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Access to healthcare among Southeast Asian migrants in Taiwan is a pressing concern. Once migrants fall ill, they are at risk of losing jobs and even jeopardizing their legal status to work and stay. While existing studies have shed light on migrants' experiences of alienation in healthcare, there has been limited attention given to the role of migrant activists in negotiating and mobilizing concepts of health. In this article, I examine how activists mediate migrants' access to health resources. As migrant organizations step in to care for migrants, they render migrants' bodies legible and admissible by guiding them through the healthcare system. I suggest that activists wield the power to govern by shaping the ideals of a healthy and morally responsible migrant. Their authority to care also hinges upon crafting narratives of collective wellness that foreground the interdependent relationship between citizens and migrants, elevating migrants' health into vital projects of governance. Through a critical analysis of discourse and praxis around migrant care, my intention is not only to challenge the narrow focus on migrants' physical wellbeing but also to cast light on the affects of mediating care and how it shapes meanings and values attributed to migrants' lives. [ABSTRACT FROM AUTHOR]

This paper investigates the biological, socio-economic, and institutional factors shaping the individual risk of death during a major pre-industrial epidemic. We use a micro-demographic database for an Italian city (Carmagnola) during the 1630 plague to explore in detail the survival dynamics of the population admitted to the isolation hospital (lazzaretto). We develop a theoretical model of admissions to the lazzaretto, for better interpretation of the observational data. We explore how age and sex shaped the individual risk of death, and we provide a one-of-a-kind study of the impact of socio-economic status. We report an inversion of the normal mortality gradient by status for those interned at the lazzaretto. The rich enjoyed a greater ability to make decisions about their hospitalization, but this backfired. Instead, the poor sent to the lazzaretto faced a relatively low risk of death because they enjoyed better conditions than they would have experienced outside the hospital. [ABSTRACT FROM AUTHOR]

AbstractMediation analysis is conducted to make inferences on the effects of mediators that intervene in the relationship between an exposure variable and an outcome. Bayesian mediation analysis (BMA) naturally considers the hierarchical structure of the effects from the exposure variable to mediators and then to the outcome. We propose three BMA methods on survival outcomes, where mediation effects are measured in terms of hazard rate, survival time, or log of survival time respectively. In addition, we allow setting a limited survival time in the time-to-event analysis. The methods are validated by comparing the estimation precision at different scenarios through simulations. The three methods all give effective estimates. Finally, the methods are applied to the Surveillance, Epidemiology, and End Results Program (SEER) supported special studies to explore the racial disparity in breast cancer survival. The included variable completely explained the observed racial disparities. We provide visual aids to help with the result interpretations. [ABSTRACT FROM AUTHOR]

Since 2010, the Chinese government has developed several batches of low-carbon pilot provinces and cities continuously. And in the backdrop of carbon peak and carbon neutralisation recently, the carbon emission reduction policies and achievements of China have attracted more and more worldwide attention. In the field of human health, this paper investigates whether the Low-carbon Province Pilot Policy of China has positive effects on residents' health based on the micro data of China Family Panel Studies (CFPS) from 2010 to 2016. Using the time-varying difference-in-difference model to solve the endogeneity problem commonly faced in the literature, we find that Low-carbon Province Pilot Policy has a positive impact on public health through air quality improvement and the unemployment level alleviation mainly. And in urban areas, the policy effect is more obvious than that in rural regions. This paper expands the content of national low-carbon governance effects to residents' health further and contribute to China's low-carbon development. Specifically, it reminds us to focus on the dynamic adjustment and effective continuation of the policy, and also the all-round support for 'the disadvantaged' in environmental governance process. [ABSTRACT FROM AUTHOR]

Global rates of excess mortality attributable to the Covid-19 pandemic provide a fresh impetus to make sense of the associations between income inequality, housing inequality and the social gradient in health, suggesting new questions about the ways in which housing and health are treated in the framing and development of public policy. The first half of the paper uses a social harm lens to examine the threefold associations of the social inequality, housing and health trifecta and offers new insights for policy analysis which foregrounds the production, transmission, and experience of various types of harm which occur within the home. The main body of the paper then draws upon the outcomes of an international systematic literature mapping review of 213 Covid-19 research papers to demonstrate three specific harms associated with stay-at-home lockdowns: (i) intimate partner and domestic violence, (ii) poor mental health and (iii) health harming behaviours. The reported findings are interpreted using a social harm perspective and some implications for policy analysis are illustrated. The paper concludes with a reflection on the efficacy of social harm as a lens for policy analysis and suggests directions for further research in housing studies and zemiology. [ABSTRACT FROM AUTHOR]

The American Public Health Association (APHA) and prominent U.S. health organizations have acknowledged racism as a central cause of health inequality. In the midst of the COVID-19 pandemic, the U.S. confronts an additional public health crisis: mass impairment from Long COVID. Occupational segregation and institutionalized racism have made working-class Black, Indigenous, and people of color (BIPOC) more likely to experience Long COVID. Medical gatekeepers also prevent equal access to health: BIPOC face more obstacles in their search for disability accommodations and social support. To provide health equity to the Long COVID community, Disability Studies must confront racialized understandings of chronic pain and the consequences of these meanings by centering the lived experiences of BIPOC living with chronic pain. [ABSTRACT FROM AUTHOR]

Does social class matter in understanding health inequalities in early 21st century China, when the country experienced unprecedented social stratification? Using nationally representative data from the latest waves of China Household Income Project surveys, we examine to what extent an individual's health is structured by social class and how that structure evolved. We draw on a neo-Marxist measure of social class to tap into the hidden mechanism that engenders and sustains inequalities. Four classes are defined based primarily on their relationships to productive resources: owners/managers, professionals/skilled workers, less-skilled workers, and farmers. Such a measure has not been considered in the health gradient literature in the Chinese context. Our results show that, despite remedial policies that helped mitigate economic inequalities, inequalities in health have mostly widened during the early years of the current century between the 'haves', who own productive assets and/or managerial authority, and the 'have-nots'. In 2002, self-rated health (SRH) was not clearly associated with class rank; in 2007, when China's economic inequality reached a historical zenith, a gradational pattern between SRH and class emerged, and the largest health gap was found between the class of owners/managers and farmers; in 2013, when China's income inequality reached a plateau, the health gap between owners/managers and less-skilled workers grew larger. Further, we identify job security as a mediator that links class and health among the lower social strata. In addition to improving the health of the disadvantaged, policies designed to narrow health inequalities should be orientated towards addressing social stratification. [ABSTRACT FROM AUTHOR]

