Search

Interactions in the healthcare system today involve an important new set of actors: evaluative health platforms (EHPs). These platforms are not neutral intermediaries, but active moderators of how patients express opinions, choose providers, and consume health-related information. This paper adds to our understanding of the varied and evolving commercial interests of EHPs and the implications these have for patient voice. We analyze 71 platforms in the USA, UK, and Germany and identify five ideal types: subscribers, analyzers, advertisers, regulators, and scammers. Each platform type enacts a unique competitive strategy through an evaluative infrastructure which constrains but also generates possibilities for patient voice. Based on our typology, we develop three contributions. First, we nuance universalizing claims about the consequences of platform capitalism by specifying the diverse strategies underpinning competition between EHPs in different countries, and showing how each strategy leads evaluative infrastructures to develop in ways that impact patient voice. Second, we show how patients can navigate the challenges of a complex EHP space by exercising their ability to choose between platforms. Finally, we outline the conditions platforms need to fulfil to become empowering. Overall, this study highlights the varied and complex relationship between platform business models and user voice, which exists not only in healthcare, but also in many other fields. • Typology of evaluative health platforms (EHPs) in the US, the UK, and Germany. • EHP business models and content moderation techniques vary considerably. • EHPs have a wide range of implications for patient voice. • More transparency and competition can help platforms increase patient empowerment. [ABSTRACT FROM AUTHOR]

Understanding the extent and evolution of pandemic-induced mortality risk is critical given its wide-ranging impacts on population health and socioeconomic outcomes. We examine empirically the persistence and scale of influenza mortality risk following the main waves of influenza pandemics, a quantitative analysis of which is required to understand the true scale of pandemic-induced risk. We provide evidence from municipal public health records that multiple recurrent outbreaks followed the main waves of the 1918-19 pandemic in eight large cities in the UK, a pattern we confirm using data for the same period in the US and data for multiple influenza pandemics during the period 1838–2000 in England and Wales. To estimate the persistence and scale of latent post-pandemic influenza mortality risk, we model the stochastic process of mortality rates as a sequence of bounded Pareto distributions whose tail indexes evolves over time. Consistently across pandemics and locations, we find that influenza mortality risk remains elevated for around two decades after the main pandemic waves before more rapid convergence to background influenza mortality, amplifying the impact of pandemics. Despite the commonality in duration, there is heterogeneity in the persistence and scale of risk across the cities, suggesting effects of both immunity and socioeconomic conditions. • We examine influenza mortality risk following the main waves of influenza pandemics. • We analyse data for England & Wales from 1838 to 2000, capturing five pandemics. • We also analyse data for eight large UK cities and the US after the 1918-19 pandemic. • Influenza outbreak risk remains high for two decades after the main pandemic waves. • Immunity effects and socioeconomic conditions contribute to the persistence of risk. [ABSTRACT FROM AUTHOR]

National health departments across the globe have utilized persuasive strategies to promote COVID-19 vaccines through Twitter. However, the effectiveness of those strategies is unclear. This study thereby examined how national health departments deployed persuasive strategies to promote citizen engagement in COVID-19 vaccine-related tweets in six countries, including the UK, the US, Germany, Japan, South Korea, and India. Guided by the heuristic-systematic model and the health belief model, we found that national health departments differed significantly in the use of systematic-heuristic cues and health belief constructs in COVID-19 vaccine-related tweets. Generally, the provision of scientific information and appeals to anecdotes and fear positively, while appeals to bandwagon negatively, predicted citizen engagement. Messages about overcoming barriers and promoting vaccine benefits and self-efficacy positively affected engagement. Emphases of COVID-19 threats and cues to vaccinate demonstrated negative impacts. Importantly, health departments across countries often used futile or detrimental strategies in tweets. A locally adapted evidence-based approach for COVID-19 vaccination persuasion was discussed. • Health departments often used detrimental tactics in promoting COVID-19 vaccines. • Appeals to facts, anecdotes, and fear promoted citizen engagement. • Appeals to bandwagon reduced citizen engagement. • Messages about efficacies and benefits promoted citizen engagement. • Emphases of COVID-19 threats and cues to vaccinate harmed citizen engagement. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries—Germany, the Netherlands, the United Kingdom (UK), and the United States (US)—to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors—physical activity, screen time, and breakfast consumption—in explaining these inequalities. Children were aged 5–7 at our first timepoint and were followed up at age 8–11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families. • All countries showed substantial socioeconomic inequalities in childhood BMI. • In all countries, inequalities in BMI steepen over course of primary school. • Protective factors among the most advantaged seem to mainly drive inequalities. • Across most countries, underlying mechanisms for inequalities in BMI are similar. • The relative contribution of each mechanism to BMI inequalities differs per country. [ABSTRACT FROM AUTHOR]

