43 results on '"Social Determinants of Health legislation & jurisprudence"'
Search Results
2. Journal Voices in the Civil Rights Era - New Horizons and Limits in Medical Publishing.
- Author
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Chowkwanyun M
- Subjects
- Humans, Black or African American, Editorial Policies, History, 20th Century, Hospitals history, Medicare economics, Medicare history, Periodicals as Topic history, Social Determinants of Health economics, Social Determinants of Health ethnology, Social Determinants of Health history, Social Determinants of Health legislation & jurisprudence, Sociological Factors, United States, White, Civil Rights history, Civil Rights legislation & jurisprudence, Community Participation history, Community Participation legislation & jurisprudence, Physicians economics, Physicians history, Physicians legislation & jurisprudence, Political Activism, Public Policy history, Public Policy legislation & jurisprudence, Publishing history, Systemic Racism ethnology, Systemic Racism history
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- 2024
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3. Research to Move Policy - Using Evidence to Advance Health Equity for Substance Use Disorders.
- Author
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Blanco C, Kato EU, Aklin WM, Tong ST, Bierman A, Meyers D, and Volkow ND
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- Humans, Policy, Health Equity legislation & jurisprudence, Health Policy legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence, Substance-Related Disorders therapy
- Published
- 2022
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4. Immigration Detention in the United States: Identifying Alternatives That Comply With Human Rights and Advance Public Health.
- Author
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Ly A, Sprague A, Pierce B, Post C, and Heymann J
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- COVID-19 epidemiology, Emigration and Immigration legislation & jurisprudence, Health Services Accessibility legislation & jurisprudence, Human Rights statistics & numerical data, Humans, Right to Health statistics & numerical data, Social Determinants of Health legislation & jurisprudence, Social Justice, Transients and Migrants legislation & jurisprudence, Undocumented Immigrants legislation & jurisprudence, United States, COVID-19 prevention & control, Emigration and Immigration statistics & numerical data, Health Services Accessibility statistics & numerical data, Social Determinants of Health statistics & numerical data, Transients and Migrants statistics & numerical data, Undocumented Immigrants statistics & numerical data
- Abstract
Under international law, the United States is obligated to uphold noncitizens' fundamental rights, including their rights to health. However, current US immigration laws-and their enforcement-not only fail to fulfill migrants' health rights but actively undermine their realization and worsen the pandemic's spread. Specifically, the US immigration system's reliance on detention, which precludes effective social distancing, increases risks of exposure and infection for detainees, staff, and their broader communities. International agreements clearly state that the prolonged, mandatory, or automatic detention of people solely because of their migration status is a human rights violation on its own. But in the context of COVID-19, the consequences for migrants' right to health are particularly acute. Effective alternatives exist: other countries demonstrate the feasibility of adopting and implementing immigration laws that establish far less restrictive, social services-based approaches to enforcement that respect human rights. To protect public health and realize its global commitments, the United States must shift away from detaining migrants as standard practice and adopt effective, humane alternatives-both amid COVID-19 and permanently.
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- 2021
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5. COVID-19 Highlights the Need for Inclusive Responses to Public Health Emergencies in Africa.
- Author
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Adebisi YA, Ekpenyong A, Ntacyabukura B, Lowe M, Jimoh ND, Abdulkareem TO, and Lucero-Prisno DE
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- Africa epidemiology, COVID-19 prevention & control, Delivery of Health Care legislation & jurisprudence, Delivery of Health Care methods, Female, Health Services Accessibility legislation & jurisprudence, Health Services Accessibility standards, Humans, Public Health legislation & jurisprudence, Public Health methods, Social Determinants of Health legislation & jurisprudence, Social Determinants of Health standards, COVID-19 epidemiology, Delivery of Health Care standards, Health Facilities legislation & jurisprudence, Health Facilities standards, Public Health standards
- Abstract
COVID-19 is a global public health emergency affecting many countries around the world. Although African governments and other stakeholders are making efforts to contain the pandemic, the outbreak continues to impact human rights and exacerbates inequalities and disparities that are already in existence. The concept of inclusive health focuses on good health and well-being for everyone, and this entails health services that are equitable, affordable, and efficacious. Creating equitable access to mainstream health and healthcare services and ensuring inclusive health responses remain a means of addressing health inequities and disparities. In this article, we argue on the need for inclusive responses to public health emergencies in Africa using COVID-19 as a case example. Africa's response to public health emergencies needs to recognize that for every marginalized/vulnerable group, it is important to strategize to address their particular needs in such a way to surmount any barrier to the right to health. For Africa's public health response to be more inclusive, we therefore need to be more strategic and proactive in reaching out to specific groups and to identify and address their needs. Strengthening the healthcare systems of African countries through increased political will, increased funding to health care, collaboration and cooperation among stakeholders, and effective leadership remains essential in ensuring inclusive responses to health emergencies.
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- 2020
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6. Intersectoral action on the social determinants of health and health equity in Canada: December 2019 federal government mandate letter review.
- Author
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Lucyk K
- Subjects
- Canada, Federal Government, Government Regulation, Health Policy, Humans, Policy Making, Health Equity organization & administration, Intersectoral Collaboration, Social Determinants of Health legislation & jurisprudence, Social Determinants of Health standards
- Abstract
Competing Interests: None.
- Published
- 2020
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7. Legal Interventions to Address US Reductions in Life Expectancy.
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Gostin LO, Hodge JG Jr, and Levin DE
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- Firearms legislation & jurisprudence, Health Services Accessibility legislation & jurisprudence, Health Status Disparities, Humans, Socioeconomic Factors, United States, Environmental Policy legislation & jurisprudence, Insurance, Health legislation & jurisprudence, Life Expectancy, Public Health legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence
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- 2020
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8. Towards an update of the Italian Ministerial Decree July 5th, 1975.
