Tackling health inequity: a commentary on the potential of acupuncture to improve health outcomes of marginalised populations

2020 ◽  
pp. 096452842096140
Author(s):  
Kirsten Baker ◽  
John McDonald ◽  
Amie Steel
Keyword(s):  
Health Outcomes ◽  
Low Income ◽  
Group Treatment ◽  
Minority Groups ◽  
Acupuncture Treatment ◽  
Health Behaviours ◽  
Health Service Delivery ◽  
Health Inequity ◽  
Poor Quality ◽  
Complex Health Problems

Background: Health inequities or disparities challenge governments and public health systems, impacting health service delivery worldwide. Inherent disadvantage linked to the social determinants of health is intrinsic to the health outcomes among society’s marginalised and most vulnerable members. It is acknowledged that marginalised individuals present with higher levels of chronic disease, multi-morbidities and adverse health behaviours than their non-disadvantaged peers. Marginalised individuals and communities present with complex health problems and often receive poor quality or inadequate health care that is unable to meet their needs, leading to stigmatisation and perpetuating the cycle of disadvantage. Discussion: Emerging research indicates that there may be a role for acupuncture in managing the health needs of marginalised populations and that when historical barriers to accessing acupuncture treatment (such as awareness, availability and affordability of this therapy) are removed, certain marginalised populations are open to engaging with acupuncture treatment. Acupuncture has been used by low-income, refugee, veteran and ethnic minority groups to manage chronic pain, substance use disorders, stress and the impacts of trauma in conventional health settings such as community clinics and hospitals. There is the suggestion that integrative health settings and group treatment models may improve access and uptake of acupuncture among marginalised groups. Conclusion: Evidence suggests that the sociodemographic profile of acupuncture users is diverse and acupuncture therapy holds potential value in the treatment of marginalised populations. Further research that investigates reframing and expanding the scope of practice for acupuncture is timely and may contribute to tackling health inequity.

scholarly journals Effects of divorce and widowhood on subsequent health behaviours and outcomes in a sample of middle-aged and older Australian adults

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ding Ding ◽  
Joanne Gale ◽  
Adrian Bauman ◽  
Philayrath Phongsavan ◽  
Binh Nguyen
Keyword(s):  
Quality Of Life ◽  
Health Outcomes ◽  
Psychological Health ◽  
Public Awareness ◽  
Health Behaviours ◽  
Marital Disruption ◽  
Poor Quality ◽  
Anxiety And Depression ◽  
Potential Health

AbstractMarital disruption is a common life event with potential health implications. We examined the prospective association of divorce/widowhood with subsequent lifestyles, psychological, and overall health outcomes within short and longer terms using three waves of data from the 45 and Up Study in Australia (T1, 2006–09; T2, 2010; T3, 2012–16). Marital status and health-related outcomes were self-reported using validated questionnaires. Nine outcomes were examined including lifestyles (smoking, drinking, diet and physical activity), psychological outcomes (distress, anxiety and depression) and overall health/quality of life. Logistic regression was adjusted for sociodemographic characteristics and baseline health outcomes. Of the 33,184 participants who were married at T1 (mean age 59.5 ± 9.3 years), after 3.4 years, 2.9% became divorced and 2.4% widowed at T2. Recent divorce was positively associated with smoking, poor quality of life, high psychological distress, anxiety and depression at T2. Similar but weaker associations were observed for widowhood. However, these associations were much attenuated at T3 (5 years from T2). Marital disruption in midlife or at an older age can be detrimental to health, particularly psychological health in the short term. Public awareness of the health consequences of spousal loss should be raised. Resources, including professional support, should be allocated to help individuals navigate these difficult life transitions.

scholarly journals 1258Development of a valid evaluation tool assessing health behaviours among Māori & Pasifika young people

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Jessica Hardt ◽  
Ellen Cooper ◽  
Freya MacMillan ◽  
Sebastien Brignano ◽  
Kirstine Kira ◽  
...  
Keyword(s):  
Young People ◽  
Health Outcomes ◽  
Cultural Values ◽  
Health Behaviours ◽  
Health Inequity ◽  
Cognitive Interviewing ◽  
Evaluation Tool ◽  
Future Health ◽  
Validated Questionnaire ◽  
Improve Health

