scholarly journals Linked data and inclusion health: Harmonised international data linkage to identify determinants of health inequalities

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Jesse Young ◽  
Rohan Borschmann ◽  
Ximena Camacho ◽  
Josh Knight ◽  
Fiona Kouyoumdjian ◽  
...  
Keyword(s):  
Health Disparities ◽  
Social Exclusion ◽  
Health Inequalities ◽  
Sex Workers ◽  
Data Linkage ◽  
Determinants Of Health ◽  
Linkage Studies ◽  
Health Response ◽  
International Data ◽  
Socially Excluded

A recent article in The Lancet establishing the principles of inclusion health, highlighted substantial gaps in our understanding of the drivers of health inequalities in socially excluded groups such as people with a history of incarceration, people who experience homelessness, sex workers, people with mental illness, and people who inject drugs1. Cross-sectoral data linkage of electronic health records with services working with socially excluded groups was one of the key recommendations of this article. The magnitude of health disparities observed in people that experience social exclusion necessitates an international public health response and addressing the determinants of social exclusion has been identified as a key component of closing the gap of Indigenous disadvantage2. This symposium will establish data linkage as a key component of the inclusion health and will complement the efforts of the Pan American Health Oranization's (PAHO) Commission on Equity and Health Inequalities in the Americas. Traditional survey methodology is costly and often results in studies that are highly parochial in nature. Due to difficulties recruiting and retaining marginalized groups, these studies are commonly forced to adopt methodological concessions, often selecting the most convenient participants (i.e., selection bias) or incurring increased rates of loss-to-follow-up (i.e., attrition bias). Conversely, global studies aimed at modelling the burden of disease are often not sufficiently nuanced to answer specific inferential research questions. Data-linkage has the potential to overcome these common biases and limitations. Thus, harmonised international data-linkage studies are an important component of the inclusion health response to identify the determinants of health inequalities in socially excluded groups and inform the global inclusion health agenda. This symposium will bring together facilitators from three countries with extensive experience conducting data linkage studies that generate evidence on health and social inequality in socially excluded groups. Using a current multinational study as an example, barriers to international data-linkage studies, methodological solutions, and distributed approaches to generating international comparative evidence will be presented. Innovative examples of cross-sectoral approaches to linkage with social service, correctional and national survey data will be discussed. The development of a novel framework for identifying social exclusion exposures and determinants of health inequalities typically not captured in administrative health data will also be discussed. The session will conclude with a discussion aimed at forming the foundation of an international data linkage project to address these current gaps identified in the inclusion health series and best practice for translation to policy and practice to address health disparities in socially excluded groups. References Aldridge et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. The Lancet. 2017;391(10117):241-250. https://doi.org/10.1016/S0140-6736(17)31869-X Greenwood M et al. Challenges in health equity for Indigenous peoples in Canada. The Lancet. 2018;Epub ahead of print. https://doi.org/10.1016/S0140-6736(18)30177-6

SOCIAL EXCLUSION AND HEALTH INEQUALITIES IN THE TIME OF COVID-19

2021 ◽  
Vol 27 (6) ◽  
pp. 1563-1581
Author(s):  
Predrag Bejaković ◽  
Marinko Škare ◽  
Romina Pržiklas Družeta
Keyword(s):  
Social Exclusion ◽  
Health Inequalities ◽  
Social Life ◽  
Social Inequalities ◽  
Power Relationships ◽  
Health Crisis ◽  
Policies And Measures ◽  
Or Groups ◽  
Employment Education ◽  
Socially Excluded

Social exclusion as a process leads to a state of multiple relative deprivations in diverse areas of social life, like employment, education, healthcare, social ties, respect. Individuals or groups may have a worse position in several areas, particularly with other individuals or groups in society. Coronavirus pandemics disproportionately affect poorer communities and socially excluded people. Socially excluded are double victims; due to their position, they are more prone to infection by a coronavirus, further increasing their exclusion. The purpose of this contribution is to provide a conceptual framework for analyzing the relationship between social exclusion and health disparities during the COVID-19 pandemic. The goal is to comprehend the causes and consequences of unequal power relationships and offer critical assessments of current policies and measures to reduce health inequalities. Health and social inequalities are a significant constraint to economic revival and a successful fight against pandemics. The extent of the economic and health crisis caused by pandemic shock largely depends on past health and social inequality.