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Appolloni L, Gola M, Raffo M, Capasso L, Settimo G, Moscato U, Azara A, Dettori M, Capolongo S, and D'Alessandro D
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- Building Codes legislation & jurisprudence, Humans, Italy, Social Determinants of Health legislation & jurisprudence, Housing legislation & jurisprudence, Hygiene legislation & jurisprudence, Public Health legislation & jurisprudence
- Abstract
In recent years, the Scientific Community and the Public Health world, in general, have devoted increasing interest to housing conditions, which are considered, to date, one of the main environmental and social determinants of the population's health. In particular, the Scientific Community has identified and studied various indoor well-being factors (e.g. lighting, temperature, ventilation, air quality, etc.). Some of these factors have been regulated by laws and regulations at various levels: the availability of clear and updated health requirements dictated by the regulations is fundamental to effectively protect public health, especially in confined environments. In the present work, we propose a revision of the Italian Ministerial Decree of July 5th, 1975 titled Modificazioni alle istruzioni ministeriali 20 giugno 1896 relativamente all'altezza minima ed ai requisiti igienico sanitari principali dei locali d'abitazione (Modifications to the ministerial instructions of June 20th, 1896 regarding the minimum height and the main hygienic-sanitary requirements of living spaces) in order to update the definition of the essential elements that qualify a space as habitable from the hygienic-sanitary point of view, taking into account the evidence gathered from the technical and scientific literature on the requirements and contents of the Building Codes of the major European countries.
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- 2020
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9. Law Everywhere: A Causal Framework for Law and Infectious Disease.
- Author
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Siegler AJ, Komro KA, and Wagenaar AC
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- Health Behavior, Health Equity legislation & jurisprudence, Hepatitis prevention & control, Humans, Sexually Transmitted Diseases prevention & control, Social Determinants of Health legislation & jurisprudence, Socioeconomic Factors, Tuberculosis prevention & control, Communicable Disease Control legislation & jurisprudence, Health Policy legislation & jurisprudence, Public Health legislation & jurisprudence
- Published
- 2020
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10. Reflections on two decades of public health achievements.
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Mason L
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- Humans, Smoke-Free Policy legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence, Sugar-Sweetened Beverages legislation & jurisprudence, Public Health Practice
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- 2020
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11. Message framing to reduce stigma and increase support for policies to improve the wellbeing of people with prior drug convictions.
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Bandara SN, McGinty EE, and Barry CL
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- Humans, Law Enforcement, Surveys and Questionnaires, United States, Social Justice, Substance-Related Disorders, Prisoners, Random Allocation, Social Determinants of Health legislation & jurisprudence, Public Policy, Social Stigma
- Abstract
Background: Individuals with drug convictions are at heightened risk of poor health, due in part to punitive public policies. This study tests the effects of message frames on: (1) public stigma towards individuals with felony drug convictions and (2) support for four policies in the United States (U.S.) affecting social determinants of health: mandatory minimum sentencing laws, 'ban-the-box' employment laws, and restrictions to supplemental nutrition and public housing programs., Methods: A randomized experiment (n = 3,758) was conducted in April 2018 using a nationally representative online survey panel in the U.S. Participants were randomized to a no-exposure arm or one of nine exposure arms combining: (1) a description of the consequences of incarceration and community reentry framed in one of three ways: a public safety issue, a social justice issue or having an impact on the children of incarcerated individuals, (2) a narrative description of an individual released from prison, and (3) a picture depicting the race of the narrative subject. Logistic regression was used to assess effects of the frames., Results: Social justice and the impact on children framing lowered social distance measures and increased support for ban-the-box laws., Conclusion: These findings can inform the development of communication strategies to reduce stigma and advocacy efforts to support the elimination of punitive polices towards individuals with drug convictions., (Copyright © 2019 Elsevier B.V. All rights reserved.)
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- 2020
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12. New Budgeting Tools Will Help Foster Social Determinants of Health.
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Butler SM
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- Delivery of Health Care economics, Delivery of Health Care legislation & jurisprudence, Federal Government, Financing, Government legislation & jurisprudence, Humans, State Government, United States, Budgets, Delivery of Health Care organization & administration, Financial Management organization & administration, Financing, Government organization & administration, Social Determinants of Health economics, Social Determinants of Health legislation & jurisprudence
- Published
- 2020
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13. Gun Violence and Cardiovascular Health.
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Konstam MA and Konstam AD
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- Cardiovascular Diseases diagnosis, Cardiovascular Diseases mortality, Gun Violence legislation & jurisprudence, Humans, Leadership, Policy Making, Professional Role, Risk Assessment, Risk Factors, Societies, Medical, United States epidemiology, Cardiovascular Diseases epidemiology, Gun Violence prevention & control, Health Status, Social Determinants of Health legislation & jurisprudence
- Published
- 2019
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14. Two Paths to Health in All Policies: The Traditional Public Health Path and the Path of Social Determinants.
- Author
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Hahn RA
- Subjects
- Humans, Health Policy legislation & jurisprudence, Health Services Accessibility, Public Health, Public Policy legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence
- Published
- 2019
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15. Antihunger Groups Are Blocking Nutrition Progress in the Supplemental Nutrition Assistance Program.
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Bleich SN, Gorski Findling MT, and Block JP
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- Health Promotion methods, Humans, Poverty legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence, United States, Food Assistance legislation & jurisprudence, Food Supply legislation & jurisprudence, Health Promotion legislation & jurisprudence, Health Status Disparities, Nutritional Status, Politics, Social Justice legislation & jurisprudence
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- 2019
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16. A Meta-Narrative Literature Synthesis and Framework to Guide Future Evaluation of Legal Empowerment Interventions.
