bank, their impact on Kenya’s health economy and their ultimate impact on the capacity of the health system to meet the complex needs of survivors of sexual violence. In this paper, study results are analysed within the context of these macroeconomic policies and their legacy.

scholarly journals COVID-19’s impact on contraception experiences: Exacerbation of structural inequities in women's health

Contraception ◽  
2021 ◽  
Author(s):  
Nadia Diamond-Smith ◽  
Rachel Logan ◽  
Cassondra Marshall ◽  
Chiara Corbetta-Rastelli ◽  
Sirena Gutierrez ◽  
...  
Keyword(s):  
Women’S Health ◽  
Women's Health ◽  
Structural Inequities

scholarly journals Exploring equity, gender and social determinants aspects of antimicrobial resistance: Scoping review

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
V Saint ◽  
A Mohsenpour ◽  
C Mühling ◽  
K Bozorgmehr
Keyword(s):  
Antimicrobial Resistance ◽  
Social Determinants ◽  
Scoping Review ◽  
Research Policy ◽  
Modern Medicine ◽  
Vulnerable Groups ◽  
Structural Level ◽  
Policy And Practice ◽  
Social Construct ◽  
Structural Inequities

Abstract Background Antimicrobial resistance (AMR) is a considerable threat to modern medicine and global health. Inequity, gender and social determinants of health (SDH) have a significant impact on health and health services, including in relation to AMR. Despite this, there is a lack of systematic focus on these dimensions in AMR research, policy and practice. We aimed to scope and review the existing evidence related to the equity, gender and SDH considerations for AMR globally through a systematic, iterative approach. Methods We conducted a scoping review by searching PubMed, Web of Science and CINAHL for empirical research on AMR in humans, with consideration of equity, gender or SDH, published in English between January 2000 and September 2019. In a two-stage process, we analysed full texts to extract information about explicit and then implicit references to equity, gender or SDH. Results The search yielded 4628 articles after removing 578 duplicates. 737 articles were analysed with explicit reference to equity, gender or SDH in title or abstract. Preliminary results show that 93.2% of these studies mentioned gender but mostly meaning biological sex (90.8%) rather than its social construct. Articles on equity (6.0%) and SDH (1.1%) reported on associations between AMR rates and income and non-income dimensions of inequality, health system issues and disadvantaged subpopulations within countries. Other articles in this category explored public and policy discourse or approaches for AMR (0.8%) and equity issues for AMR-related R&D (0.7%). These results combined with the PROGRESS-Plus acronym informed the subsequent analysis of the 4628 articles for implicit considerations of equity, gender and SDH. Conclusions Despite casting a wide net, we found relatively little research explicitly considering equity, gender and SDH aspects of AMR especially at a systematic or structural level. This reflects an important gap in the current understanding of and efforts to tackle AMR. Key messages We conducted a scoping review on equity, gender and social determinants considerations of AMR that indicates limited research on these important aspects of the social and structural drivers of AMR. Further research on these aspects is essential to inform the design of effective policy and practice interventions that target vulnerable groups and address structural inequities.

scholarly journals Tailoring interventions for social isolation among older persons during the COVID-19 pandemic: challenges and pathways to healthcare equity

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Lise Dassieu ◽  
Nadia Sourial
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Social Isolation ◽  
Older Persons ◽  
Vulnerable Population ◽  
Subjective Experiences ◽  
Main Text ◽  
Healthcare Equity ◽  
Structural Inequities

Abstract Background Social isolation among older adults raises major issues for equity in healthcare in the context of the COVID-19 pandemic. Main text This commentary describes current challenges in preventing social isolation among older adults and proposes pathways to develop inclusive approaches to intervention in this vulnerable population. Building interventions that take account of structural inequities among older persons, as well as their subjective experiences, expectations and perspectives, appears fundamental to improve their health and quality of life in pandemic and post-pandemic contexts. Conclusions We argue that equity-based and person-centered approaches are critical to counter the negative outcomes of social isolation in the vulnerable older population.

Sign in / Sign up

Export Citation Format

Share Document