Social determinants of health affecting treatment of pediatric brain tumors

2019 ◽  
Vol 24 (2) ◽  
pp. 159-165
Author(s):  
Jillian M. Berkman ◽  
Jonathan Dallas ◽  
Jaims Lim ◽  
Ritwik Bhatia ◽  
Amber Gaulden ◽  
...  
Keyword(s):  
African American ◽  
Health Disparities ◽  
Brain Tumors ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Cns Tumor ◽  
Initial Symptoms ◽  
Caucasian Patients

OBJECTIVELittle is understood about the role that health disparities play in the treatment and management of brain tumors in children. The purpose of this study was to determine if health disparities impact the timing of initial and follow-up care of patients, as well as overall survival.METHODSThe authors conducted a retrospective study of pediatric patients (< 18 years of age) previously diagnosed with, and initially treated for, a primary CNS tumor between 2005 and 2012 at Monroe Carell Jr. Children’s Hospital at Vanderbilt. Primary outcomes included time from symptom presentation to initial neurosurgery consultation and percentage of missed follow-up visits for ancillary or core services (defined as no-show visits). Core services were defined as healthcare interactions directly involved with CNS tumor management, whereas ancillary services were appointments that might be related to overall care of the patient but not directly focused on treatment of the tumor. Statistical analysis included Pearson’s chi-square test, nonparametric univariable tests, and multivariable linear regression. Statistical significance was set a priori at p < 0.05.RESULTSThe analysis included 198 patients. The median time from symptom onset to initial presentation was 30.0 days. A mean of 7.45% of all core visits were missed. When comparing African American and Caucasian patients, there was no significant difference in age at diagnosis, timing of initial symptoms, or tumor grade. African American patients missed significantly more core visits than Caucasian patients (p = 0.007); this became even more significant when controlling for other factors in the multivariable analysis (p < 0.001). African American patients were more likely to have public insurance, while Caucasian patients were more likely to have private insurance (p = 0.025). When evaluating survival, no health disparities were identified.CONCLUSIONSNo significant health disparities were identified when evaluating the timing of presentation and survival. A racial disparity was noted when evaluating missed follow-up visits. Future work should focus on identifying reasons for differences and whether social determinants of health affect other aspects of treatment.

Health Disparities and the Social Determinants of Health: Ethical and Social Justice Issues

2019 ◽  
pp. 265-276
Author(s):  
Sridhar Venkatapuram
Keyword(s):  
Health Disparities ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Global Justice ◽  
Social Epidemiology ◽  
Social Groups ◽  
Determinants Of Health ◽  
Housing Conditions ◽  
Early Infant ◽  
The Social

The term health disparities (also called health inequalities) refers to the differences in health outcomes and related events across individuals and social groups. Social determinants of health, meanwhile, refers to certain types of causes of ill health in individuals, including lack of early infant care and stimulation, lack of safe and secure employment, poor housing conditions, discrimination, lack of self-respect, poor personal relationships, low community cohesion, and income inequality. These social determinants stand in contrast to others, such as individual biology, behaviors, and proximate exposures to harmful agents. This chapter presents some of the revolutionary findings of social epidemiology and the science of social determinants of health, and shows how health disparities and social determinants raise profound questions in public health ethics and social/global justice philosophy.

scholarly journals Exploring the local policy context for reducing health inequalities in children and young people: an in depth qualitative case study of one local authority in the North of England, UK

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eleanor Holding ◽  
Hannah Fairbrother ◽  
Naomi Griffin ◽  
Jonathan Wistow ◽  
Katie Powell ◽  
...  
Keyword(s):  
Child Health ◽  
Social Determinants Of Health ◽  
Health Inequalities ◽  
Social Determinants ◽  
Qualitative Case Study ◽  
Determinants Of Health ◽  
Local Policy ◽  
Inequalities In Health ◽  
The North