Abstract Background The Māori & Pasifika population experience high rates of health inequity, with a greater prevalence of obesity and the associated, life diminishing comorbidities. This is in part attributable to higher socioeconomic disadvantage, low health literacy and a lack of culturally tailored health services. Currently no validated tool exists to assess health behaviour change among Māori & Pasifika populations or success of tailored health interventions to tackle chronic disease. Methods The project incorporates a comprehensive validation and pilot testing process, including 1) cognitive interviewing and 2) test-retest reproducibility. Participants will include a representative sample of Māori & Pasifika young people and their parents/guardians. All research methodology is guided by cultural experts, specific to the Māori & Pasifika population. Results Qualitative data collected via cognitive interviewing will provide feedback regarding the readability, comprehension and content validity of the questionnaire items. Thematic analysis will inform improvements, optimising participant understandability. Cronbach’s alpha will be used to assess internal consistency and Pearson’s r will determine questionnaire test-retest reproducibility. Conclusions A validated questionnaire articulating with cultural values will provide meaningful data to researchers, health practitioners and government bodies regarding the lifestyle decisions of Māori & Pasifika peoples. Enhanced monitoring will determine the success of health initiatives to improve health outcomes of a priority population, across Australia and internationally. Key messages Lifestyle programs aiming to improve health outcomes are increasingly adapted to incorporate and acknowledge cultural values. Reliable measurement tools, including questionnaires, are fundamental to advancing future health research and tackling health inequity among priority populations.

The Impact of Social Mobilization on Health Service Delivery and Health Outcomes

2018 ◽  
Author(s):  
Xavier Giné ◽  
Salma Khalid ◽  
Mansuri Ghazala
Keyword(s):  
Health Services ◽  
Service Delivery ◽  
Health Outcomes ◽  
Health Workers ◽  
Health Service Delivery ◽  
Health Providers ◽  
Child Health Outcomes ◽  
Rural Pakistan ◽  
Post Natal Care ◽  
The Impact

This chapter uses a randomized community development programme in rural Pakistan to assess the impact of citizen engagement on public service delivery and maternal and child health outcomes. The programme had a strong emphasis on organizing women, who also identified health services as a development priority at baseline. At midline, we find that the mobilization effort alone had a significant impact on the performance of village-based health providers. We detect economically large improvements in pregnancy and well-baby visits by female health workers, as well as increased utilization of pre- and post-natal care by pregnant women. In contrast, the quality of supra-village health services did not improve, underscoring the importance of community enforcement and monitoring capacity for improving service delivery.

scholarly journals Lack of fit with the neighbourhood social environment as a risk factor for psychosis – a national cohort study

2021 ◽  
pp. 1-9
Author(s):  
Peter Schofield ◽  
Jayati Das-Munshi ◽  
Roger T. Webb ◽  
Henriette Thisted Horsdal ◽  
Carsten B. Pedersen ◽  
...  
Keyword(s):  
Low Income ◽  
Minority Groups ◽  
Density Effect ◽  
Ethnic Minority Groups ◽  
Ethnic Density ◽  
Affective Psychosis ◽  
Lack Of Fit ◽  
National Cohort ◽  
Group Density ◽  
Manual Occupation

Abstract Background Many studies report an ethnic density effect whereby psychosis incidence among ethnic minority groups is higher in low co-ethnic density areas. It is unclear whether an equivalent density effect applies with other types of socioeconomic disadvantages. Methods We followed a population cohort of 2 million native Danes comprising all those born on 1st January 1965, or later, living in Denmark on their 15th birthday. Socioeconomic disadvantage, based on parents' circumstances at age 15 (low income, manual occupation, single parent and unemployed), was measured alongside neighbourhood prevalence of these indices. Results Each indicator was associated with a higher incidence of non-affective psychosis which remained the same, or was slightly reduced, if neighbourhood levels of disadvantage were lower. For example, for individuals from a low-income background there was no difference in incidence for those living in areas where a low-income was least common [incidence rate ratio (IRR) 1.01; 95% confidence interval (CI) 0.93–1.10 v. those in the quintile where a low income was most common. Typically, differences associated with area-level disadvantage were the same whether or not cohort members had a disadvantaged background; for instance, for those from a manual occupation background, incidence was lower in the quintile where this was least v. most common (IRR 0.83; 95% CI 0.71–0.97), as it was for those from a non-manual background (IRR 0.77; 95% CI 0.67–0.87). Conclusion We found little evidence for group density effects in contrast to previous ethnic density studies. Further research is needed with equivalent investigations in other countries to see if similar patterns are observed.