- Author
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Footer K, Windle M, Ferguson L, Hatcher J, Lyons C, Gorin E, Stangl AL, Golub S, Gruskin S, and Baral S
- Subjects
- Humans, Human Rights, Power, Psychological, Social Determinants of Health legislation & jurisprudence
- Abstract
Legal empowerment is increasingly recognized as a key approach for addressing socio-structural determinants of health and promoting the well-being and human rights of vulnerable populations. Legal empowerment seeks to increase people's capacity to understand and use the law. However, limited consensus remains on the effectiveness of legal empowerment interventions in optimizing health outcomes. Leveraging a meta-narrative approach, we synthesized literature describing how legal empowerment interventions have been operationalized and empirically studied with respect to health determinants. The studies included here document diverse legal empowerment approaches and highlight how interventions changed the context surrounding the health of vulnerable populations. The absence of robust conceptualization, operationalization, and measurement of the risk contexts in which legal empowerment approaches operate limits the clarity with which interventions' impact on health can be ascertained. Despite this, legal empowerment is a promising approach to address the health of marginalized populations. To foster support between the fields of legal empowerment and health, we explore the limitations in study design and measurement of the existing evidence base; such scrutiny could strengthen the rigor of future research. This paper provides a guide to the socio-structural levels across which legal empowerment interventions impact health outcomes in order to inform future interventions., Competing Interests: Competing interests: None declared.
- Published
- 2018
17. Carbon trading, co-pollutants, and environmental equity: Evidence from California's cap-and-trade program (2011-2015).
- Author
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Cushing L, Blaustein-Rejto D, Wander M, Pastor M, Sadd J, Zhu A, and Morello-Frosch R
- Subjects
- Air Pollution prevention & control, California, Climate Change, Government Regulation, Greenhouse Effect legislation & jurisprudence, Greenhouse Effect prevention & control, Greenhouse Gases adverse effects, Health Status, Humans, Inhalation Exposure prevention & control, Program Evaluation, Risk Assessment, Risk Factors, Social Determinants of Health legislation & jurisprudence, Time Factors, Air Pollution adverse effects, Air Pollution legislation & jurisprudence, Carbon adverse effects, Environmental Monitoring legislation & jurisprudence, Inhalation Exposure adverse effects, Inhalation Exposure legislation & jurisprudence, Particulate Matter adverse effects, Residence Characteristics
- Abstract
Background: Policies to mitigate climate change by reducing greenhouse gas (GHG) emissions can yield public health benefits by also reducing emissions of hazardous co-pollutants, such as air toxics and particulate matter. Socioeconomically disadvantaged communities are typically disproportionately exposed to air pollutants, and therefore climate policy could also potentially reduce these environmental inequities. We sought to explore potential social disparities in GHG and co-pollutant emissions under an existing carbon trading program-the dominant approach to GHG regulation in the US and globally., Methods and Findings: We examined the relationship between multiple measures of neighborhood disadvantage and the location of GHG and co-pollutant emissions from facilities regulated under California's cap-and-trade program-the world's fourth largest operational carbon trading program. We examined temporal patterns in annual average emissions of GHGs, particulate matter (PM2.5), nitrogen oxides, sulfur oxides, volatile organic compounds, and air toxics before (January 1, 2011-December 31, 2012) and after (January 1, 2013-December 31, 2015) the initiation of carbon trading. We found that facilities regulated under California's cap-and-trade program are disproportionately located in economically disadvantaged neighborhoods with higher proportions of residents of color, and that the quantities of co-pollutant emissions from these facilities were correlated with GHG emissions through time. Moreover, the majority (52%) of regulated facilities reported higher annual average local (in-state) GHG emissions since the initiation of trading. Neighborhoods that experienced increases in annual average GHG and co-pollutant emissions from regulated facilities nearby after trading began had higher proportions of people of color and poor, less educated, and linguistically isolated residents, compared to neighborhoods that experienced decreases in GHGs. These study results reflect preliminary emissions and social equity patterns of the first 3 years of California's cap-and-trade program for which data are available. Due to data limitations, this analysis did not assess the emissions and equity implications of GHG reductions from transportation-related emission sources. Future emission patterns may shift, due to changes in industrial production decisions and policy initiatives that further incentivize local GHG and co-pollutant reductions in disadvantaged communities., Conclusions: To our knowledge, this is the first study to examine social disparities in GHG and co-pollutant emissions under an existing carbon trading program. Our results indicate that, thus far, California's cap-and-trade program has not yielded improvements in environmental equity with respect to health-damaging co-pollutant emissions. This could change, however, as the cap on GHG emissions is gradually lowered in the future. The incorporation of additional policy and regulatory elements that incentivize more local emission reductions in disadvantaged communities could enhance the local air quality and environmental equity benefits of California's climate change mitigation efforts., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2018
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18. Elusive implementation: an ethnographic study of intersectoral policymaking for health.
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Holt DH, Rod MH, Waldorff SB, and Tjørnhøj-Thomsen T
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- Anthropology, Cultural, Denmark epidemiology, Health Equity, Health Policy economics, Humans, Cities legislation & jurisprudence, Health Policy legislation & jurisprudence, Policy Making, Public Health, Social Determinants of Health legislation & jurisprudence
- Abstract
Background: For more than 30 years policy action across sectors has been celebrated as a necessary and viable way to affect the social factors impacting on health. In particular intersectoral action on the social determinants of health is considered necessary to address social inequalities in health. However, despite growing support for intersectoral policymaking, implementation remains a challenge. Critics argue that public health has remained naïve about the policy process and a better understanding is needed. Based on ethnographic data, this paper conducts an in-depth analysis of a local process of intersectoral policymaking in order to gain a better understanding of the challenges posed by implementation. To help conceptualize the process, we apply the theoretical perspective of organizational neo-institutionalism, in particular the concepts of rationalized myth and decoupling., Methods: On the basis of an explorative study among ten Danish municipalities, we conducted an ethnographic study of the development of a municipal-wide implementation strategy for the intersectoral health policy of a medium-sized municipality. The main data sources consist of ethnographic field notes from participant observation and interview transcripts., Results: By providing detailed contextual description, we show how an apparent failure to move from policy to action is played out by the ongoing production of abstract rhetoric and vague plans. We find that idealization of universal intersectoralism, inconsistent demands, and doubts about economic outcomes challenge the notion of implementation as moving from rhetoric to action., Conclusion: We argue that the 'myth' of intersectoralism may be instrumental in avoiding the specification of action to implement the policy, and that the policy instead serves as a way to display and support good intentions and hereby continue the process. On this basis we expand the discussion on implementation challenges regarding intersectoral policymaking for health.