Abstract Background Improving children and young people’s (CYP) health and addressing health inequalities are international priorities. Reducing inequalities is particularly pertinent in light of the Covid-19 outbreak which has exacerbated already widening inequalities in health. This study aimed to explore understandings of inequality, the anticipated pathways for reducing inequalities among CYP and key factors affecting the development and implementation of policy to reduce inequalities among CYP at a local level. Methods We carried out a qualitative case study of one local government region in the North of England (UK), comprising semi structured interviews (n = 16) with service providers with a responsibility for child health, non-participant observations of key meetings (n = 6 with 43 participants) where decisions around child health are made, and a local policy documentation review (n = 11). We employed a novel theoretical framework, drawing together different approaches to understanding policy, to guide our design and analysis. Results Participants in our study understood inequalities in CYP health almost exclusively as socioeconomically patterned inequalities in health practices and outcomes. Strategies which participants perceived to reduce inequalities included: preventive support and early intervention, an early years/whole family focus, targeted working in local areas of high deprivation, organisational integration and whole system/place-based approaches. Despite demonstrating a commitment to a social determinants of health approach, efforts to reduce inequalities were described as thwarted by the prevalence of poverty and budget cuts which hindered the ability of local organisations to work together. Participants critiqued national policy which aimed to reduce inequalities in CYP health for failing to recognise local economic disparities and the interrelated nature of the determinants of health. Conclusions Despite increased calls for a ‘whole systems’ approach to reducing inequalities in health, significant barriers to implementation remain. National governments need to work towards more joined up policy making, which takes into consideration regional disparities, allows for flexibility in interpretation and addresses the different and interrelated social determinants of health. Our findings have particular significance in light of Covid-19 and indicate the need for systems level policy responses and a health in all policies approach.

scholarly journals From fringe to centre-stage: experiences of mainstreaming health equity in a health research collaboration

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ana Porroche-Escudero ◽  
Jennie Popay ◽  
Fiona Ward ◽  
Saiqa Ahmed ◽  
Dorkas Akeju ◽  
...  
Keyword(s):  
Health Equity ◽  
Health Inequalities ◽  
National Health ◽  
Health Research ◽  
Research Collaboration ◽  
Determinants Of Health ◽  
Gender Mainstreaming ◽  
Health Improvement ◽  
Structural Determinants ◽  
Applied Health Research

Abstract Background Action to address the structural determinants of health inequalities is prioritized in high-level initiatives such as the United Nations Sustainable Development Goals and many national health strategies. Yet, the focus of much local policy and practice is on behaviour change. Research shows that whilst lifestyle approaches can improve population health, at best they fail to reduce health inequalities because they fail to address upstream structural determinants of behaviour and health outcomes. In health research, most efforts have been directed at three streams of work: understanding causal pathways; evaluating the equity impact of national policy; and developing and evaluating lifestyle/behavioural approaches to health improvement. As a result, there is a dearth of research on effective interventions to reduce health inequalities that can be developed and implemented at a local level. Objective To describe an initiative that aimed to mainstream a focus on health equity in a large-scale research collaboration in the United Kingdom and to assess the impact on organizational culture, research processes and individual research practice. Methods The study used multiple qualitative methods including semi-structured interviews, focus groups and workshops (n = 131 respondents including Public Advisers, university, National Health Service (NHS), and local and document review. Results utilizing Extended Normalization Process Theory (ENPT) and gender mainstreaming theory, the evaluation illuminated (i) the processes developed by Collaboration for Leadership in Applied Health Research and Care North West Coast to integrate ways of thinking and acting to tackle the upstream social determinants of health inequities (i.e. to mainstream a health equity focus) and (ii) the factors that promoted or frustrated these efforts. Conclusions Findings highlight the role of contextual factors and processes aimed at developing and implementing a robust strategy for mainstreaming health equity as building blocks for transformative change in applied health research.

scholarly journals Praca wychowawcza z dziewczętami wykluczonymi społecznie – w ujęciu bł. Marii Karłowskiej (1865–1935)

2021 ◽  
Vol 7 ◽  
pp. 337-348
Author(s):  
Katarzyna Wasilewska-Ostrowska
Keyword(s):  
Young People ◽  
Social Exclusion ◽  
Young Women ◽  
Educational System ◽  
Risky Behaviors ◽  
Educational Work ◽  
The Social ◽  
Universal Values ◽  
Socially Excluded ◽  
Work Education

