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Scoping review: national monitoring frameworks for social determinants of health and health equity

Scoping review: national monitoring frameworks for social determinants of health and health equity Background: The strategic importance of monitoring social determinants of health (SDH) and health equity and inequity has been a central focus in global discussions around the 2011 Rio Political Declaration on SDH and the Millennium Development Goals. This study is part of the World Health Organization (WHO) equity-oriented analysis of linkages between health and other sectors (EQuAL) project, which aims to define a framework for monitoring SDH and health equity.Objectives: This review provides a global summary and analysis of the domains and indicators that have been used in recent studies covering the SDH. These studies are considered here within the context of indicators proposed by the WHO EQuAL project. The objectives are as follows: to describe the range of international and national studies and the types of indicators most frequently used; report how they are used in causal explanation of the SDH; and identify key priorities and challenges reported in current research for national monitoring of the SDH.Design: We conducted a scoping review of published SDH studies in the PubMed® database to obtain evidence of socio-economic indicators. We evaluated, selected, and extracted data from national scale studies published from 2004 to 2014. The research included papers published in English, Italian, French, Portuguese, and Spanish.Results: The final sample consisted of 96 articles. SDH monitoring is well reported in the scientific literature independent of the economic le ...

Publicado en ODS2016-03-11

Swimming "upstream" to tackle the social determinants of health

Swimming "upstream" to tackle the social determinants of health Quality improvement interventions typically focus on how to improve the care delivered within healthcare organisations or by health systems. Rarely do efforts venture beyond the walls of clinics and hospitals to target the social determinants of health. Berkowitz et al remind us that swimming "upstream" is essential if we want to improve health outcomes for vulnerable or disadvantaged patients.The authors conducted a cross-sectional study of a Health Leads intervention in two urban adult primary care practices. Social needs were identified and then addressed by advocates based in the practices. They found that 15% of patients seen had an unmet resource need, most commonly food insecurity or a health resource need such as difficulty obtaining health insurance or affording medications. Patients with unmet resource needs were less healthy, had more "no-show" appointments, more emergency department visits and were less likely to meet care targets.

Publicado en ODS2016-03-09

Monitoring inequality: an emerging priority for health post-2015

The Millennium Development Goals focused on poverty and development and reducing inequalities between countries.1 Progress was monitored through national averages without adequate attention to within-country inequality. The post-2015 sustainable development goals (SDG) stress “leaving no one behind” – with goal 10 specifically calling for the reduction of inequality, within and among countries. Monitoring of inequalities within countries focuses on indicators and dimensions of inequality that are particularly relevant to each country. Drawing upon the outputs of within-country inequality monitoring, policies can be tailored to be maximally effective in reducing inequalities.3 At the same time, having comparable disaggregated data across countries is important to track within-country inequality at a regional or global level. One of the SDG targets specifically addresses the importance of disaggregated data, calling on countries to increase “…the availability of high-quality, timely and reliable data disaggregated by income, gender, age, race, ethnicity, migratory status, disability, geographic location and other characteristics relevant in national contexts”. Such disaggregated data are vital to identify where and why inequalities exist and ensure that policies, programmes and practices are successful in reaching the most vulnerable. Many countries have made major progress in monitoring health inequalities through household surveys such a ...

Publicado en ODS2015-09-03

Research on health inequalities: a bibliometric analysis

The objective of this study is to report on research production and publications on health inequalities through a bibliometric analysis covering publications from 1966 to 2014 and a content analysis of the 25 most-cited papers. A database of 49,294 references was compiled from the search engine Web of Science. The first article appears in 1966 and deals with equality and civil rights in the United States and the elimination of racial discrimination in access to medical care. By 2003, the term disparity has gained in prominence relative to the term inequality which was initially elected by the researchers. Marmot's 1991 article is one of the five papers with the largest number of citations and contributes to the central perspective of social determinants of health and the British influence on the international status of research on social inequalities of health.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-09-01

Moving Towards a Better Understanding of Socioeconomic Inequalities in Preventive Health Care Use: A Life Course Perspective