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- 2018
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19. The Rule of Law as a Social Determinant of Health.
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Dingake OBK
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- Humans, United States, Human Rights, Law Enforcement, Social Determinants of Health legislation & jurisprudence
- Published
- 2017
20. Intersectoriality in Danish municipalities: corrupting the social determinants of health?
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Holt DH, Frohlich KL, Tjørnhøj-Thomsen T, and Clavier C
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- Denmark, Health Equity, Humans, Policy Making, Public Policy, Social Welfare legislation & jurisprudence, Cities legislation & jurisprudence, Health Policy legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence
- Abstract
Action on the social determinants of health (SDH) through intersectoral policymaking is often suggested to promote health and health equity. This paper argues that the process of intersectoral policymaking influences how the SDH are construed and acted upon in municipal policymaking. We discuss how the intersectoral policy process legitimates certain practices in the setting of Danish municipal health promotion and the potential impact this can have for long-term, sustainable healthy public policy. Based on ethnographic fieldwork, we show how the intention of intersectoriality produces a strong concern for integrating health into non-health sectors to ensure productive collaboration. To encourage this integration, health is often framed as a means to achieve the objectives of non-health sectors. In doing so, the intersectoral policy process tends to favor smaller-scale interventions that aim to introduce healthier practices into various settings, e.g. creating healthy school environments for increased physical activity and healthy eating. While other more overarching interventions on the health impacts of broader welfare policies (e.g. education policy) tend to be neglected. The interventions hereby neglect to address more fundamental SDH. Based on these findings, we argue that intersectoral policymaking to address the SDH may translate into a limited approach to action on so-called 'intermediary determinants' of health, and as such may end up corrupting the broader SDH. Further, we discuss how this corruption affects the intended role of non-health sectors in tackling the SDH, as it may impede the overall success and long-term sustainability of intersectoral efforts., (© The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Published
- 2017
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21. Interprofessional Medical-Legal Education of Medical Students: Assessing the Benefits for Addressing Social Determinants of Health.
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Pettignano R, Bliss L, McLaren S, and Caley S
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- Adult, Attitude of Health Personnel, Educational Measurement, Female, Humans, Male, Surveys and Questionnaires, United States, Curriculum, Education, Medical, Undergraduate, Social Determinants of Health legislation & jurisprudence
- Abstract
Problem: Screening tools exist to help identify patient issues related to social determinants of health (SDH), but solutions to many of these problems remain elusive to health care providers as they require legal solutions. Interprofessional medical-legal education is essential to optimizing health care delivery., Approach: In 2011, the authors implemented a four-session didactic interprofessional curriculum on medical-legal practice for third-year medical students at Morehouse School of Medicine. This program, also attended by law students, focused on interprofessional collaboration to address client/patient SDH issues and health-harming legal needs. In 2011-2014, the medical students participated in pre- and postintervention surveys designed to determine their awareness of SDH's impact on health as well as their attitudes toward screening for SDH issues and incorporating resources, including a legal resource, to address them. Mean ratings were compared between pre- and postintervention respondent cohorts using independent-sample t tests., Outcomes: Of the 222 medical students who participated in the program, 102 (46%) completed the preintervention survey and 100 (45%) completed the postintervention survey. Postintervention survey results indicated that students self-reported an increased likelihood to screen patients for SDH issues and an increased likelihood to refer patients to a legal resource (P < .001)., Next Steps: Incorporating interprofessional medical-legal education into undergraduate medical education may result in an increased likelihood to screen patients for SDH and to refer patients with legal needs to a legal resource. In the future, an additional evaluation to assess the curriculum's long-term impact will be administered prior to graduation.
- Published
- 2017
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22. To Close the Gap we need to identify the best (and worst) buys in Indigenous health.
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Angell B, Eades S, and Jan S
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- Australia, Health Services, Indigenous organization & administration, Humans, Health Policy, Health Services, Indigenous legislation & jurisprudence, Healthcare Disparities legislation & jurisprudence, Native Hawaiian or Other Pacific Islander, Social Determinants of Health legislation & jurisprudence
- Published
- 2017
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23. Solidarity, Love, and the Social Determinants of Morbidity, Mortality, and Equity.
- Author
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Slatin C
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- Adult, Asbestosis epidemiology, Female, Health Policy, Humans, Male, Middle Aged, Politics, United States epidemiology, Asbestosis mortality, Asbestosis physiopathology, Health Equity legislation & jurisprudence, Health Equity statistics & numerical data, Morbidity, Mortality, Social Determinants of Health legislation & jurisprudence
- Published
- 2017
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24. Redefining "Medical Care."