Educational Work with Socially Excluded Girls – in Terms of the Blessed Maria Karłowska (1865–1935) This text presents the concept of education developed by Blessed Maria Karłowska (1865–1935). The foundress of the Congregation of the Shepherds of Divine Providence worked all her life with socially excluded people, especially girls and young women who were prostitutes. She established care and educational centers for them, where, together with her colleagues, she helped them to overcome their life crises. Several important assumptions can be distinguished in the educational system introduced by Karłowska. First of all, the social and moral development of the pupil was important. Much emphasis was placed on apprenticeship and work. Education to freedom, independence, and citizenship was also a priority, which was based on the assumptions of the pedagogy of dialogue and love. The educators had to show patience and understanding, work on the resources of the charges, and also prevent risky behaviors. Despite the passage of time, this concept has not lost its importance as it is based on universal values that are fundamental in educational work with young people at risk of social exclusion.

scholarly journals Socially Excluded Persons in Ireland Have an Increased Annual Risk of Hospitalisation Due to Venous Thromboembolic Disease

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4702-4702
Author(s):  
Karl Ewins ◽  
Fionnuala Ni Ainle ◽  
Eoghan Dunlea ◽  
Sarah Kelliher ◽  
Vicky Sandys ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Social Exclusion ◽  
Research Funding ◽  
Hospital Admissions ◽  
Significant Proportion ◽  
Service Planning ◽  
Hospital Inpatient ◽  
Care Provision ◽  
Advisory Committees ◽  
Socially Excluded

Introduction Social exclusion in Ireland is strongly associated with injecting drug use, particularly injection of opiates into the groin: a strong risk factor for venous thromboembolism (VTE) (O'Reilly et al, 2015). Ní Cheallaigh et al (2017) reported a high burden of disease in socially excluded individuals in Ireland that can be effectively addressed by dedicated service planning and care provision. VTE in socially excluded persons has been identified by our group as a key knowledge gap. We have generated preliminary data demonstrating that socially excluded people account for a significant proportion of patients presenting with VTE in Dublin. Methods We extracted national Hospital InPatient Enquiry (HIPE) data from Health Atlas Ireland using the methods outlined in Kevane et al (2019). We identified individuals as "socially excluded persons" if their records contained one or more of the variables identified by Aldridge et al (2018): homeless individuals, prisoners, sex workers and individuals with substance use disorders. We identified all emergency inpatient hospital admissions for those with any diagnosis of VTE during 2017 using VTE-associated ICD-10 codes. Results There were 494,972 emergency inpatient admissions in patients >16 years during this 12 month period, of which 5,717 (1.2%) had a VTE diagnosis (55% of which were DVTs). 306 (5.3%) of hospital episodes with VTE occurred in socially excluded individuals. Applying maximum and minimum assumptions on the estimated population denominator we estimated that overall the annual incidence rate of VTE-related hospitalisation per person was approximately 10-fold higher in socially excluded individuals when compared to the general population (in which it was 0.12%). Conclusions This is the first time that an approximately ten-fold increase in the risk of hospitalisation due to VTE has been shown to be associated with social exclusion. This information was generated from national data, using surrogate identifiers for socially excluded persons. We hypothesise that detailed characterisation of VTE events in socially excluded clients will permit improved service planning and care provision for these vulnerable patients, enabling better VTE prevention and management. This may save lives and prevent the disabling and common long-term consequence of post-thrombotic syndrome with debilitating leg ulcers, which in this population results in numerous admissions and severe mobility issues. Planning such initiatives has the potential to reduce morbidity and mortality, improve quality of life but also to reduce hospital admissions (which are hugely over-represented in this patient group), save costs and resources and most importantly results in more equitable health care for socially excluded patients. Disclosures Ewins: Amgen: Other: Conference Fees & Travel Expenses; Bayer: Other: Conference Fees & Travel Expenses. Ni Ainle:BMS: Membership on an entity's Board of Directors or advisory committees; Daiichi Sankyo: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees, Research Funding; Boehringer: Membership on an entity's Board of Directors or advisory committees; Leo Pharma: Research Funding; Actelion: Research Funding. Cliona:Pfizer: Research Funding; MSD: Other: Travel Expenses.

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