This study explored the age trajectories of depressive symptoms across multiple cohort groups who were in middle and late adulthood; examined sociodemographic differences in these trajectories; and investigated how relevant factors contributed to depressive symptoms trends of different cohorts. Drawing on data from the 1994–2016 Health and Retirement Study (HRS), we used growth curve models to examine the age patterns of depressive symptoms, changes in sociodemographic gaps in depressive symptoms trajectories, and predictors of changes in depressive symptoms. In general, adults' depressive symptoms started high in middle-adulthood, declined in young-old life, increased moderately in mid-old life, and peaked in old-old life; In detail, more nuanced cohort-specific age trajectories of depressive symptoms were observed, challenging the prevailing assumption of a common age trajectory of depressive symptoms. Later-born cohorts displayed higher levels of depressive symptoms than earlier-born cohorts at observed ages. Second, we found intra-cohort sociodemographic differences in levels of depressive symptoms, but these differences' growth rates varied by specific factors. Regardless of the cohort group, as people age, the gender gap in depressive symptoms persisted but the partnership gap reduced. A widening educational gap across cohorts was observed, but it declined with age in some cohorts. Results suggest more evidence for the persistent inequality and age-as-leveler hypotheses rather than the cumulative (dis-)advantage hypothesis. Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2021.2010182. [ABSTRACT FROM AUTHOR]

Third variable effect refers to the effect from a third variable that explains an observed relationship between an exposure and an outcome. Depending on whether there is causal relationship, typically, a third variable takes the format of a mediator or a confounder. A moderation effect is a special case of the third-variable effect, where the moderator and other variables have an interactive effect on the outcome. In this paper, we extend the R package 'mma' for moderation analysis so that third-variable effects can be reported at different levels of the moderator. The proposed moderation analysis use tree-structured models to automatically detect moderation effects and can handle both categorical and numerical moderators. We propose algorithms and graphical methods for making inference on moderation effects and illustrate the method under different scenarios of moderation effects. Finally, we apply the proposed method to explore the trend of racial disparities in the use of Oncotype DX recurrence tests among breast cancer patients. We found that the unexplained racial differences in using the tests have decreased from 2010 to 2015. [ABSTRACT FROM AUTHOR]

By analysing survey data collected from 1,033 adults, this study examines health inequality related to COVID-19 protective health behaviours by ethnicity, trust, and concern in the U.S. There are three major findings. First, the U.S. adults can be categorized into four clusters based on their concern and public trust. Second, there are significant differences in concern and public trust among different ethnic groups. Finally, concern and public trust are the significant predictors for individuals' protective health behaviours. When individuals have higher levels of concern and public trust, they are more likely to comply with the public health policies to adopt protective health measures. The results of this study highlight the importance of building public trust with co-cultural groups in order to promote protective health behaviours. Thus, this study brings additional insights into effective intercultural communication in the healthcare context. [ABSTRACT FROM AUTHOR]

This paper examines the effect of housing price on health of China's urban residents, and further explores the issue of health inequality. We find that the increase of housing price significantly improves people's physical health, but hurts their mental health, and this effect is affected by residents' housing wealth. Furthermore, the health inequality related to housing wealth exists in mental health rather than physical health. [ABSTRACT FROM AUTHOR]

Research has established the disproportionate impact of COVID-19 on communities of colour. Drawing on three waves of in-depth interviews with 36 college students (for a total of 94 interviews), we extend the conceptual metaphor of "tightness" (derived from the sociology of punishment) to understand the experiential dimensions of structural racism in America, especially during periods of crisis. We argue that tightness intensified for Black and Latinx participants as they struggled to cope with the loss of loved ones, fears surrounding their own health, financial challenges, and concerns about police surveillance. We also find that the demonstrations following the killing of George Floyd represented a brief release from the suffocating tightness that Black participants experienced during the pandemic. Using the tightness metaphor to capture the compounding hardships endured by vulnerable populations, we build on existing research that has largely focused on isolated measures of harms associated with the pandemic. [ABSTRACT FROM AUTHOR]

The increasing informal urbanism in Africa exposes its residents to multiple shocks, including urban public health pandemics. South Africa is not an exception due to the squalid living conditions, lack of essential services and amenities, and overcrowding characterizing informal settlements. We argue that such conditions compromise the liveability of the informal settlements and the wellbeing of the communities. The urban health inequality concept is used to analyse the risks and vulnerability of informal settlements to public health problems. This study uses the impact of the novel coronavirus (COVID-19) to investigate the exposure of the urban poor in South Africa's informal settlements to public health crises. This study is ethnographic and uses the case of Dinaweng informal settlement, Bloemfontein. Data was collected from secondary data sources triangulated with 60 in-depth interviews with household heads to enhance the validity of the findings. The study found that the poor in Dinaweng are disproportionately affected by disease pandemics that are exacerbated by the challenges in their daily lives characterized by their informal livelihoods. We conclude that informal settlements are complex spaces that require carefully considered strategies and responses for addressing pandemics such as COVID-19; otherwise, the residents in these settlements remain marginalized. [ABSTRACT FROM AUTHOR]

