جستجوی مقالات مرتبط با کلیدواژه « inequalities » در نشریات گروه « پزشکی »

In health policy-making, various deliberative mechanisms can be used to engage the members of the public in exploring what might be a reasonable course of action. Scurr et al take power dynamics into consideration to analyse a deliberative dialogue involving stakeholders with diverse points of view. Given such asymmetries at play, the conclusions of deliberations could be biased. Scholars would benefit from guidance on designing and evaluating deliberative processes. This commentary aims to broadly reflect on the possible sources of power and information asymmetries in deliberative dialogues, and to bring the biographical resources approach to deal with such asymmetries.

This paper provides a commentary on Lacy-Nichols and Williams’ analysis of the emerging tactics of the ultraprocessed food transnational corporations (TNCs). Our paper provides an overview of the growth in power and influence of TNCs in the past three decades and considers how this change impacts on health and health equity. We examine how wealth inequities have increased dramatically and how many of the health harms are externalised to governments or individuals. We argue that human interests and corporate interests differ. The article concludes with a consideration of alternative ways of organising an economy that are more human centred and health promoting. We suggest five changes are required: improved measurement of economic outputs beyond gross domestic product (GDP); improved regulation of finance and TNCs; development of localised economic models including cooperatives; reversal of privatisations; making the reduction of economic inequalities a goal of financial policy. We consider the barriers to these changes happening.

We aimed to examine the available evidence about the impact of the crisis on the use of healthcare services in Europe.

We developed a systematic review of scientific literature for the period 2008-2017. The researchers searched three databases Medline/PubMed, Scopus and Web of Knowledge. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Descriptive and thematic analyses were carried out. PRISMA quality criteria and the recommendations of the Centre for Reviews and Dissemination were followed.

Of 3,685 studies, 35 met inclusion criteria. Regarding “Effects of the social structure” healthcare accessibility inequalities increased by socioeconomic levels, especially in unemployed, people with low educational levels and migrants. Regarding “Healthcare effect”, the impact of the recession was observed in unmet needs, pharmaceutical spending containment, reduction of hospital beds, and privatization of services.

Austerity policies have contributed to increasing inequalities in the use of health services during the economic downturn. In the current economic climate, new management and health planning strategies such as hospitalisation at home, new models of integrated care and pharmaceutical management are needed to help achieve greater equity and equality in health.

BackgroundNon-communicable diseases (NCDs) account for some 90% of premature UK deaths, most being preventable. However, the systems driving NCDs are complex. This complexity can make NCD prevention strategies difficult to develop and implement. We therefore aimed to explore with key stakeholders the upstream policies needed to prevent NCDs and related inequalities. MethodsWe developed a theory-based co-production process and used a mixed methods approach to engage with policy- and decision-makers from across the United Kingdom in a series of 4 workshops, to better understand and respond to the complex systems in which they act. The first and fourth workshops (London) aimed to better understand the public health policy agenda and effective methods for co-production, communication and dissemination. In workshops 2 and 3 (Liverpool and Glasgow), we used nominal group techniques to identify policy issues and equitable prevention strategies, we prioritised emerging policy options for NCD prevention, using the MoSCoW approach. ResultsWe engaged with 43 diverse stakeholders. They identified ‘healthy environment’ as an important emerging area. Reducing NCDs and inequalities was identified as important, underpinned by a frustration relating to the evidence/policy gap. Evidence for NCD risk factor epidemiology was perceived as strong, the evidence underpinning the best NCD prevention policy interventions was considered patchier and more contested around the social, commercial and technological determinants of health. A comprehensive communications strategy was considered essential. The contribution of ‘elite actors’ (ministers, public sector leaders) was seen as key to the success of NCD prevention policies. ConclusionsNCDs are generated by complex adaptive systems. Early engagement of diverse stakeholders in a theory-based co-production process can provide valuable context and relevance. Subsequent partnership-working will then be essential to develop, disseminate and implement the most effective NCD prevention strategies.

To determine socioeconomic inequalities in cardiovascular health (CVH) metrics among Peruvian adults as well as differences according to sex.

