Correction to: Social inequalities in health‑related quality of life among people aging with HIV/AIDS: the role of comorbidities and disease severity

A correction to this paper has been published: https://doi.org/10.1007/s11136-021-02854-w

Supporting parents by combatting social inequalities in health: a realist evaluation

Background To reduce social inequities in health, the World Health Organization’s Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever. The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period. Methods To meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires. Results The main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented. While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents’ behavior, aiming to empower them but without giving them the means to do so. Conclusions This research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should clearly state among its objectives the intention to reduce social inequalities in health. The policy should also state that it will be evaluated according to the criteria of proportionate universalism, interprofessional coordination, and actions based on the diversity of parents’ needs.

Maliqua: A study within Malakit, a project on malaria and gold miners in French Guiana

Malaria is endemic in French Guiana, especially within the gold mining community working illegally. Gold miners travel to remote camps in the forest to carry out their activities, exposing themselves to the presumed contamination area. This paper presents the results of a qualitative case study of the Malakit project, a free distribution of self-diagnosis and self-treatment kits, along with appropriate training/information from health facilitators, at resting sites in Brazil and Suriname on the borders with French Guiana. This study documents how Malakit is part of the care trajectory of gold miners. The data was collected using three methods: 1) on-site observation; 2) semi-structured individual interviews (n=26); 3) semi-structured group interviews (n=2). The results inform us that Malakit responds to the need for treatment and facilitates access to care. Gold miners say they trust the facilitators and receive accurate explanations. The majority of participants find the kit easy to use and to carry and explanations given were sufficient, although some people needed to be reminded how to use it once in the forest. Results remind us that malaria among illegal gold miners in French Guiana is a question of social inequalities in health, where the interaction of the health, social, economic and political contexts of Brazil and French Guiana influence exposure to numerous risk factors. Thus, malaria intervention practices such as Malakit cannot be carried out without considering the complexity generated by social inequalities in health.

The development of skills in Primary Health Care nurses for coping with social inequalities in health

The objective of this study was to identify and develop skills with Primary Health Care nurses to work the social inequalities in health. This is a qualitative research based on action-research, performed with six primary health care nurses in a municipality of Minas Gerais, who participated in educational workshops addressing coping strategies for social inequalities in health. The data collection occurred through a focal group and non-participant observation, from March to May 2018. The data were analyzed through the thematic content analysis technique. The identification and training of skills to cope with this was founded on knowledge, skills and attitudes. The participants stressed the importance of knowing their role in the scenario where they work, as well as the functioning of the Health Care Network and legislation to support them to coping with this problem, being the communicational skills essential in this process. The knowledge acquired in the workshop enabled participants to recognize attitudes in their professional routine, which enable them to act in the face of this reality. The present study indicates the importance of appreciating and strengthening the training of nurses for the development of competences to act on social inequalities.

Tackling social inequalities in health: acceptability and feasibility of a systematic approach toward health impact assessment of urban projects

Introduction: The general objective of this research project was to explore the feasibility and acceptability of an original method intended to systematically identify urban planning projects whose potential impacts on health and social inequalities in health (SIH) would be most damaging. An approach based on a short meeting and a tool would help to discuss whether or not to engage in a more comprehensive health impact assessment. Methods: A tool was developed by the research team based on various tools reported in the literature and modified with urban planners. Meetings were organized for each development project with the volunteer planners, who were working on the projects selected. Reviews of six projects at different stages of design made it possible to assess the acceptability and feasibility of this approach to identify public health and social equity issues in health. Results: The process and the use of the tool were found to be feasible. The tool was easily understandable, adapted to the practices of planners and usable without real training other than a quick introduction to tool usage. It was also found to be acceptable. Despite an interest in the inclusion of SIH, the integration of the relationship between SIH and urban development was not easy for most of the urban planners. Conclusion: This exploratory work suggests that a systematic approach to assessing the impact of urban projects on health and SIH is feasible and acceptable. Dealing with SIH was not found to be easy by the urban planners.

A deep learning approach to identify unhealthy advertisements in street view images

While outdoor advertisements are common features within towns and cities, they may reinforce social inequalities in health. Vulnerable populations in deprived areas may have greater exposure to fast food, gambling and alcohol advertisements, which may encourage their consumption. Understanding who is exposed and evaluating potential policy restrictions requires a substantial manual data collection effort. To address this problem we develop a deep learning workflow to automatically extract and classify unhealthy advertisements from street-level images. We introduce the Liverpool $${360}^{\circ }$$ 360 ∘ Street View (LIV360SV) dataset for evaluating our workflow. The dataset contains 25,349, 360 degree, street-level images collected via cycling with a GoPro Fusion camera, recorded Jan 14th–18th 2020. 10,106 advertisements were identified and classified as food (1335), alcohol (217), gambling (149) and other (8405). We find evidence of social inequalities with a larger proportion of food advertisements located within deprived areas and those frequented by students. Our project presents a novel implementation for the incidental classification of street view images for identifying unhealthy advertisements, providing a means through which to identify areas that can benefit from tougher advertisement restriction policies for tackling social inequalities.

Systemic Materialist Realist Ontology, Epistemology, Semantics, Axiology and Ethics: Why Pearl’s counterfactuals and Pawson’s methods are insufficient for causation in Social Epidemiology and Public Health

We evaluate counterfactual empiricism, the dominant philosophy of science in contemporary epidemiology and public health from a scientific realist perspective. Building on our earlier work, we critique the dominant counterfactual/potential outcomes epistemology in epidemiology and public health, based on its neglect of ontology and exclusion of causal mechanisms which are confused with statistical inference methods (e.g., mediation). We argue that a realist systemic materialist ontology of levels , scientific realist epistemology, and realist semantics, axiology and ethics could constitute a best philosophical system for the disciplines of social epidemiology and public health, and their social inequalities in health subdivisions