The present study aims at comparing physical and mental health outcomes of different migrant groups and the native German population, testing for the presence of a healthy migrant effect (HME) and its potential differences between groups. The HME is marked by an observed health advantage for migrants compared to the host population, which declines with increasing years since migration. Macroeconomic, institutional and cultural differences of sending countries or regions define the pre-migration and the host country situation differently for European, Non-European and internal migrants. These conditions are assumed to have an impact on initial health differences as well as on health differences after longer exposure to the host country. Using cross-sectional data from the 2016 wave of the German Socioeconomic Panel, physical and mental health outcomes (generated from the SF-12) are compared between recent international and internal migration groups (≤10 years since migration), non-recent international and internal migration groups (>10 years since migration) and the native German-born population without migration experience. Propensity score matching analyses reveal the presence of a HME for both European and Non-European migrants, but not for internal migrants. This effect differs on the outcome measure and the native comparison group. [ABSTRACT FROM AUTHOR]

This paper explores public health policy implementation through partnership working at the local level by examining how local actors from public health, and the wider workforce make sense of and work on social inequalities in health. An ethnographic case study was used to examine policy implementation in one local strategic partnership in north-west England during a period of significant resource constraint. Semi-structured interviews were the primary method of data generation. Sensitising concepts from figurational sociology were used to develop a theoretical account of how local policy implementation directed at narrowing social inequalities in health tended to give rise to relatively fragmented and short-term services, projects and practices, which focused on lifestyle factors and behaviour change. Theorising partnership work as figurations goes some way to explaining the apparent paradox among participants who expressed a relatively detached appreciation of wider social influences, alongside emotional involvement in their work. This process of individualisation explains how local professionals tended to conceptualise health inequality and the social determinants of health as personal troubles. Individualisation meant that the social reality of working in partnerships on difficult issues was simplified. Thus, any scope for working on the social determinants of health tended to be overlooked. The extent to which this was intentional or a matter of struggling to see opportunities, or a mixture of the two, was difficult to discern. Although the policy landscape has changed, the findings give some insight into understanding how local collaborative processes reproduce local public health work underpinned by lifestyle choices. [ABSTRACT FROM AUTHOR]

In this article, the author investigates the inequality of health conditions in Japan using self-reported health condition data collected during a Comprehensive Survey of Living Conditions in Japan. The used data is ordinal, and inequality measures for ordinal data are introduced. Bayesian and decomposition analyses for the inequality of health conditions show that the proportion of young people has decreased and that, from 1998 to 2016, health inequality also decreased. The decrease in the proportion of young people is responsible for the lower health inequality. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has posed many challenges to societies, individual healthcare systems and global public health. Manifestations of increasing health inequalities, social stigmatization and challenging ethical decision-making have been previously noticed. The aim of this article is to analyse the perceptions of frontline healthcare professionals regarding the potential impact of COVID-19 on the provision of healthcare services and the ethical challenges it may entail. This research is a part of a larger research project which was conducted among frontline healthcare professionals in Estonia and used both quantitative and qualitative methods of data collection. In this article, answers to specific open-ended questions from the questionnaire (n = 116) and in-depth interviews (n = 8) were analysed. For data analysis, inductive content analysis was used. The research was granted ethical approval. Findings show that through changes in regular and routinized practices in the provision of emergency medicine services, COVID-19 influences an increase of health inequality and social stigmatization. Other factors as well, such as lack of information about the disease, lack of resources, and fear of the disease, might reinforce these social phenomena. Additionally, from patient-centred and legal perspectives, issues of personal data management and privacy are highlighted. In addition to medical issues arising from COVID-19, countries worldwide should pay attention to the social and legal side effects of the illness to minimize health inequality and social stigmatization, as well as to moral, ethical and legal shortcomings in responses to the pandemic. [ABSTRACT FROM AUTHOR]

It is well established that social determinants are crucial to health outcomes. However, the link between how social determinants contribute to health inequalities for people with disability has often failed to be acknowledged. For example, Australian disability policy has paid little attention to social determinants of health, despite people with disability faring particularly badly on a range of outcomes. This paper identifies barriers to policy action on the social determinants of health for people with disability in Australia. Data obtained from interviews with key disability policy stakeholders are analysed using a micro, meso, macro level policy analysis framework. Our analysis identifies a "services drift" acting as an important barrier to policy action, where attention is focused on health service access rather than broader social determinants such as housing, employment and education. We also identify issues in how disability policy is made that hinders action on social determinants of health. The environments people live, work and interact in like their housing, employment and education, have been shown to be more important for good health than having access to health services, yet these areas are often neglected in policy for people with disability. Using interviewees with people involved in disability policy in Australia this article aims to explore why these areas are neglected in policy relative to the focus on access to health services. Reasons for focusing more on health services compared to other policy areas include people's attitudes towards disability such as thinking about it as a medical problem rather than a social problem. There are also issues with how disability policy is being made, such as a lack of consultation with people with disability, and a lack of co-ordination between government levels and departments. Identifying these policy barriers is an important step in finding ways to get more policy action on improving the environments people with disability live in. [ABSTRACT FROM AUTHOR]

As well as improving population health, promoting equity in health is one of the key goals of health policy in low- and middle-income countries (LMICs). However, it is less clear how equity is defined, or how it may impact on resource allocation decisions. We investigated the degree to which health inequalities have been considered in economic evaluation of health interventions in LMICs, and what demographic or socioeconomic characteristics were used to define equity relevant subgroups. We reviewed publications since 2010 from three main databases following the search strategy developed by including the key terms 'health inequalities/health disparities/health equity,' 'economics' and 'low- and middle-income countries' in the title or abstract. Twelve studies were identified, mainly focusing on interventions for the more vulnerable groups such as children and women. Some attempts have been made to assess interventions' impact on health inequality and there is increasing interest in evaluating it, although research in this area is lacking. Population subgroups highlighted in the included studies were those differing in socioeconomic status. Most studies reported the results across subgroups to illustrate inequality impact, and the newly developed methods, extended cost-effectiveness analysis and distributional cost-effectiveness analysis, have also been applied. [ABSTRACT FROM AUTHOR]