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Roth LR
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- Deductibles and Coinsurance, Health Benefit Plans, Employee, Humans, Insurance Coverage, Insurance, Health, Patient Protection and Affordable Care Act, Precision Medicine, United States, Delivery of Health Care legislation & jurisprudence, Medical Savings Accounts legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence
- Abstract
President Donald J. Trump has said he will repeal the Affordable Care Act (ACA) and replace it with health savings accounts (HSAs). Conservatives have long preferred individual accounts to meet social welfare needs instead of more traditional entitlement programs. The types of "medical care" that can be reimbursed through an HSA are listed in section 213(d) of the Internal Revenue Code (Code) and include expenses "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." In spite of the broad language, regulations and court interpretations have narrowed this definition substantially. It does not include the many social factors that determine health outcomes. Though the United States spends over seventeen percent of gross domestic product (GDP) on "healthcare", the country's focus on the traditional medicalized model of health results in overall population health that is far beneath the results of other countries that spend significantly less. Precision medicine is one exceptional way in which American healthcare has focused more on individuals instead of providing broad, one-size-fits-all medical care. The precision medicine movement calls for using the genetic code of individuals to both predict future illness and to target treatments for current illnesses. Yet the definition of "medical care" under the Code remains the same for all. My proposal for precision healthcare accounts involves two steps-- the first of which requires permitting physicians to write prescriptions for a broader range of goods and services. The social determinants of health are as important to health outcomes as are surgical procedures and drugs--or perhaps more so according to many population health studies. The second step requires agencies and courts to interpret what constitutes "medical care" under the Code differently depending on the taxpayer's income level. Childhood sports programs and payments for fruits and vegetables may be covered for those in the lower income brackets who could not otherwise afford these items and would not choose to spend scarce resources on them if they could. This all assumes that the government takes funds previously used to subsidize the purchase of health insurance under the ACA (or allocates new funds) and puts the funds in individual accounts so the poor or near poor have money to pay for these expenses. Section I of this Article will explore the current definition of medical care, which excludes the social determinants of health from "healthcare" spending. I then address how precision medicine has changed the types of services and treatments that it makes sense to reimburse for each individual. If efficacy can vary from person to person based on genetic code, then it also can vary depending on environment. There is an opportunity to not only vary the types of "medical care" that can be reimbursed or deducted within the traditional range of services and drugs, but also outside of that range. Section II addresses the historical shift towards health financing through individual accounts, and specifically through HSAs. If this is the only avenue for health reform in the next few years, I advocate using it to engage in the type of experiments that are typically only possible under the cover of tax expenditures. My proposal for precision healthcare accounts moves the government to experiment with individual social spending that can lead to improved overall health outcomes. Finally, in Section III, I address two dichotomies that affect any healthcare proposal: (1) entitlement programs v. grants-in-aid, and (2) pooled insurance v. consumer-driven health plans (CDHPs). In the end, I argue that an entitlement method of funding precision HSAs along with pooled insurance subsidized by the government is the most realistic resolution to these dichotomies. Only a broad-based entitlement to funding for all healthcare expenses (medical and social) allows for significant improvements in overall population health.
- Published
- 2017
25. Should the governments of 'developed' countries be held responsible for equalizing the indigenous health gap?
- Author
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Abdolhosseini P, Bonner C, Montano A, Young YY, Wadsworth D, Williams M, and Stoner L
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- Australia, Canada, Developed Countries, Government, Health Status Disparities, Humans, Life Expectancy, New Zealand, Population Groups, Socioeconomic Factors, United States, Health Services, Indigenous legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence
- Abstract
Across the globe there is significant variation between and within indigenous populations in terms of world view, culture, and socio-political forces. However, many indigenous groups do share a striking commonality: greater rates of non-communicable diseases and shorter life expectancies than non-indigenous compatriots. Notably, this health gap persists for 'developed' countries, including Australia, Canada, New Zealand and the United States. The question of who is responsible for equalizing the gap is complicated. Using Australia as an exemplar context, this commentary will present arguments 'for' and 'against' the governments of developed nations being held liable for closing the indigenous health gap. We will discuss the history and nature of the health gap, actions needed to 'close the gap', and which party has the necessary resources to do so., (© The Author(s) 2015.)
- Published
- 2016
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26. The ethics and politics of mindfulness-based interventions.
- Author
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Schmidt AT
- Subjects
- Democracy, Humans, Life Style, Policy Making, Politics, Social Determinants of Health legislation & jurisprudence, Social Responsibility, Mental Disorders therapy, Mindfulness ethics, Mindfulness legislation & jurisprudence, Mindfulness methods, Public Policy legislation & jurisprudence, Social Determinants of Health ethics, Stress, Psychological therapy
- Abstract
Recently, there has been a lot of enthusiasm for mindfulness practice and its use in healthcare, businesses and schools. An increasing number of studies give us ground for cautious optimism about the potential of mindfulness-based interventions (MBIs) to improve people's lives across a number of dimensions. This paper identifies and addresses some of the main ethical and political questions for larger-scale MBIs. First, how far are MBIs compatible with liberal neutrality given the great diversity of lifestyles and conceptions of the good characteristic of modern societies? It will be argued that the potential benefits of contemporary secular mindfulness practice are indeed of a sufficiently primary or all-purpose nature to qualify as suitable goals of liberal public policy. Second, what challenges are brought up if mindfulness is used in contexts and applications-such as military settings-whose goals seem incompatible with the ethical and soteriological views of traditional mindfulness practice? It will be argued that, given concerns regarding liberal neutrality and reasonable disagreement about ethics, MBIs should avoid strong ethical commitments. Therefore, it should, in principle, be applicable in contexts of controversial moral value. Finally, drawing on recent discussions within the mindfulness community, it is argued that we should not overstate the case for mindfulness and not crowd out discussion of organisational and social determinants of stress, lowered well-being, and mental illness and the collective measures necessary to address them., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
- Published
- 2016
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27. State and Local Policies as a Structural and Modifiable Determinant of HIV Vulnerability Among Latino Migrants in the United States.