The aim of this book chapter is to outline how the life course perspective can move forward the debate on socioeconomic inequalities in preventive health care use. Recent theoretical developments in medical sociology, including health lifestyle theory and cultural health capital theory, have implicitly encapsulated a longer-term view of an individual’s life, in order to develop a better understanding of the social causes of good health and conversely illness. I will elaborate more explicitly on how the five central principles of the life course perspective apply to preventive health care use, using the empirical example of mammography screening. Central and unanswered questions pertain to (i) the life stages that are important in the development of cultural health capital or a healthy lifestyle (life-span development); (ii) the temporality of socioeconomic inequalities in preventive health care (timing); (iii) the impact of different socialization contexts for healthy lifestyles or cultural health capital (structure-agency debate); (iv) the change in preventive health care use across policy implementations (time and place); and (v) the role of significant others for health care use (linked lives).

TipoObras de Referencia
Publicado en ODS2015-09-02

Critical examination of knowledge to action models and implications for promoting health equity

Critical examination of knowledge to action models and implications for promoting health equity Introduction:Knowledge and effective interventions exist to address many current global health inequities. However, there is limited awareness, uptake, and use of knowledge to inform action to improve the health of disadvantaged populations. The gap between knowledge and action to improve health equity is of concern to health researchers and practitioners. This study identifies and critically examines the usefulness of existing knowledge to action models or frameworks for promoting health equity. Methods:We conducted a scoping review of existing literature to identify knowledge to action (KTA) models or frameworks and critiqued the models using a health equity support rubric. Results:We identified forty-eight knowledge to action models or frameworks. Six models scored between eight and ten of a maximum 12 points on the health equity support rubric. These high scoring models or frameworks all mentioned equity-related concepts. Attention to multisectoral approaches was the factor most often lacking in the low scoring models. The concepts of knowledge brokering, integrative processes, such as those in some indigenous health research, and Ecohealth applied to KTA all emerged as promising areas. Conclusions:Existing knowledge to action models or frameworks can help guide knowledge translation to support action on the social determinants of health and health equity. There is a need to further test existing models or frameworks. This process should be informed by participatory an ...

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-07-25

Advocacy for Health Equity: A Synthesis Review

Context:Health inequalities are systematic differences in health among social groups that are caused by unequal exposure to -and distributions of- the social determinants of health (SDH). They are persistent between and within countries despite action to reduce them. Advocacy is a means of promoting policies that improve health equity, but the literature on how to do so effectively is dispersed. The aim of this review is to synthesize the evidence in the academic and gray literature and to provide a body of knowledge for advocates to draw on to inform their efforts. Methods:This article is a systematic review of the academic literature and a fixed-length systematic search of the gray literature. After applying our inclusion criteria, we analyzed our findings according to our predefined dimensions of advocacy for health equity. Last, we synthesized our findings and made a critical appraisal of the literature. Findings:The policy world is complex, and scientific evidence is unlikely to be conclusive in making decisions. Timely qualitative, interdisciplinary, and mixed-methods research may be valuable in advocacy efforts. The potential impact of evidence can be increased by "packaging" it as part of knowledge transfer and translation. Increased contact between researchers and policymakers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, although health professionals and disadvantaged people, who have direct contact with ...

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-07-15

Inequalities in health: definitions, concepts and theories

Inequalities in health: definitions, concepts and theories Individuals from different backgrounds, social groups, and countries enjoy different levels of health. This article defines and distinguishes between unavoidable health inequalities and unjust and preventable health inequities. We describe the dimensions along which health inequalities are commonly examined, including across the global population, between countries or states, and within geographies, by socially relevant groupings such as race/ethnicity, gender, education, caste, income, occupation, and more. Different theories attempt to explain group-level differences in health, including psychosocial, material deprivation, health behavior, environmental, and selection explanations. Concepts of relative versus absolute; dose-response versus threshold; composition versus context; place versus space; the life course perspective on health; causal pathways to health; conditional health effects; and group-level versus individual differences are vital in understanding health inequalities. We close by reflecting on what conditions make health inequalities unjust, and to consider the merits of policies that prioritize the elimination of health disparities versus those that focus on raising the overall standard of health in a population.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-07-13

Inequities in the freedom to lead a flourishing and healthy life: issues for healthy public policy