The aim was to find out if there are any such differences due to gender in a cohort of workers followed for ten years, comparing their lifestyles and following the evolution of the main cardiovascular risk factors (CVRF) and their impact on cardiovascular risk. An observational longitudinal study of 698 civil servants workers (186 women and 512 men) of a local government office from Córdoba (Spain), was conducted over the period 2003–2014. We compared the initial and final prevalence of physical activity, smoking, obesity, hypertension, metabolic syndrome and diabetes. Cardiovascular risk was also assessed using the REGICOR (Registre Gironí del Cor) and SCORE (Systematic Coronary Risk Evaluation) equations. There was a greater rise in the prevalence of hypertension and hypercholesterolemia in the cohort in women than in men (94.2% vs. 38% and 92% vs 21.1%), while the reduction in smoking also differed by gender (26.4% vs. 36.5%). It could be that since women present a lower cardiovascular risk profile, they are treated less or less effort is made to keep the risk factors low, resulting in a worse evolution of smoking, hypercholesterolemia and hypertension in women. [ABSTRACT FROM AUTHOR]

Adult stature has become a widely used indicator of childhood nutritional status in historical populations and may provide insights into health inequalities that are not discernible in mortality rates. However, most pre-twentieth-century British data on heights suffer from selection biases. Here we present unique evidence on heights of adult males by occupation from an unbiased sample of adult males in Dorset in 1798–99. The mean height of fully grown (married) men was very similar to that of older military recruits, and our sample therefore confirms the taller stature of English males relative to males of other European countries in the same period. In contrast to previous evidence of negligible or U-shaped socio-economic gradients in mortality in this period, we found a fairly linear gradient in height by socio-economic status, that is similar in magnitude to class differences in adult height among English males born in the mid-twentieth century. Supplementary material for this article is available at: [ABSTRACT FROM AUTHOR]

Consumer research has posited an ambivalent role of choice in consumer empowerment, from liberating and including to disciplining and totalising. This article provides empirical evidence for this ambivalence and nuances how consumers navigate the liminal space between expert authority and consumer autonomy. We investigate the role of choice in consumer empowerment through an ethnographic study of medicine consumption practices in acute non-life-threatening situations in Denmark, finding these practices to be dominated by consumer choice, not only for over-the-counter but, interestingly, also for prescription-only medicine. The implications of these findings extend beyond the context of medicine consumption. First, we provide insights on the ambivalent role of choice in consumer empowerment in a complex context of mixed commercial and public agencies. Second, we demonstrate how online information access empowers consumers to resist expert authority and act autonomously. Third, we exemplify the processes by which globalisation and ideologies inform and shape consumer resistance. [ABSTRACT FROM AUTHOR]

Molecular pathological epidemiology (MPE) is an integrative transdisciplinary area examining the relationships between various exposures and pathogenic signatures of diseases. In line with the accelerating advancements in MPE, social science and its health-related interdisciplinary areas have also developed rapidly. Accumulating evidence indicates the pathological role of social-demographic factors. We therefore initially proposed social MPE in 2015, which aims to elucidate etiological roles of social-demographic factors and address health inequalities globally. With the ubiquity of molecular diagnosis, there are ample opportunities for researchers to utilize and develop the social MPE framework. Molecular subtypes of breast cancer have been investigated rigorously for understanding its etiologies rooted from social factors. Emerging evidence indicates pathogenic heterogeneity of neurological disorders such as Alzheimer's disease. Presenting specific patterns of social-demographic factors across different molecular subtypes should be promising for advancing the screening, prevention, and treatment strategies of those heterogeneous diseases. This article rigorously reviewed literatures investigating differences of race/ethnicity and socioeconomic status across molecular subtypes of breast cancer and Alzheimer's disease to date. With advancements of the multi-omics technologies, we foresee a blooming of social MPE studies, which can address health disparities, advance personalized molecular medicine, and enhance public health. [ABSTRACT FROM AUTHOR]

Objectives: This paper studies the institutional inequality that exists in the prevalence of diabetes and hypertension, as well as their diagnosis and medication management, between urban and rural residency status (hukou) holders in China. Methods: Exploiting the Chinese Health and Nutrition Survey, we primarily demonstrate that while a lower proportion of rural residency holders suffer from diabetes and hypertension, a larger proportion have never been diagnosed with these conditions and do not take medicine to control them. We explore the determinants of these disparities by the non-linear decomposition method. Results: Decomposition results illustrate that a large part of disparities in the prevalence of diabetes and hypertension can be explained by the differences in demographic structure and occupational socio-economic status. Regarding the ruralurban disparity in the under diagnosis and under-medication rates, the differences in demographic structure, household affluence, occupational socio-economic status and consumption patterns make the greatest contributions. Conclusions: This evidence suggests that improving the institutional economic inequality and enhancing the occupational mobility of rural residency holders are of paramount importance to mitigate any inequality in health and healthcare utilisation. [ABSTRACT FROM AUTHOR]

Education is a main cause of health inequality because it influences health behavior as well as structural conditions that impact health, such as living and working conditions. We examine how different educational groups reacted to the beginning of the COVID-19 pandemic in Germany by looking at health-related behavior – social distancing, increased hygiene, and mask wearing – as well as changes in working conditions – work from home, reduced working hours, and not working – as a structural indicator that can mitigate the risk of infection. More than three quarters of respondents in all educational groups complied with recommended social distancing and hand hygiene behaviors, and differences by education did not exceed ten percentage points. Regarding working conditions, highly educated respondents had a likelihood of over 45 percent to work from home during the pandemic. This number decreased to 17 and 11 percent for those with intermediate and low levels of education, respectively. It seems that education-based inequalities in the risk of infection with COVID-19 do not primarily stem from differences in health behavior but rather from structural causes, that is, inability to practice social distancing at work. [ABSTRACT FROM AUTHOR]