- Author
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Galeucia M and Hirsch JS
- Subjects
- Health Services Accessibility, Hispanic or Latino statistics & numerical data, Humans, Language, Local Government, Policy, Residence Characteristics, Risk Factors, Risk-Taking, Social Determinants of Health legislation & jurisprudence, Social Determinants of Health statistics & numerical data, Socioeconomic Factors, State Government, Transients and Migrants legislation & jurisprudence, United States, Vulnerable Populations, HIV Infections ethnology, Hispanic or Latino psychology, Social Determinants of Health ethnology, Transients and Migrants psychology
- Abstract
We explore how state and local policies in labor, health, education, language, community and neighborhood environments, deportation, and state-authorized identification can reduce or exacerbate HIV vulnerability among Latino migrants in the United States. We reviewed literature on Latino migrants and HIV risk, on the structural-environmental contexts experienced by Latino migrants, and on the many domains in which policies influence those contexts. To illustrate the pathways through which policies across multiple sectors are relevant to HIV vulnerability, we describe how policies shape 2 mediating domains (a climate of hostility toward Latino migrants and the relative ease or difficulty of access to beneficial institutions) and how those domains influence behavioral risk practices, which increase vulnerability to HIV. This argument demonstrates the utility of considering the policy context as a modifiable element of the meso-level through which structural factors shape vulnerability to HIV. This approach has specific relevance to the consideration of HIV prevention for Latino migrants, and more generally, to structural approaches to HIV prevention.
- Published
- 2016
- Full Text
- View/download PDF
28. Civil Rights Laws as Tools to Advance Health in the Twenty-First Century.
- Author
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McGowan AK, Lee MM, Meneses CM, Perkins J, and Youdelman M
- Subjects
- Communication Barriers, Culture, Disaster Planning organization & administration, Health Care Reform organization & administration, Health Services Accessibility organization & administration, Humans, Immunization Programs organization & administration, Language, Public Health Surveillance methods, Quality of Health Care organization & administration, Social Determinants of Health legislation & jurisprudence, Social Justice, Socioeconomic Factors, United States epidemiology, Violence legislation & jurisprudence, Violence prevention & control, Civil Rights legislation & jurisprudence, Health Policy, Health Status Disparities
- Abstract
To improve health in the twenty-first century, to promote both access to and quality of health care services and delivery, and to address significant health disparities, legal and policy approaches, specifically those focused on civil rights, could be used more intentionally and strategically. This review describes how civil rights laws, and their implementation and enforcement, help to encourage health in the United States, and it provides examples for peers around the world. The review uses a broad lens to define health for both classes of individuals and their communities--places where people live, learn, work, and play. Suggestions are offered for improving health and equity broadly, especially within societal groups and marginalized populations. These recommendations include multisectorial approaches that focus on the social determinants of health.
- Published
- 2016
- Full Text
- View/download PDF
29. Am I My Brother's Keeper? African American Men's Health Within the Context of Equity and Policy.
- Author
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Enyia OK, Watkins YJ, and Williams Q
- Subjects
- Black or African American psychology, Government Programs, Health Behavior ethnology, Humans, Male, Men's Health economics, Men's Health standards, Patient Protection and Affordable Care Act, Social Class, Social Determinants of Health economics, Social Determinants of Health legislation & jurisprudence, Stress, Psychological economics, Stress, Psychological ethnology, Stress, Psychological etiology, United States, Black or African American statistics & numerical data, Cultural Competency, Health Policy legislation & jurisprudence, Health Status Disparities, Men's Health ethnology, Social Determinants of Health ethnology
- Abstract
African American men's health has at times been regarded as irrelevant to the health and well-being of the communities where they are born, grow, live, work, and age. The uniqueness of being male and of African descent calls for a critical examination and deeper understanding of the psycho-socio-historical context in which African American men have lived. There is a critical need for scholarship that better contextualizes African American Male Theory and cultural humility in terms of public health. Furthermore, the focus of much of the social determinants of health and health equity policy literature has been on advocacy, but few researchers have examined why health-related public policies have not been adopted and implemented from a political and theoretical policy analysis perspective. The purpose of this article will be to examine African American men's health within the context of social determinants of health status, health behavior, and health inequalities-elucidating policy implications for system change and providing recommendations from the vantage point of health equity., (© The Author(s) 2014.)
- Published
- 2016
- Full Text
- View/download PDF
30. Association of rule of law and health outcomes: an ecological study.
- Author
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Pinzon-Rondon AM, Attaran A, Botero JC, and Ruiz-Sternberg AM
- Subjects
- Adult, Aged, Cardiovascular Diseases mortality, Criminal Law, Diabetes Mellitus mortality, Female, Government, Human Rights, Humans, Infant, Infant Mortality, Maternal Mortality, Pregnancy, Socioeconomic Factors, Developing Countries, Health Status Indicators, Jurisprudence, Law Enforcement, Life Expectancy, Mortality, Social Determinants of Health legislation & jurisprudence
- Abstract
Objectives: To explore whether the rule of law is a foundational determinant of health that underlies other socioeconomic, political and cultural factors that have been associated with health outcomes., Setting: Global project., Participants: Data set of 96 countries, comprising 91% of the global population., Primary and Secondary Outcome Measures: The following health indicators, infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, were included to explore their association with the rule of law. We used a novel Rule of Law Index, gathered from survey sources, in a cross-sectional and ecological design. The Index is based on eight subindices: (1) Constraints on Government Powers; (2) Absence of Corruption; (3) Order and Security; (4) Fundamental Rights; (5) Open Government; (6) Regulatory Enforcement, (7) Civil Justice; and (8) Criminal Justice., Results: The rule of law showed an independent association with infant mortality rate, maternal mortality rate, life expectancy, and cardiovascular disease and diabetes mortality rate, after adjusting for the countries' level of per capita income, their expenditures in health, their level of political and civil freedom, their Gini measure of inequality and women's status (p<0.05). Rule of law remained significant in all the multivariate models, and the following adjustment for potential confounders remained robust for at least one or more of the health outcomes across all eight subindices of the rule of law. Findings show that the higher the country's level of adherence to the rule of law, the better the health of the population., Conclusions: It is necessary to start considering the country's adherence to the rule of law as a foundational determinant of health. Health advocates should consider the improvement of rule of law as a tool to improve population health. Conversely, lack of progress in rule of law may constitute a structural barrier to health improvement., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