There are many reasons for the health inequities that we see around the world today. Public policy and the way society organises its affairs affects the economic, social and physical factors that influence the conditions in which people are born, grow, live, work and age - the social determinants of health. Tackling health inequities is a political issue that requires leadership, political courage, progressive public policy, social struggle and action, and a sound evidence base.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-06-17

Social determinants of health, inequality and social inclusion among people with disabilities

Objective: to analyze the socio-familial and community inclusion and social participation of people with disabilities, as well as their inclusion in occupations in daily life. Methods: qualitative study with data collected through open interviews concerning the participants' life histories and systematic observation. The sample was composed of ten individuals with acquired or congenital disabilities living in the region covered by a Family Health Center. The social conception of disability was the theoretical framework used. Data were analyzed according to an interpretative reconstructive approach based on Habermas' Theory of Communicative Action. Results: the results show that the socio-familial and community inclusion of the study participants is conditioned to the social determinants of health and present high levels of social inequality expressed by difficult access to PHC and rehabilitation services, work and income, education, culture, transportation and social participation. Conclusion: there is a need to develop community-centered care programs in cooperation with PHC services aiming to cope with poverty and improve social inclusion.

Publicado en ODS2015-06-15

In It Together: Why less Inequality Benefits All

In It Together: Why less Inequality Benefits All The gap between rich and poor keeps widening. Growth, if any, has disproportionally benefited higher income groups while lower income households have been left behind. This long-run increase in income inequality not only raises social and political concerns, but also economic ones. It tends to drag down GDP growth, due to the rising distance of the lower 40% from the rest of society. Lower income people have been prevented from realising their human capital potential, which is bad for the economy as a whole. This book highlights the key areas where inequalities are created and where new policies are required, including: the consequences of current consolidation policies; structural labour market changes with rising non-standard work and job polarization; persisting gender gaps; the challenge of high wealth concentration, and the role for redistribution policies.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-06-02

Action on the social determinants of health: Views from inside the policy process

Action on the social determinants of health: Views from inside the policy process It is now well documented that many of the key drivers of health reside in our everyday living conditions. In the last two decades, public health has urged political action on these critical social determinants of health (SDH). As noted by the World Health Organisation, encouraging action in this area is challenging. Recent research has argued that public health researchers need to gain a deeper understanding of the complex and changing rationalities of policymaking. This, it seems, is the crucial next step for social determinants of health research. In this paper, we turn our attention to the practitioners of 'the art of government', in order to gain insight into how to secure upstream change for the SDH. Through interviews with policy actors (including politicians, senior government advisors, senior public servants and experienced policy lobbyists) the research sought to understand the nature of government and policymaking, as it pertains to action on the SDH. Through exploring the policy process, we examine how SDH discourses, evidence and strategies align with existing policy processes in the Australian context. Participants indicated that approaches to securing change that are based on linear conceptualisations of the policy process (as often found in public health) may be seen as 'out of touch' with the messy reality of policymaking. Rather, a more dialogic approach that embraces philosophical and moral reasoning (alongside evidence) may be more effective. Based on our ...

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-03-09

A three-stage approach to measuring health inequalities and inequities

A three-stage approach to measuring health inequalities and inequities Introduction:Measurement of health inequities is fundamental to all health equity initiatives. It is complex because it requires considerations of ethics, methods, and policy. Drawing upon the recent developments in related specialized fields, in this paper we incorporate alternative definitions of health inequity explicitly and transparently in its measurement. We propose a three-stage approach to measuring health inequities that assembles univariate health inequality, univariate health inequity, and bivariate health inequities in a systematic and comparative manner. Methods:We illustrate the application of the three-stage approach using the Joint Canada/United States Survey of Health, measuring health by the Health Utilities Index (HUI). Univariate health inequality is the distribution of the observed HUI across individuals. Univariate health inequity is the distribution of unfair HUI – components of HUI associated with ethically unacceptable factors – across individuals. To estimate the unfair HUI, we apply two popular definitions of inequity: “equal opportunity for health” (health outcomes due to factors beyond individual control are unfair), and “policy amenability” (health outcomes due to factors amenable to policy interventions are unfair). We quantify univariate health inequality and inequity using the Gini coefficient. We assess bivariate inequities using a regression-based decomposition method. Results:Our analysis reveals that, empirically, different definitions ...

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2014-11-19