Suicide rates vary by race/ethnicity, but little is known about how the circumstances that contribute to suicide differ across racial/ethnic groups. This study investigated suicide circumstances among non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic Asian/Pacific Islanders, non-Hispanic Native American/Alaskan Natives, and Hispanics by sex and age. Using de-identified National Violent Death Reporting System (NVDRS) Restricted Access Database files from 2006-2015, we examined proximal circumstances of suicide among decedents aged 10 years and older. Hierarchical logistic regression analysis revealed racial/ethnic differentials in non-alcohol substance abuse problem, intimate partner problem, and physical health problem across sex and age, controlling for potential confounders. Study findings highlight priority areas for suicide interventions. [ABSTRACT FROM AUTHOR]

Objective: Evidence shows that recent immigrants are healthier than the native-born population, a phenomenon known as the healthy immigrant effect. With increasing duration of stay, this health gap significantly narrows as immigrants' health deteriorates to either resemble or become worse than the host population. However, little is known about the category of immigrants for whom this decline is most pronounced since the extant research largely considers immigrants as a homogeneous group, thus overlooking important racial/ethnic differences. Design: Using data from the 2014 Canadian Community Health Survey (CCHS), we categorised immigrants by race/ethnicity and duration of stay in Canada and compared them to their native-born white Canadian counterparts on the likelihood of having a chronic health condition, using type 2 diabetes (T2D) as a case. Results: In the base model, recent visible minority (i.e. non-white or non-Caucasian) immigrants and recent white immigrants were less likely than the native-born white Canadian population to have T2D (recent visible minority immigrants OR = 0.46, CI = 0.27–0.79, p = 0.005; recent white immigrants OR = 0.26, CI = 0.11–0.64, p = 0.003). The odds of having T2D were significantly higher for long-term immigrants than the native-born white Canadian population (long-term visible minority immigrants OR = 1.59, CI = 1.27–2.00, p = 0.000; long-term white immigrants OR = 1.74, CI = 1.44–2.10, p = 0.000). In the multivariate model, long-term visible minority immigrants were about 2.3 times more likely than their white Canadian born counterparts to have T2D (CI = 1.86–2.96, p = 0.000). Long-term visible minority immigrants were about 2.1 times more likely than long-term white immigrants to have T2D (CI = 1.49–2.94, p = 0.000) Conclusion: Immigrants' health deterioration varies significantly across ethnic categories in Canada. Interventions for facilitating the integration of visible minority immigrants may help reduce these health inequities. [ABSTRACT FROM AUTHOR]

Fundamental Cause Theory suggests the replacement of mechanisms that produce the persistent relationship between socioeconomic status and health over time. Understanding how this process operates is central to explaining the reproduction of health inequality. We use data from the Onco-barometer survey (2010) to test a set of hypotheses derived from FCT, Diffusion Of Innovations theory and the intersection between these theories to examine how socioeconomic inequality emerges and evolves across the cycle of diffusion of six relevant preventive practices in Spain: faecal occult blood tests, prostate-specific antigen tests, Papanicolaou tests, mammograms, cholesterol readings and blood-pressure checks. Because these preventive measures are characterised by differing rates of spontaneous knowledge and use amongst the Spanish population, we assume that they are at different stages in the diffusion cycle. Results suggest that SES has a dynamic influence according to the diffusion stage of each preventive measure. We argue that the conjunction of these theories offers a dynamic 'imagery' that can help to explain the generation and diminishment of inequalities. Moreover, this integration has the potential to bring 'social change' back into the study of health inequalities, which is essential to understanding equitable (and inequitable) returns produced by preventive innovations. [ABSTRACT FROM AUTHOR]

This article explores the physicians' perspective regarding the potential of computerized cognitive behavioral therapies (cCBTs) to overcome inequalities in the context of mental health care provision. The main benefits were related to the ability of cCBTs to provide care in a convenient and efficient manner, enhancing its accessibility. These aspects were perceived more important than cost-effectivity of treatment, which is often claimed to be the key benefit of cCBTs. Age and general acceptance of CBT were the most significant individual-level separators of perceptions, while the sector in which the physician works was seen as the main structural-level separator. [ABSTRACT FROM AUTHOR]

This article examines the relationship between food insecurity and health-care decision-making among mobile food pantry clients in Tampa Bay, Florida. Results show a high rate of food insecurity, high stress levels, and chronic health conditions among mobile pantry clients, many of whom are long-term users of food pantry services. The fruits and vegetables supplied by the pantry allow clients to manage chronic health conditions and mitigate some of the financial burden of health-care costs. Research was conducted in cooperation with the Anthropology Department at the University of South Florida, Feeding Tampa Bay, and WellCare. [ABSTRACT FROM AUTHOR]

This paper explores which African countries had relatively low rates of underweight children and relatively high birth coverage (percentage of births with a skilled attendant) in the poorest quintile. Swaziland and Rwanda emerged as relatively ‘pro-poor’ in that both measures were more than one standard deviation better than predicted by GDP per capita. Unlike Swaziland, Rwanda’s status as an outlier was eliminated in regressions controlling also for urbanisation, medical professionals per 1000 people and health spending, suggesting that its pro-poor outcomes were related to these factors. AIDS funding may have helped Swaziland provide primary health care to the poor, but its high birth coverage preceded the HIV epidemic. Although relatively pro-poor in international terms, Swaziland and Rwanda emerged as relatively unequal by the CIX measure of health inequality with regard to percentage of underweight children across quintiles. It is important not to conflate relatively equal with relatively pro-poor health outcomes. [ABSTRACT FROM AUTHOR]