Family structure can influence adolescent health with cascading implications into adulthood. Life course theory emphasizes how this phenomenon is dynamic across time, contextualized in policy systems, and grounded in processes of selection and socialization. This study used data from the U.S. (National Longitudinal Survey of Youth 1979 Child and Young Adults, n = 6,236) and U.K. (Millennium Cohort Study, n = 11,095) to examine associations between a single mother family structure between ages 0–14 and early adolescent substance use at age 14 across time and place, using inverse probability of treatment weighting to explore how results varied by selection into family structure. In both countries, single parenthood, regardless of its timing during childhood, consistently predicted adolescent substance use when samples were re-weighted to resemble the overall population. However, when samples were re-weighted so that their background characteristics resembled those of actual single parent families, there was little evidence that single parenting posed risks, suggesting that single parenting might matter less for adolescents who are likely to experience it (and vice versa). In addition, more generous welfare policy in the U.K. than in the U.S. did not appear to have ameliorated the observed role of single parenting in adolescent substance use. Findings supported a model of disadvantage saturation, where single parenting has little additional impact over the myriad other disadvantages that single parent families tend to experience, rather than a model of cumulative disadvantage, where single parenting compounds or adds to other disadvantages. Policy and interventions might more valuably focus on these other disadvantages than on family structure. • Living with a single mother was associated with early adolescent substance use. • Associations were similar across the U.S. and U.K. and not differentiated by age. • Single mother families were more risky to adolescents less likely to live in one. • Findings were consistent with a disadvantage saturation model. • Policy should focus on economic disadvantages associated with single parenthood. [ABSTRACT FROM AUTHOR]

Influenza vaccination uptake among health care workers (HCWs) protects patients and staff. Still, many health institutions' coverage rates are unsatisfactory. We aimed to test the effect of communicating moral appeals in increasing vaccination uptake in a real life setting. In three field experiments among HCWs, a moral appeal highlighting morally relevant consequences of influenza vaccination was manipulated. The outcome variables were vaccination intention right after exposure to the moral appeal (Study 1; N = 569 US and UK HCWs from various institutions) and vaccination uptake in subsequent weeks for those respondents who consented in sharing this data during the survey (Studies 2 and 3, respectively N = 121 and N = 770 Dutch hospital employees). Studies 1 and 3 showed that moral appeal enhanced vaccination intention and uptake (vaccination uptake increased by 11%), due to increased awareness that vaccination is a moral decision. In Study 2, moral appeal had no effect, probably because people with more outspoken vaccination attitudes had responded to the call to fill in the survey. Moreover, moral appeal increased support for an influenza vaccination mandate. Furthermore, the results suggest that moral appeal was especially effective among HCWs with no history of influenza vaccination. These results indicate that moral appeal can be a useful tool for increasing both vaccination uptake and mandate support within health care institutions. • Influenza vaccination coverage rates among health care workers are unsatisfying. • Moral appeal was tested in a field experiment among health care workers (HCWs). • Exposure to a moral appeal increased influenza vaccination uptake with 11%. • Exposure to a moral appeal increased support for an influenza vaccination mandate. • Moral appeal affected HCWs without an influenza vaccination history more strongly. [ABSTRACT FROM AUTHOR]