Longitudinal Links between Income Dynamics and Young Adult Socioeconomic and Behavioral Health Outcomes

2021 ◽  
pp. 0044118X2199638
Author(s):  
Kendra Whitfield ◽  
Laura Betancur ◽  
Portia Miller ◽  
Elizabeth Votruba-Drzal
Keyword(s):  
Young Adult ◽  
Health Outcomes ◽  
Behavioral Health ◽  
Low Income ◽  
Family Income ◽  
Adult Outcomes ◽  
Income Volatility ◽  
Income Loss ◽  
Socioeconomic Outcomes ◽  
Young Adult Outcomes

Longitudinal links between childhood family income and adult outcomes are well documented. However, research on childhood income volatility and young adult outcomes is limited. This study utilizes data from the NLSY ( N = 6,410) to examine how childhood family income and income volatility relate to socioeconomic outcomes and mental/behavioral health in emerging adulthood. Results show that lower childhood income was associated with young adult socioeconomic and behavioral health outcomes. Higher income volatility was associated with increased depression and teen parenthood during young adulthood. Additional analyses examining trajectories of income volatility illustrated that children in families with unstable income trajectories (i.e., frequent income losses and gains) showed higher depression scores than those with stable trajectories. These findings suggest that income volatility, not just income level or income loss, is important to consider when studying economic disparities in young adult outcomes. Implications for policies and programs for low-income, high-volatility households are discussed.

scholarly journals How to do (or not to do)… Measuring health worker motivation in surveys in low- and middle-income countries

2017 ◽  
Vol 33 (2) ◽  
pp. 192-203 ◽  
Author(s):  
J Borghi ◽  
J Lohmann ◽  
E Dale ◽  
F Meheus ◽  
J Goudge ◽  
...  
Keyword(s):  
Health Worker ◽  
Low Income ◽  
Health Workers ◽  
Poor Quality ◽  
Validity And Reliability ◽  
High Quality Research ◽  
Quality Health Care ◽  
Middle Income ◽  
Health Worker Motivation ◽  
Worker Motivation

Abstract A health system’s ability to deliver quality health care depends on the availability of motivated health workers, which are insufficient in many low income settings. Increasing policy and researcher attention is directed towards understanding what drives health worker motivation and how different policy interventions affect motivation, as motivation is key to performance and quality of care outcomes. As a result, there is growing interest among researchers in measuring motivation within health worker surveys. However, there is currently limited guidance on how to conceptualize and approach measurement and how to validate or analyse motivation data collected from health worker surveys, resulting in inconsistent and sometimes poor quality measures. This paper begins by discussing how motivation can be conceptualized, then sets out the steps in developing questions to measure motivation within health worker surveys and in ensuring data quality through validity and reliability tests. The paper also discusses analysis of the resulting motivation measure/s. This paper aims to promote high quality research that will generate policy relevant and useful evidence.

scholarly journals An Intergenerational Women’s Empowerment Intervention to Mitigate Domestic Violence

2012 ◽  
Vol 18 (3) ◽  
pp. 346-370 ◽  
Author(s):  
Suneeta Krishnan ◽  
Kalyani Subbiah ◽  
Sajida Khanum ◽  
Prabha S. Chandra ◽  
Nancy S. Padian
Keyword(s):  
Domestic Violence ◽  
Health Outcomes ◽  
Low Income ◽  
Program Planning ◽  
Women's Empowerment ◽  
Reproductive Age ◽  
Women’S Empowerment ◽  
Adverse Health Outcomes ◽  
Prevention Interventions ◽  
Domestic Violence Prevention

A growing body of literature has documented the global prevalence of domestic violence against women of reproductive age as well as the association between violence and an array of adverse reproductive, psychosocial, and child health outcomes . However, there is a dearth of research on domestic violence prevention interventions in the peer-reviewed literature to guide program planning and policy-making efforts. In this article, the authors describe the development and assessment of the feasibility, acceptability, and potential effectiveness of an intergenerational women’s empowerment-based intervention to mitigate domestic violence and related adverse health outcomes in low-income urban communities in Southern India.

scholarly journals Health Inequalities in the Diverse World of Self-Employment: A Swedish National Cohort Study

2021 ◽  
Vol 18 (23) ◽  
pp. 12301
Author(s):  
Karl Gauffin ◽  
Andrea Dunlavy
Keyword(s):  
Health Outcomes ◽  
Health Inequalities ◽  
Low Income ◽  
Employment Status ◽  
The Self ◽  
Poor Health ◽  
Self Employment ◽  
Regular Employment ◽  
National Cohort ◽  
The Relationship