Background: The prevalence of adolescent tobacco use in Indonesia is among the highest in the world. Monitoring the extent and distribution of adolescent cigarette smoking is crucial to being able to target prevention and reduction strategies and evaluate the effectiveness of interventions. Objectives: To quantify the prevalence of adolescent cigarette smoking in Indonesia and assess the association with key socio-economic, demographic and geographic factors. Methods: We used data from the 2013 Indonesian Basic Health Research (RISKESDAS) national household survey to quantify the prevalence of cigarette smoking in adolescents aged 10-18 years by sex, age, education, economic status, place of residence and province. We used logistic regression to assess the adjusted association between adolescent smoking and these factors. Results: The overall smoking prevalence among Indonesian  adolescents was 7.2% (95% Confidence Interval/CI: 7.1-7.4). The prevalence was substantially higher among males (14.0%; 95% CI: 13.6-14.4) compared with females (0.2%; 95% CI: 0.1-0.4). After controlling for socio-economic, demographic and geographic characteristics, higher odds of smoking were observed among males (OR = 118.1; 95% CI: 91.2-153.0) as compared to female and among  adolescents aged 13-15 and 16-18 years as compared to those aged 10-12 years (OR = 13.2; 95% CI: 10.8-16.2 and OR = 72.7; 95% CI: 59.1-89.4, respectively). The odds of smoking were greater among adolescents with higher education as compared to those with lower education (OR = 1.3; 95% CI: 1.1-1.4) and adolescents in the poorest quintile had more than twice the odds of smoking compared with adolescents from the richest quintile (OR = 2.5; 95% CI: 2.2-2.8). Conclusion: Smoking prevention and cessation interventions in Indonesia need to be specific considering the sex, age, socioeconomic status and geographic location of adolescents. Ongoing monitoring of adolescent smoking is important for targeting interventions at higher-risk groups and assessing the effectiveness of current tobacco control strategies. [ABSTRACT FROM AUTHOR]

Background: Universal and equitable access to safe and affordable drinking water and adequate sanitation and hygiene in Indonesia are vital to ensure healthy lives and promote well-being for all at all ages. Objectives: To quantify subnational regional inequality in access to improved drinking water and sanitation in Indonesia. Methods: Data about access to improved drinking water and sanitation were derived from the 2015 Indonesian National Socioeconomic Survey (SUSENAS) and disaggregated by 510 districts across the 34 provinces of Indonesia. Two summary measures of inequality, mean difference from mean and weighted index of disparity, were calculated to quantify within-province absolute and relative inequality, respectively. Results: While the majority of Indonesian households had access to improved drinking water (71.0%) and sanitation (62.1%), there were large variations between and within provinces. Access to improved drinking water ranged from 93.4% in DKI Jakarta to 41.1% in Bengkulu, and access to improved sanitation ranged from 89.3% in Jakarta to 23.9% in East Nusa Tenggara. Provinces with similar numbers of districts and similar overall averages showed variable levels of absolute and/or relative inequality. Certain districts reported very low levels of access to improved drinking water and/or sanitation. Conclusions: There are inequalities in access to improved drinking water and sanitation by subnational region in Indonesia. Monitoring within-country inequality in these indicators serves to identify underserved areas, and is useful for developing approaches to improve inequalities in access that can help Indonesia make progress towards the 2030 Agenda for Sustainable Development. [ABSTRACT FROM AUTHOR]

As a key step in advancing the sustainable development goals, the World Health Organisation (WHO) has placed emphasis on building capacity for measuring and monitoring health inequalities. A number of resources have been developed, including the Health Equity Assessment Toolkit (HEAT), a software application that facilitates the assessment of within-country health inequalities. Following user demand, an Upload Database Edition of HEAT, HEAT Plus, was developed. Launched in July 2017, HEAT Plus allows users to upload their own databases and assess inequalities at the global, national or subnational level for a range of (health) indicators and dimensions of inequality. The software is open-source, operates on Windows and Macintosh platforms and is readily available for download from the WHO website. The flexibility of HEAT Plus makes it a suitable tool for both global and national inequality assessments. Further developments will include interactive graphs, maps and translation into different languages. [ABSTRACT FROM AUTHOR]

National health inequality monitoring needs considerably more investment to realize equity-oriented health improvements in countries, including advancement towards the Sustainable Development Goals. Following an overview of national health inequality monitoring and the associated resource requirements, we highlight challenges that countries may encounter when setting up, expanding or strengthening national health inequality monitoring systems, and discuss opportunities and key initiatives that aim to address these challenges. We provide specific proposals on what is needed to ensure that national health inequality monitoring systems are harnessed to guide the reduction of health inequalities. [ABSTRACT FROM AUTHOR]

The past two decades have seen an increasing role for the UK community and voluntary sector (CVS) in health promotion in disadvantaged areas, largely based on assumptions on the part of funders that CVS providers are better able to engage ‘hard-to-reach’ population groups in services than statutory providers. However, there is limited empirical research exploring CVS provider practices in this field. Using ethnographic data, this paper examines the experiences of a network of CVS providers seeking to engage residents in health-promoting community services in a disadvantaged region in the North of England. The paper shows how CVS providers engaged in apparently contradictory practices, fluctuating between an empathically informed response to complex resident circumstances and (in the context of meeting externally set targets) behavioural lifestyle approaches to health promotion. Drawing on concepts from figurational sociology, the paper explains how lifestyle drift occurs in health promotion as a result of the complex web of relations (with funders, commissioners and residents) in which CVS providers are embedded. Despite the fact that research has revealed the impact of targets on the work of the CVS before, this paper demonstrates more specifically the way in which monitoring processes within CVS contracts can draw providers into the neoliberal lifestyle discourse so prevalent in health promotion. [ABSTRACT FROM PUBLISHER]

Cross-national comparisons on health inequalities have puzzled health researchers in the last years. Contrary to what is theoretically expected, Northern European countries, known for their advanced welfare state regime and universalistic policies in health and social protection, do not present smaller health inequalities than other European nations. Within the debate triggered by these surprising results, some authors consider the possibility that the differences among the welfare state regimes may be shaping the relevance of specific pathways or mechanisms underlining the association between socioeconomic position (SEP) and health. This research addresses this hypothesis by comparing the contribution of social networks to health inequality in later life across different welfare state regimes. Mediation effects between SEP and health by social networks variables are compared across four different welfare state regimes, using data from Survey of Health, Ageing, and Retirement in Europe. Findings suggest that the socioeconomic advantages in health are partially explained by the differentials in social integration and quality of social ties. Welfare state regimes appear to shape the contribution of social networks in health inequality concerning the implications of the exchanges of social support in health. [ABSTRACT FROM PUBLISHER]