How is medical labor power, that being the capacity to assemble, adjust, or arrange medical subjects, converted into medical practice? Drawing on three qualitative case studies in the United States, Canada, and the United Kingdom, we argue that this conversion is shaped by pressures channeled through the relations that medical workers enter into with patients "from below" and managers "from above." We demonstrate this by examining a common empirical object: ambulance labor. In addition to providing a unique window into the varieties of medical work, paramedicine offers a strategic venue for examining the kinds of productive relations that medical laborers enter into. Our research shows how the labor process is shaped by patient requests that can either conform or contradict workers' shared sense of vocation. We also detail how this same process is simultaneously pressured by managers who are generally focused on increasing both the flexibility and the visibility of their workers. Many of these pressures, we argue, can be linked to common forces of neoliberalism across our three nations. Our analysis of the medical labor process inspires some practical recommendations to reform ambulance-based care. However, our primary aim is to advance a labor-centric approach to studying medicine. • Examines medicine as a labor process through three case studies of ambulance work. • Unique pressures shape the conversion of medical labor power into medical practice. • Ambulance workers in U.S., Canada, and UK are pressured by patients "from below.". • Those same workers are also pressured by managers "from above.". • These pressures are linked to common forces of neoliberalism across our cases. [ABSTRACT FROM AUTHOR]

Most people want to be both happy and healthy. But which matters most when there is a trade-off between them? This paper addresses this question by asking 4000 members of the UK and US public to make various choices between being happy or being physically healthy. The results suggest that these trade-offs are determined in substantial part by the respondent's own levels of happiness and health, with unhappy people more likely to choose unhappy lives and unhealthy people more likely to choose unhealthy ones: "better the devil you know, than the devil you don't". Age also plays an important role; older people are more likely to choose being healthy over being happy. Information about adaptation to physical health conditions matters too, but less so than respondent characteristics. These results further our understanding of public preferences with important implications for policymakers concerned with satisfying those preferences. • Most people want to be both happy and healthy, but which matters most? • We trade-off levels of happiness and physical health in the UK and the US. • Choices are determined by respondents' own levels of happiness and health. • Information about adaptation to physical health conditions matters too. • The results have implications for policymakers seeking to satisfy those preferences. [ABSTRACT FROM AUTHOR]

'Sibling support' is a form of support for the brothers and sisters of people with disability within medical, health and social care practice, promoting outcomes for them such as improved self-expression, mental health, wellbeing, skills and networks. There has been significant research interest in sibling support, however most has only evaluated individual interventions. There has been little-to-no research that has examined what sibling support is as a sector or overall field of practice. This paucity of research on sibling support as a field of practice is a problematic gap as it prevents recognition of sibling support as a distinct service type/sector, and may ultimately prevent sibling support from getting due support, acknowledgement, funding and promotion. Drawing on a study of national-level sibling support providers in the USA, UK, Canada, New Zealand and Australia, this article therefore seeks to describe sibling support as a sector and field of practice: the principles underpinning it, purposes/functions it addresses and delivery methods used. The article also discusses variation and emerging practice between sibling support providers, as well as the importance and implications of the findings for building greater recognition of sibling support within medicine, health and social care, particularly within the context of policy changes and increasing conditions of austerity, requiring more targeted decisions about what service types service systems support and promote. • There has been little research about what sibling support is as a field of practice. • This article examines sibling support in the USA, UK, Canada, New Zealand and Australia. • It outlines sibling support's underpinning principles, functions and delivery methods. • The findings can help to build greater recognition for sibling support. • The findings can also prompt the continued development of sibling support. [ABSTRACT FROM AUTHOR]