An observational, cross‑sectional study was conducted in 26,175 individuals aged 18–65 years using the 2017 Peruvian Demographic and Health Survey. According to the American Heart Association, 5 CVH metrics which comprised three ideal health behaviors (diet, non smoking, ideal body mass index [BMI]), and two ideal health factors (ideal blood pressure and no history of diabetes) were evaluated. The concentration curves (CC) methodology was used to analyze whether CVH metrics vary between socioeconomic status and sex. The concentration index (CI) was used to quantify socioeconomic‑related inequality in health variables.

Overall, the mean age was 36.5 years (SD = 11.9) and 51.2% were women. Only 2.4% had 5 ideal CVH metrics (women 3.7%, men 1.0%) with a CI very close to the equality line (0.0135). (0.0135; higher in women [0.0262], compared to men [0,0002]). A greater prevalence of ideal CHV metrics (3 or more) was found in women (P < 0.001). Ideal health factors were more prevalent (52.1%) than ideal health behaviors (13.8%). Regarding inequality measures, CCs for most CVH metrics had a higher concentration in the lowest wealth population, except for ideal diet, which was more frequent among higher levels of wealth. An ideal BMI was the CVH metric with the lowest CI (overall: −0.0817; men: −0.2699).

Peruvian women presented a higher prevalence of ideal CVH metrics and fewer inequalities. Ideal CVH metrics tend to be concentrated in the wealthiest women. Low‑ and middle‑income countries should consider socioeconomic inequalities in cardiovascular disease prevention programs.

  Ethnic  minorities  are  underrepresented  in  health  sciences  programs  in  various   nations. Furthermore, there is no known research studying the occurrence of physical inactivity (PI)  and insufficient sleep (IS), and their effects on academic achievement (AA) in ethnic minority  students (EMS) in higher education.

The objective of this study is to explore the occurrence of PI and IS, and their  independent and mixed effects on AA in EMS of a dental school.

Thirty EMS and sixty non‑EMSs were matched (1:2) in this  case–control study. It was utilized as an administrative dataset that stores register related to the  students. Moreover, the grade point average was considered an indicator of AA. Logistic regressions  models were run, expressed in odds ratios, complemented by confidence intervals (CIs) of 95%.

A total of 73% and 60% EMS were PI and slept insufficiently, respectively. The groups  presented statistically significant differences (P < 0.0001) in physical activity, sleep, and AA, with  inferior values for EMS. All unadjusted models showed that PS, IS, and low AA were strongly  associated with EMS, demonstrating their independent effect. After controlling for PI and IS, the  multivariate model for AA and EMS increased odds by 6.5 times (95%CI: 1.8–23;), indicating  that EMS is strongly associated with low AA. Besides, PI and IS were also statistically significant  higher (<0.0001) in the model, demonstrating their mixed effect.

This study found a higher occurrence of PI and IS in EMS. Besides, independent  and mixed effects of these variables on low AA in EMS were very significant.

Power, socioeconomic inequalities, and poverty are recognized as some of the fundamental determinants of differences in vulnerability of societies to infectious disease threats. The economic south is carrying a higher burden than those in the economic north. This raises questions about whether social preventions and biomedical preventions for infectious disease are given equal consideration, and about social institutions and structures that frame the debate about infectious disease. This article examines how institutionalized ways of talking about infectious disease reinforces, creates, and sustains health inequalities.

Critical discourse analysis was considered to be epistemologically and ontologically consistent with the aims and context of this study.

The study examined three types of infectious disease: • Emerging infectious diseases/pathogens • Neglected tropical diseases • Vector‑borne infections. Examination revealed that poverty is the most common determinant of all three.

A sustainable reduction in infectious disease in the southern countries is most likely to be achieved through tackling socioeconomic determinants. There is a need for a change in the discourse on infectious disease, and adopt a discourse that promotes self‑determination, rather than one that reinforces the hero‑victim scenario and power inequalities.

Social inequalities are public health issues that require the development of professional competence in the training of nurses through highlighting actions based on equality. The present study aimed to assess the teaching strategies to approach social inequalities in nursing training. The publications in the past 10 years in Portuguese, English, and Spanish were reviewed and indexed in five databases. In total, 426 papers were found, and 16 were selected and grouped based on similarities or the adopted teaching strategies. The selected studies were mostly conducted in the United States at the undergraduate level, presenting predominantly low evidential levels. Punctual interventions were observed as the proposition of elective disciplines and adoption of counseling and innovative and structuring guidelines with the potential to reach the discussion of inequalities. In addition, service learning has been identified as a potent strategy to address social disparities by enabling the development of active reflection for experiential learning. Virtual and classroom simulations and theoretical classes have also been employed to provide training on the social inequalities associated with clinical education. Although the analyzed strategies have specificities, their combined use could further enhance the commitment of nursing education to surpass inequalities.