For several decades now, critical public health researchers have highlighted the deleterious effects that pursuing neoliberal policies can have on the ‘causes of the causes’ of poor health and upon growing health inequalities. This paper argues that the conceptual tools of Karl Polanyi can help lend particular insight into this issue. The specific example that this paper focuses upon is the ‘social enterprise’: a form of organisation that combines both social and business objectives. The paper explores, conceptually, whether social enterprises may have the potential to act as one component of a neo-Polanyian countermovement: helping to re-embed the economy back into society, and offering greater recognition for a more comprehensive and socially imbued concept of health. Importantly, this potential is critically examined in the context of neoliberal hegemony, where challenges to the status quo have regularly been met with assimilation, co-option and/or repression. [ABSTRACT FROM PUBLISHER]

Objective: How health equity is communicated plays an important role in how it is perceived, and to what degree it will inspire collective action. The goal of this mixed-methods study is to develop and test health equity messages to: (1) determine which messages resonate most amongst health care staff and leaders of the Fraser Health Authority (FH); (2) compare these results with that from the United States; and (3) contribute to health equity message framing in Canada. Methods: Twelve health equity statements and packages were developed and piloted between June and August 2012. Quantitative data were collected through a semi-structured survey with FH upper management (n = 468) at a quarterly business meeting and focus groups; data were analysed using ANOVA and Tukey HSD statistical tests. Qualitative data were gathered through a series of 11 focus group discussions with health care staff (n = 55) and analysed using NVIVO 10. Results: The diverse cultural values present within the FH region carried significantly more weight in message resonance than 'Canadian' values. Health equity statements with action-oriented solutions were favoured. Messages need to be clear, simple and concise, colloquial and cohesive. Relevant, broader and inclusive messages, with context, were preferred. Conclusion: This study highlights how health equity messages could be framed at FH and differences between Canadian and American messaging preferences. Our results present opportunities to improve future health equity messaging within the Canadian context so that we can engage a wide range of audiences on social change towards health equity. [ABSTRACT FROM AUTHOR]

The Gini index is the most commonly used measure of income inequality. Like any single summary measure of a set of data, it cannot capture all aspects that are of interest to researchers. One of its widely reported flaws is that it is supposed to be overly sensitive to changes in the middle of the distribution. By studying the effect of small transfers between households or an additional increment in income going to one member of the population on the value of the index, this claim is re-examined. It turns out that the difference in the rank order of donor and recipient is usually the most important factor determining the change in the Gini index due to the transfer, which implies that transfers from an upper income household to a low income household receive more weight that transfers involving the middle. Transfers between two middle-income households do affect a higher fraction of the population than other transfers but those transfers do not receive an excessive weight relative to other transfers because the difference in the ranks of donor and recipient is smaller than the corresponding difference in other transfers. Thus, progressive transfers between two households in the middle of the distribution changes the Gini index less than a transfer of the same amount from an upper income household to a lower income household. Similarly, the effect on the Gini index when a household in either tail of the distribution receives an additional increment is larger than when a middle-income household receives it. Contrary to much of the literature, these results indicate that the Gini index is not overly sensitive to changes in the middle of the distribution. Indeed, it is more sensitive to changes in the lower and upper parts of the distribution than in the middle. [ABSTRACT FROM AUTHOR]

Objective:Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers. Design:Community-level, cross-sectional analysis with multidimensional clinical work ability assessments. Setting:Paltamo, Finland. Participants:Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n = 230, 81%). Main outcome measures:Based on data from theme interviews, patient records, supervisors’ observations of work performance and clinical examinations, a physician concluded the individual’s work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated. Results:Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability. Conclusions:Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed.KEY POINTSAlthough the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce.Work disabilities are common among the unemployed.Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to work.Context sensitivity may add to the accuracy of the doctor’s conclusions on work ability. [ABSTRACT FROM PUBLISHER]

This paper outlines how the quality and outcomes framework (QOF) has done little to close the health inequality gap, and proposes possible ways in which future iterations of QOF could do more to address this crucial public health problem. [ABSTRACT FROM PUBLISHER]

The timing of education across the life cycle is differentially associated with older age health outcomes and socioeconomic status among military retirees, a subpopulation with common levels of adolescent health, but variation in educational timing. A year of education obtained before military service lowers the probability of poor health in retirement by 2.5 percentage points, while a year obtained after service reduces poor health by only 0.6 percentage point. By contrast, education raises income and wealth uniformly through vintage. This suggests that education improves health through fostering the lifelong accumulation of healthy behaviors and habits rather than raising income or wealth. [ABSTRACT FROM AUTHOR]

This article explores imagined geographies of health care among Lesbian, gay, bisexual, transgender and queer (LGBTQ) women in Halifax and Vancouver. In expressing the possibilities and limitations of accessing care, participants frame their own experiences through spatialized narratives of how LGBTQ people are thought to be treated elsewhere. Participants’ explicit connections and distinctions between Halifax and Vancouver gave insight into how their perceived difficulties in one health care context are sometimes framed by imagining more ease in accessing care in the other. We explore here the implications of these imagined, idealized spaces, which may set up false expectations that things are always better elsewhere. We reveal imagined geographies and senses of place as highly relevant features in LGBTQ women’s accounts of experiences with and access to health care and expand conventional arguments about physical access to care. [ABSTRACT FROM AUTHOR]