With labor being a central social determinant of health, there is an increasing need to investigate health inequalities within the heterogenous and growing population in self-employment. This study aimed to longitudinally investigate the relationship between income level, self-employment status and multiple work-related health indicators in a Swedish national cohort (n = 3,530,309). The study investigated the relationship between self-employment status and health outcomes later in life. All poor health outcomes, with the exception of alcohol-related disorders, were more common in the self-employed population, compared to the group in regular employment. The income gradient, however, was more pronounced in the group with regular employment than the groups in self-employment. The study found clear connections between low income and poor health in all employment groups, but the gradient was more pronounced in the group in regular employment. This suggests that income has a weaker connection to other types of health promoting resources in the self-employed population. Potentially, lacking social and public support could make it difficult for unhealthy individuals to maintain low-income self-employment over a longer time period.

scholarly journals EMDR-Based Divorce Recovery Group: A Case Study

2018 ◽  
Vol 12 (2) ◽  
pp. 58-70
Author(s):  
Sik-Lam Wong
Keyword(s):  
Low Income ◽  
Traumatic Stress ◽  
Group Treatment ◽  
Group Discussion ◽  
Treatment Protocol ◽  
Post Traumatic Stress ◽  
Divorce Recovery ◽  
Adolescents And Adults ◽  
Recovery Group

This case study investigated the effects of an eye movement desensitization and reprocessing (EMDR)-based divorce recovery group, consisting of four modalities: (a) modified EMDR Integrative Group Treatment Protocol adapted for adolescents and adults living with ongoing traumatic stress (EMDR-IGTP-OTS) to deal with the trauma from the divorce, (b) modified Affect Circuit Reset protocol to reduce intensity of negative affects, (c) psychoeducation on affects and divorce-related issues, and (d) small group discussion. The divorce recovery program is an attempt to provide an affordable, trauma-focused intervention for divorce recovery for low-income populations. This report summarizes the outcomes in a divorce recovery group of six women, all Chinese immigrants. Aside from one person in the midst of divorce, the group consisted of individuals divorced for 7 years or more, for whom the distress had lasted more than the 2 to 3 years typical of divorce recovery. Short Post-Traumatic Stress Disorder (PTSD) Rating Interview (SPRINT) scores collected at the beginning of week 2, at the end of week 7, and at the beginning of week 8 showed PTSD symptoms dropping from severe to mild. The mean SPRINT scores at 6 weeks and 13 weeks after treatment continued to decrease, approaching the no/minimal symptom range. The SPRINT scores showed a 65.6% reduction between week 2 (18.0 [SD = 8.4]) and 13 weeks after treatment (6.2 [SD= 5.5]), with a large effect size of d = 1.40, and a significant decrease of t(4)=4.0, p = .016.

scholarly journals Socioeconomic differences in self-medication among middle-aged and older people: data from the China health and retirement longitudinal study

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e017306 ◽  
Author(s):  
Jie Chang ◽  
Qing Wang ◽  
Yu Fang
Keyword(s):  
Longitudinal Study ◽  
Older People ◽  
Low Income ◽  
Health Indicators ◽  
Health Behaviours ◽  
Education Programme ◽  
Easy Access ◽  
Self Medication ◽  
Clear Trend ◽  
Income Groups

ObjectivesSelf-medication with over-the-counter medicines (OTCs) and prescription-only medicines (POMs) are both pervasive in China, although the latter is an inappropriate practice. We examined the relationship between socioeconomic status (SES) and self-medication with OTCs versus POMs.MethodsMultivariate logistic regressions based on the Andersen framework were estimated using a subsample of respondents aged 45 years and over from the China Health and Retirement Longitudinal Study collected between 2011 and 2013 (n=23 699). As dependent variables, we used OTC and POM consumption without a medical prescription. SES was operationalised by household income per capita and education. Control variables included health indicators, demographic characteristics, and health behaviours.ResultsIn our study sample, 32.69% and 15.02% of people aged 45 years and over had self-medicated with OTCs and POMs in the 4 weeks before the survey, respectively. OTC use by income exhibited an inverse U shape. Respondents from middle income groups were more likely to self-medicate with OTCs compared with those from the lowest and highest income groups. In contrast, respondents from the lowest income group were more inclined to self-medicate with POMs. There was a clear trend towards more self-medication with OTCs, but not POMs, among those with higher educational attainment.ConclusionPeople with low income tended to rely on self-medication with POMs for treatment, which is risky and of low quality. A health education programme for older people, particularly those living in low-income households, aimed at improving the quality of self-medication behaviour is warranted. Urgent measures are needed to address the issue of easy access to POMs at community pharmacies, and to improve access to formal medical care among the low-income population.

Sign in / Sign up

Export Citation Format

Share Document