Equity in healthcare utilization is a major health policy goal in all healthcare systems. This study aimed to examine socioeconomic inequalities in public healthcare utilization in Kermanshah City, western Iran.
Study design: A cross-sectional study.
Using convenience sampling method, 2040 adult aged 18-65 yr were enrolled from Kermanshah City in 2017. A self-administrated questionnaire was used to collect data on socio-demographic characteristics, socioeconomic status, behavioral factors, and utilization of public healthcare services (inpatient and outpatient care) over the period between from May to Aug 2017. The concentration index (C) was used to measure and decompose socioeconomic inequalities in the utilization inpatient and outpatient care in public sector. The indirect standardization method was used to estimate the horizontal inequity (HI) indices in inpatient and outpatient care use.
The utilization outpatient (C=-0.121, 95% CI: -0.171, -0.071) and inpatient care in public sector (C=-0.165, 95% CI: -0.229, -0.101) were concentrated among the poor in Kermanshah, Iran. Socioeconomic status, health-related quality of life, marital status and having a chronic health condition were the main determinants of socioeconomic-related inequalities in the utilization of inpatient and outpatient care in public sector among adults. The distributions of outpatient (HI=-0.045, CI: -0.093 to 0.003) and inpatient care (HI= -0.044 95% CI: -0.102, 0.014) in Kermanshah were pro-poor. These results were not statistically significant (P The utilization of public healthcare services in Iran are pro-poor. The pro-poor distribution of inpatient and outpatient care in public facilities calls for initiatives to increase the allocation of resources to public facilities in Iran that may greatly benefit the health outcomes of the poor.

This study measured socioeconomic inequalities in different types of disabilities in Iran. We also examined the prevalence of disabilities across different socio-demographic groups in Iran in 2011.
This was cross-sectional study using secondary data analysis on all Iranian. Data related to disability prevalence and socioeconomic status (SES) of each province was extracted from the 2011 National Census of Population and Housing (NCPH) and the 2011 Households Income and Expenditure Survey (HIES), conducted by Statistical Center of Iran (SCI). The concentration index and concentration curve were used to measure and illustrate socioeconomic inequalities in different types of disabilities. Chi-squared test was also used to examine the relationship between the socio-demographic variables (age-groups, sex, education level, employment status) and disability.
The results suggested the existence of socioeconomic inequalities in blindness, deafness, vocal disorders and hand disorders in Iran. The concentration index for these four disabilities were -0.0527 (95% confidence interval [CI]: -0.0881, -0.0173), -0.0451 (CI: -0.0747, -0.0156), -0.0663 (CI: -0.1043, -0.0282) and -0.0545 (CI: -0.0940, -0.0151), respectively. There were also significant associations between the demographic variables such as age-groups, sex, education level, employment status and disability (P There were significant socioeconomic inequalities in different types of disabilities in Iran with poorer provinces having higher prevalence of disabilities in blindness, deafness, vocal disorders and hand disorders. Strategies to address the higher prevalence of different types of disabilities among poorer provinces should be considered a priority in Iran.

Socioeconomic status (SES) is an important determinant of health-related quality of life (HRQoL). We aimed to quantify socioeconomic-related inequality in poor-HRQoL among adults in Kermanshah, western Iran.
Study design: A cross-sectional study.
Overall, 1730 adults (18-65 yr) were selected using convenience sampling from Kermanshah, Iran. A self-administrated questionnaire was used to collect data on socio-demographic characteristics, SES, lifestyle factors and HRQoL of participants over the period between May and Aug 2017. The concentration curve and concentration index (C) were used to illustrate and measure wealth-related inequality in poor-HRQoL. Additionally, we decomposed the C index to identify factors explaining wealth-related inequality in poor-HRQoL.
The overall prevalence of poor-HRQoL was 35.3% (95% confidence interval[CI]: 33.1%, 37.6%). The poor-HRQoL was mainly concentrated among the poor adults (C=-0.256, 95% CI: -0.325, -0.187). Poor-HRQoL was concentrated among men (C=-0.256, 95% CI: -0.345, -0.177) and women (C=-0.261, 95% CI: -0.310, -0.204). Wealth, physical inactivity, the presence of chronic health condition(s), lack of health insurance coverage were the main factors contributing to the concentration of poor-HRQoL among socioeconomically disadvantaged adults.
Socioeconomic-related inequalities in poor-HRQoL among adult should warrant more attention. Policies should be designed to not only improve HRQoL among adults but also reduce the pro-rich distribution of HRQoL among adults in Kermanshah.