Background: Intersectionality has received increased interest within population health research in recent years, as a concept and framework to understand entangled dimensions of health inequalities, such as gender and socioeconomic inequalities in health. However, little attention has been paid to the intersectional middle groups, referring to those occupying positions of mixed advantage and disadvantage. Objective: This article aimed to 1) examine mental health inequalities between intersectional groups reflecting structural positions of gender and economic affluence and 2) decompose any observed health inequalities, among middle groups, into contributions from experiences and conditions representing processes of privilege and oppression. Design: Participants (N = 25,585) came from the cross-sectional 'Health on Equal Terms' survey covering 16- to 84-year-olds in the four northernmost counties of Sweden. Six intersectional positions were constructed from gender (woman vs. men) and tertiles (low vs. medium vs. high) of disposable income. Mental health was measured through the General Health Questionnaire-12. Explanatory variables covered areas of material conditions, job relations, violence, domestic burden, and healthcare contacts. Analysis of variance (Aim 1) and Blinder-Oaxaca decomposition analysis (Aim 2) were used. Results: Significant mental health inequalities were found between dominant (high-income women and middle-income men) and subordinate (middle-income women and low-income men) middle groups. The health inequalities between adjacent middle groups were mostly explained by violence (mid-income women vs. men comparison); material conditions (mid- vs. low-income men comparison); and material needs, job relations, and unmet medical needs (high- vs. mid-income women comparison). Conclusions: The study suggests complex processes whereby dominant middle groups in the intersectional space of economic affluence and gender can leverage strategic resources to gain mental health advantage relative to subordinate middle groups. [ABSTRACT FROM AUTHOR]

Introduction: Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly. Objectives: This study examines mortality differentials in children of different age groups by key social determinants of health (SDH) including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities), and other geographical contextual factors (area of residence, road conditions). Design: We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality. Results: The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh. Conclusion: The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage. [ABSTRACT FROM AUTHOR]

Background: Health equity is a priority in the post-2015 sustainable development agenda and other major health initiatives. The World Health Organization (WHO) has a history of promoting actions to achieve equity in health, including efforts to encourage the practice of health inequality monitoring. Health inequality monitoring systems use disaggregated data to identify disadvantaged subgroups within populations and inform equity-oriented health policies, programs, and practices. Objective: This paper provides an overview of a number of recent and current WHO initiatives related to health inequality monitoring at the global and/or national level. Design: We outline the scope, content, and intended uses/application of the following: Health Equity Monitor database and theme page; State of inequality: reproductive, maternal, newborn, and child health report; Handbook on health inequality monitoring: with a focus on low- and middle-income countries; Health inequality monitoring eLearning module; Monitoring health inequality: an essential step for achieving health equity advocacy booklet and accompanying video series; and capacity building workshops conducted inWHOMember States and Regions. Conclusions: The paper concludes by considering how the work of the WHO can be expanded upon to promote the establishment of sustainable and robust inequality monitoring systems across a variety of health topics among Member States and at the global level. [ABSTRACT FROM AUTHOR]

Background: Action on the social determinants of health (SDH) is relevant for reducing health inequalities. This is particularly the case for South Africa (SA) with its very high level of income inequality and inequalities in health and health outcomes. This paper provides evidence on the key SDH for reducing health inequalities in the country using a framework initially developed by the World Health Organization. Objective: This paper assesses health inequalities in SA and explains the factors (i.e. SDH and other individual level factors) that account for large disparities in health. The relative contribution of different SDH to health inequality is also assessed. Design: A cross-sectional design is used. Data come from the third wave of the nationally representative National Income Dynamics Study. A subsample of adults (18 years and older) is used. The main variable of interest is dichotomised good versus bad self-assessed health (SAH). Income-related health inequality is assessed using the standard concentration index (CI).ApositiveCI means that the rich report better health than the poor. A negative value signifies the opposite. The paper also decomposes the CI to assess its contributing factors. Results: Good SAH is significantly concentrated among the rich rather than the poor (CI=0.008; pB0.01). Decomposition of this result shows that social protection and employment (contribution=0.012; p>0.01), knowledge and education (0.005; p<0.01), and housing and infrastructure (_0.003; p<0.01) contribute significantly to the disparities in good SAH in SA. After accounting for these other variables, the contribution of income and poverty is negligible. Conclusions: Addressing health inequalities inter alia requires an increased government commitment in terms of budgetary allocations to key sectors (i.e. employment, social protection, education, housing, and other appropriate infrastructure). Attention should also be paid to equity in benefits from government expenditure. In addition, the health sector needs to play its role in providing a broad range of health services to reduce the burden of disease. [ABSTRACT FROM AUTHOR]

Using household survey data from four countries ‒ Albania, Nepal, Tajikistan and Tanzania ‒ this article calculates income-related inequality in health care utilization. We measure health disparity separately for generally and chronically ill individuals by constructing two models: one for the probability of a visit to a physician and another for the number of visits. Following model-based measurements, we decompose inequality into two major parts: one accounted for by identity-related factors and another by socioeconomic and other factors such as education, geography and distance to a clinic. We propose a new method to quantify the effect of changes in income and education on health disparity. One of our important findings suggests that health disparity is pro-rich in all our sample countries. The pro-rich disparity is prevalent among generally ill as well as chronically ill patients, in both visit probability and visit frequency models. Health inequality seems primarily driven by income differences followed by nonidentity factors. Further, the principle of equal treatment for equal need is not fulfilled in any of our countries. Among policy implications, increasing average income and education in a way that also reduces disparity in income and education, respectively, will substantially shrink inequality in health care utilization. [ABSTRACT FROM AUTHOR]

A growing body of empirical research examines the effects of the so-called “social determinants of health” (SDH) on health and health inequalities. Several high-profile publications have issued policy recommendations to reduce health inequalities based on a specific interpretation of this empirical research as well as a set of normative assumptions. This article questions the framework defined by these assumptions by focusing on two issues: first, the normative judgments about the (un)fairness of particular health inequalities; and second, the policy recommendations issued on this basis. We argue that the normative underpinnings of the approach are insufficiently supported and that the policy recommendations do not necessarily follow from the arguments provided. Furthermore, while many of the policies recommended—such as improving people's living conditions and reducing inequalities in wealth and power—are justified in their own right, the way these recommendations are tied to health is problematic. [ABSTRACT FROM PUBLISHER]