scholarly journals Achievements and Challenges of Social Epidemiology Research Aiming to Reduce Health Inequality: A Revised English Version of Japanese in the Journal of the Japan Medical Association 2020;149 (9):1626-30

JMA Journal ◽  
2022 ◽  
Vol 5 (1) ◽  
pp. 9-16
2019 ◽  
Vol 20 (4) ◽  
pp. e913-e948 ◽  
Author(s):  
Volker Grossmann ◽  
Holger Strulik

Abstract This paper integrates into public economics a biologically founded, stochastic process of individual aging. The novel approach enables us to quantitatively characterize the optimal joint design of health and retirement policy behind the veil of ignorance for today and in response to future medical progress. Calibrating our model to Germany, our analysis suggests that the current social insurance policy instruments are set close to the (constrained) socially optimal levels, given proportional contribution rates for health and pension finance, the equivalence principle in the pension system, and a common statutory retirement age. Future progress in medical technology calls for a potentially drastic increase in health spending and a higher retirement age without lowering the pension contribution rate. Interestingly, from an ex ante point of view, medical progress and higher health spending are in conflict with the goal to reduce health inequality.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B T Dyer ◽  
F Swann ◽  
M Kadam ◽  
J Draper ◽  
L A Mc Gill ◽  
...  

Abstract Background Tackling health inequalities is a priority in heart failure (HF). We do not fully understand why some patients do not attend their hospital HF clinic appointments. Currently when a patient DNAs (does not attend) they are offered a repeat appointment often months later or are discharged from the service with a request to the primary care physician to re-refer. Non-attendance represents a missed opportunity to improve patients' health. Purpose The purpose of this pilot was to look at the demographics and patient factors that contribute to non-attendance. The aim is to understand and personalise our DNA policy to reduce health inequality, improve outcomes, and reduce inefficiencies in our service. Methods The last consecutive 45 patients who DNAd HF clinic were identified and for each, a patient who did attend the same clinic date (Attender), was chosen at random (random.org). The demographics were obtained (age, ethnicity, contact details) and medical notes reviewed (LVEF%, co-morbidities). The patient address was scored for its Index of Multiple Deprivation (IMD) – a UK government dataset measuring relative deprivation by ranking 32,844 neighbourhoods nationally using 37 indicators across 7 domains of deprivation where neighbourhood 1 is the most deprived nationally. Patients were phoned up to three times to establish the patient's mode, duration and cost of their last journey to clinic and, for those patients who DNAd, to ascertain the reason for non-attendance. Results Demographic and medical history was obtained for all patients. It was not possible to contact 2/45 of the Attenders, and 13/45 of the DNA patients. There was no significant difference in age, gender, number of comorbidities, LVEF%, travel time, or travel cost between DNAs and attenders. The mean one-way journey time was 53.4 mins (range 15–210 mins) and the mean return journey cost was GBP ≤10.95 (range ≤0–≤80). Common reasons for non-attendance were not receiving appointment details, forgetting appointments, being unwell on the day and difficulties with travel. The IMD score for the patients who DNAd was significantly lower confirming these patients lived in more deprived areas (9436±5863 vs. 15414±7801, p<0.001) with 71% of DNA patient's addresses in the bottom third most deprived neighbourhoods nationally. Figure 1 Conclusions There was a significant difference in deprivation score between patients who attended and DNAd their clinics. In addition, we found that all patients were travelling up to an hour each way to attend clinic, and that the cost of travel may be a barrier to attendance, even in a healthcare system that is free at the point of delivery. Despite calling three times, we were unable to speak to 29% of patients who DNAd and 4% of the patients who attended their appointments. Work is ongoing to reduce our DNA rates and personalise our response in this deprived population, with the aim of improving engagement and health inequality.


Author(s):  
Richard Cookson ◽  
James Love-Koh ◽  
Colin Angus ◽  
James Lomas

This chapter introduces the handbook spreadsheet training exercises, which are designed to provide hands-on experience in using the methods of distributional cost-effectiveness analysis (DCEA). Seven of the exercises form a cumulative step-by-step sequence relating to nicotine replacement therapy (NRT) in England, which is a classic example of a preventive healthcare programme designed to improve health and reduce health inequality. This allows us to illustrate all the main steps involved in conducting a DCEA using a single common example. There are also two stand-alone exercises relating to other topics in other countries.


REGION ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 53-73
Author(s):  
Marco Percoco

Geography and the quality of the environment may have long lasting effects on the living standards of individuals and this, in its turn, may affect even substantially the distribution of income and regional disparities. In this paper I consider malaria as a measure of “bad geography” and propose some evidence showing that it was a major determinant of the health of individuals (as measured by the height of conscripts) and its disparities between individuals and regions in Italy. In particular, to estimate the relationship between malaria exposure and height, I rely on the “fetal origins hypothesis”, that is I hypothesize that exposure to malaria in utero or during childhood has persistent effects on health. Periods under scrutiny in this paper are the last two decades of the XIX century, a period without major public health interventions, and the years around the eradication era in the 1950s. My results support the hypothesis that geographically targeted policies may reduce health inequality between regions and within regions.


2021 ◽  
Author(s):  
Jiwen Wang ◽  
Donghong Xie

Abstract Objectives To investigate whether unequal exposure to health-related expertise of intra-family is the root of health inequality in China, and to explore the underlying mechanisms through which health-related expertise shapes health outcome. Methods In a representative sample of Chinese adults ages over 18 from the 2017 Chinese General Social Survey (CGSS) (n = 3,047 respondents), we use multiple linear regression model and the two-stage least-squares model to analyze the correlation between health-related expertise of intra-family and self-rated health. Results The presence of a health professional (HP) in the family is associated with better self-rated health (SRH), and the effect is more important in rural areas than urban areas. An increased chance of exercising appears to explain a part of the association between HP and SRH. Discussions Health professionals doing for their family members would have the potential to make a substantial dent in population health and reduce health inequality. Future work will need to understand the patterns of intra-family expertise in health (and other) domains, and the potential replicability of this transmission by public policies.


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