The world was different when the Ottawa Charter for Health Promotion was released 30 years ago. Concerns over the environment and what we now call the ‘social determinants of health’ were prominent in 1986. But the acceleration of ecological crises and economic inequalities since then, in a more complex and multi-polar world, pose dramatically new challenges for those committed to the original vision of the Charter. Can the 2015 Sustainable Development Goals (SDGs), agreed to by all the world’s governments, offer a new advocacy and programmatic platform for a renewal of health promotion’s founding ethos? Critiqued from both the right and the left for, respectively, their aspirational idealism and lack of political analysis, the SDGs are an imperfect but still compelling normative statement of how much of the world thinks the world should look like. Many of the goals and targets provide signals for what we need to achieve, even if there remains a critical lacuna in articulating how this is to be done. The fundamental flaw in the SDGs is the implicit assumption that the same economic system, and its still-present neoliberal governing rules, that have created or accelerated our present era of rampaging inequality and environmental peril can somehow be harnessed to engineer the reverse. This flaw is not irrevocable, however, if health promoters – practitioners, researchers, advocates – focus their efforts on a few key SDGs that, with some additional critique, form a basic blueprint for a system of national and global regulation of capitalism (or even its transformation) that is desperately needed for social and ecological survival into the 22nd century. Whether or not these efforts succeed is a future unknown; but that the efforts are made is a present urgency.

Considering the renewed emphasis on women’s health, attention to the new aspects of their health, such as equity, among different groups is warranted. The aim of this study was to investigate the economic inequalities among women with osteoporosis-related bone fractures (ORBFs) in Sanandaj, Iran.
In this cross-sectional study, convenient sampling was employed to recruit 220 women with osteoporosis referring to the only rheumatology clinic in Sanandaj (the center of Kurdistan province in Iran) from January to April 2013. Main outcome was the history of fractures due to osteoporosis. Concentration index decomposition (CID) and logistic regression were used for data analysis.
In multivariate logistic analysis, the fourth and fifth quintiles of family economic status were found to be significantly associated with ORBFs. Risk difference and confidence interval (CI) for the relation between the history of bone fracture and family economic status was -0.115 (95% CI: -0.209, -0.021; P = 0.016), which reflected the higher prevalence of bone fractures among women with the lower economic levels. About 25% out of all ORBFs were happened among 20% of the women with low economic status.
It was concluded that economic status plays an important role in happening ORBFs among underprivileged women. A reorientation on women’s health care services in Iran with a focus on underprivileged postmenopausal women seems to be necessary. There is a need for inter-sectoral coalition between the policymakers of the health system and those of other organizations to reduce the economic inequalities among osteoporotic women.

Investments in the extension of health insurance coverage, the strengthening of public health services, as well as primary care and better hospitals, highlights the emerging role of healthcare as part of China’s new growth regime, based on an expansion of services, and redistributive policies. Such investments, apart from their central role in terms of relief for low-income people, serve to rebalance the Chinese economy away from export-led growth toward the domestic market, particularly in megacity-regions as Shanghai and the Pearl River Delta, which confront the challenge of integrating migrant workers. Based on the paper by Gusmano and colleagues, one would expect improvements in population health for permanent residents of China’s cities. The challenge ahead, however, is how to address the growth of inequalities in income, wealth and the social wage.

I agree entirely with Nir Eyal’s perspective that denying treatment to obese patients is morally wrong. However, the reasons for this belief differ in some ways from Eyal’s analysis. In this commentary, I will try to explain the similarities and differences in our perspectives. My primary claim is that the denial of treatment to obese patients is wrong principally because (i) it eschews a whole-population approach to the problem of poor nutrition and is therefore likely to be ineffective; (ii) it is likely to expand obesity-related health inequities; and (iii) it is likely to intensify stigma against already-marginalized social groups. I shall consider each in turn, and explore the extent to which Eyal would be likely to agree with my claims.