- Published
- 2015
- Full Text
- View/download PDF
31. Human rights in the new Global Strategy.
- Author
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Sanghera J, Gentile L, Guerras-Delgado I, O'Hanlon L, Barragues A, Hinton RL, Khosla R, Rasanathan K, and Stahlhofer M
- Subjects
- Adolescent, Adolescent Health Services legislation & jurisprudence, Adult, Child, Child Health Services legislation & jurisprudence, Female, Health Policy, Health Services Accessibility legislation & jurisprudence, Health Status Disparities, Humans, International Cooperation, Male, Patient Advocacy, Policy Making, Social Determinants of Health legislation & jurisprudence, Women's Health Services legislation & jurisprudence, Adolescent Health Services organization & administration, Child Health Services organization & administration, Global Health, Health Services Accessibility organization & administration, Human Rights legislation & jurisprudence, Women's Health Services organization & administration
- Published
- 2015
- Full Text
- View/download PDF
32. Addressing the Social Determinants of Health to Reduce Tobacco-Related Disparities.
- Author
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Garrett BE, Dube SR, Babb S, and McAfee T
- Subjects
- Humans, Smoking economics, Smoking epidemiology, Smoking Cessation economics, Social Determinants of Health economics, Socioeconomic Factors, Tobacco Use economics, Tobacco Use epidemiology, Tobacco Use prevention & control, Tobacco Use Disorder economics, Tobacco Use Disorder epidemiology, Tobacco Use Disorder prevention & control, Health Status Disparities, Smoking Cessation legislation & jurisprudence, Smoking Prevention, Social Determinants of Health legislation & jurisprudence
- Abstract
Introduction: Comprehensive tobacco prevention and control efforts that include implementing smoke-free air laws, increasing tobacco prices, conducting hard-hitting mass media campaigns, and making evidence-based cessation treatments available are effective in reducing tobacco use in the general population. However, if these interventions are not implemented in an equitable manner, certain population groups may be left out causing or exacerbating disparities in tobacco use. Disparities in tobacco use have, in part, stemmed from inequities in the way tobacco control policies and programs have been adopted and implemented to reach and impact the most vulnerable segments of the population that have the highest rates of smokings (e.g., those with lower education and incomes)., Methods: Education and income are the 2 main social determinants of health that negatively impact health. However, there are other social determinants of health that must be considered for tobacco control policies to be effective in reducing tobacco-related disparities. This article will provide an overview of how tobacco control policies and programs can address key social determinants of health in order to achieve equity and eliminate disparities in tobacco prevention and control., Results: Tobacco control policy interventions can be effective in addressing the social determinants of health in tobacco prevention and control to achieve equity and eliminate tobacco-related disparities when they are implemented consistently and equitably across all population groups., Conclusions: Taking a social determinants of health approach in tobacco prevention and control will be necessary to achieve equity and eliminate tobacco-related disparities., (© The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2015
- Full Text
- View/download PDF
33. Health Justice: A Framework (and Call to Action) for the Elimination of Health Inequity and Social Injustice.
- Author
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Benfer EA
- Subjects
- Asthma, Child, Environment, Food Supply, Humans, Lead Poisoning, Minority Health legislation & jurisprudence, Pediatric Obesity, Poverty, Prejudice, Primary Prevention, United States, Vulnerable Populations legislation & jurisprudence, Health Status Disparities, Social Determinants of Health legislation & jurisprudence, Social Justice legislation & jurisprudence
- Abstract
Every aspect of society is dependent upon the health of its members. Health is essential to an individual’s well-being, quality of life, and ability to participate in society. Yet the healthcare industry, even at its optimal level of functioning, cannot improve the health of the population without addressing the root causes of poor health. The health of approximately 46.7 million individuals, most of whom are low-income and racial minorities, is threatened by economic, societal, cultural, environmental, and social conditions. Poor health in any population group affects everyone, leading to higher crime rates, negative economic impacts, decreased residential home values, increased healthcare costs, and other devastating consequences. Despite this fact, efforts to improve health among low-income and minority communities are impeded by inequitable social structures, stereotypes, legal systems, and regulatory schemes that are not designed to take into account the social determinants of health in decision making models and legal interpretation. As a result, a large segment of the population is continually denied the opportunity to live long, productive lives and to exercise their rights under democratic principles. Health, equity, and justice make up the keystone of a functional, thriving society. These principles are unsatisfied when they do not apply equally to all members of society. This Article describes the social and legal roots of poor health and how health inequity, social injustice, and poverty are inextricably linked. For example, it provides an in depth overview of the social determinants of health, including poverty, institutional discrimination and segregation, implicit bias, residential environmental hazards, adverse childhood experiences, and food insecurity. It then discusses how the law is a determinant of health due to court systems that do not evaluate individual circumstances, the enactment of laws that perpetuate poor health, and the lack of primary prevention laws. It demonstrates how addressing these issues requires true adherence to equality principles and making justice and freedom of opportunity accessible to everyone. Finally, it recommends the creation of "health justice," a new jurisprudential and legislative framework for the achievement and delivery of health equity and social justice.
- Published
- 2015
34. The MLP vital sign: assessing and managing legal needs in the healthcare setting.
- Author
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Sandel M, Suther E, Brown C, Wise M, and Hansen M
- Subjects
- Adult, Child, Cooperative Behavior, Humans, Interdisciplinary Communication, Referral and Consultation legislation & jurisprudence, Social Work legislation & jurisprudence, United States, Delivery of Health Care legislation & jurisprudence, Health Services Needs and Demand legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence, Social Justice legislation & jurisprudence, Vulnerable Populations legislation & jurisprudence
- Published
- 2014
- Full Text
- View/download PDF
35. Rural health systems and legal care: opportunities for initiating and maintaining legal care after the Patient Protection and Affordable Care Act.
