Los inmigrantes representan en torno a un tercio de los nuevos diagnósticos de VIH en España y constituyen una población especialmente vulnerable a sus consecuencias negativas debido al contexto sociocultural, económico, laboral, administrativo y legal. Los inmigrantes se diagnostican más tardíamente, lo que empeora su pronóstico individual y facilita el mantenimiento de la epidemia en la población. A pesar de las diferentes barreras que experimentan para acceder a los servicios sanitarios en general, y a los relacionados con el VIH en particular, el acceso al tratamiento antirretroviral se ha producido en condiciones similares a la población autóctona. Sin embargo, los beneficios obtenidos del mismo han sido inferiores, siendo los subsaharianos y las mujeres los grupos con peor respuesta. Es necesaria una actitud proactiva para el diagnóstico precoz de la infección, la adopción de medidas preventivas para evitar nuevos casos y proporcionar una atención sanitaria accesible, adaptada y de alta calidad.
Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches
Background: There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-to-policy approaches implemented in low-resource settings.Methods: The first approach was implemented in Mexico and Nicaragua and focused on implementation research facilitated by communities of practice (CoP) among maternal health stakeholders. We conducted a process evaluation of the CoPs and assessed the professionals' abilities to acquire, analyse, adapt and apply research. The second approach, called the Policy BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills (Policy BUDDIES), was implemented in South Africa and Cameroon. The intervention put forth a "buddying" process to enhance demand and use of systematic reviews by sub-national policymakers. The Policy BUDDIES initiative was assessed using a mixed-methods realist evaluation design.Results: In Mexico, the implementation research supported by CoPs triggered monitoring by local health organizations of the quality of maternal healthcare programs. Health programme personnel involved in CoPs in ...
How could differences in "control over destiny" lead to socio-economic inequalities in health? A synthesis of theories and pathways in the living environment
We conducted the first synthesis of theories on causal associations and pathways connecting degree of control in the living environment to socio-economic inequalities in health-related outcomes. We identified the main theories about how differences in 'control over destiny' could lead to socio-economic inequalities in health, and conceptualised these at three distinct explanatory levels: micro/personal; meso/community; and macro/societal. These levels are interrelated but have rarely been considered together in the disparate literatures in which they are located. This synthesis of theories provides new conceptual frameworks to contribute to the design and conduct of theory-led evaluations of actions to tackle inequalities in health.
The World Health Organization defines the social determinants of health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” These forces and systems include economic policies, development agendas, cultural and social norms, social policies, and political systems. In an era of pronounced human migration, changing demographics, and growing financial gaps between rich and poor, a fundamental understanding of how the conditions and circumstances in which individuals and populations exist affect mental and physical health is imperative. Educating health professionals about the social determinants of health generates awareness among those professionals about the potential root causes of ill health and the importance of addressing them in and with communities, contributing to more effective strategies for improving health and health care for underserved individuals, communities, and populations.