- Author
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Teufel J, Goffinet D, Land D, and Thorne W
- Subjects
- Adult, Child, Chronic Disease epidemiology, Chronic Disease therapy, Cross-Sectional Studies, Delivery of Health Care, Integrated legislation & jurisprudence, Healthcare Disparities legislation & jurisprudence, Humans, Rural Health Services economics, Social Determinants of Health legislation & jurisprudence, United States, Cooperative Behavior, Health Services Accessibility legislation & jurisprudence, Interdisciplinary Communication, Patient Protection and Affordable Care Act legislation & jurisprudence, Rural Health Services legislation & jurisprudence, Social Justice legislation & jurisprudence
- Published
- 2014
- Full Text
- View/download PDF
36. Investing in legal prevention: connecting access to civil justice and healthcare through medical-legal partnership.
- Author
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Lawton EM and Sandel M
- Subjects
- Humans, Preventive Health Services legislation & jurisprudence, Public-Private Sector Partnerships legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence, United States, Civil Rights legislation & jurisprudence, Cooperative Behavior, Health Services Accessibility legislation & jurisprudence, Interdisciplinary Communication, Social Justice legislation & jurisprudence
- Published
- 2014
- Full Text
- View/download PDF
37. Educating the next generation of health leaders: medical-legal partnership and interprofessional graduate education.
- Author
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Benfer EA
- Subjects
- Clinical Competence legislation & jurisprudence, Curriculum, Humans, Needs Assessment legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence, Social Work legislation & jurisprudence, United States, Cooperative Behavior, Education, Medical, Graduate, Health Policy legislation & jurisprudence, Health Services Accessibility legislation & jurisprudence, Interdisciplinary Communication, Leadership, Patient Protection and Affordable Care Act legislation & jurisprudence, Social Justice legislation & jurisprudence
- Published
- 2014
- Full Text
- View/download PDF
38. Medical-legal partnership in medical education: pathways and opportunities.
- Author
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Tyler ET, Anderson LT, Rappaport L, Shah AK, Edberg DL, and Paul EG
- Subjects
- Clinical Clerkship legislation & jurisprudence, Clinical Competence legislation & jurisprudence, Curriculum, Delivery of Health Care, Integrated legislation & jurisprudence, Humans, Internship and Residency legislation & jurisprudence, Mentors, Patient Care Team legislation & jurisprudence, Patient Protection and Affordable Care Act legislation & jurisprudence, United States, Cooperative Behavior, Delivery of Health Care legislation & jurisprudence, Education, Medical, Healthcare Disparities legislation & jurisprudence, Interdisciplinary Communication, Social Determinants of Health legislation & jurisprudence
- Published
- 2014
- Full Text
- View/download PDF
39. "Small places close to home": toward a health and human rights strategy for the US.
- Author
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Tobin Tyler E
- Subjects
- Health Status, Humans, International Cooperation, Patient Advocacy, Patient Rights legislation & jurisprudence, Patient Rights standards, Power, Psychological, Social Determinants of Health legislation & jurisprudence, Social Responsibility, State Government, United States, Health Status Disparities, Human Rights legislation & jurisprudence, Human Rights standards
- Abstract
Much of the discussion about "health as a human right" has centered on global health initiatives, largely ignoring the application of human rights principles to the significant socioeconomic and racial health disparities in the United States. Given the persistent gaps in insurance coverage and access to quality preventive care in the US, the health and human rights movement has primarily focused its efforts on achieving universal health care coverage. However, this focus has left unaddressed how a human rights strategy might also address the social determinants of health. As Americans' health continues to worsen-the US Institute of Medicine recently reported that the US now fares worse in nine areas of health than 16 peer high-income democracies--a broader social determinants approach is warranted. This article explores the application of international human rights principles, including a "right to health" to the US context, and analyzes how existing domestic law may be used to advance health as a human right for America's most vulnerable populations. It demonstrates that an effective health and human rights strategy must build partnerships among health care providers, public health professionals, and lawyers to identify rights violations, hold officials and systems accountable, and mobilize communities to advocate for systems and policy change., (Copyright © 2013 Tobin Tyler. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.)
- Published
- 2013
40. Action on the social determinants of health.
- Author
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Marmot M, Bell R, and Goldblatt P
- Subjects
- Child, Preschool, Early Intervention, Educational legislation & jurisprudence, Early Intervention, Educational methods, Early Intervention, Educational statistics & numerical data, Employment statistics & numerical data, France epidemiology, Health Policy, Health Status Disparities, Humans, Socioeconomic Factors, World Health Organization, National Health Programs legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence
- Abstract
Closing the Gap in a Generation, the final report of the Commission on Social Determinants of Health (CSDH) proposed that inequities in power, money and resources were responsible for much of the inequalities in health within and between countries. A toxic combination of poor policies and programmes, unfair economic arrangements and bad governance led to inequalities in the conditions of daily life: the circumstances in which people are born, grow, live, work, and age. Our message is that there needs to be a cross-government commitment to action on social determinants of health. With this commitment, the knowledge synthesised in our report suggests that there is much that can be done at the practical level., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
41. A capabilities approach to population health and public policy-making.
- Author
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Hall PA, Taylor RC, and Barnes L
- Subjects
- Empirical Research, Health Resources statistics & numerical data, Health Resources supply & distribution, Humans, Models, Theoretical, Public Health economics, Social Class, Social Determinants of Health legislation & jurisprudence, Public Health legislation & jurisprudence, Public Health methods, Public Policy economics, Public Policy legislation & jurisprudence
- Abstract
Background: The objective of this study is to outline a capabilities approach to the social determinants of population health and to compare its explanatory power and implications for public policy-making with psychosocial approaches., Methods: A model linking the structures of economic and social relations to health outcomes is developed and logistic methods used to confirm its base validity for a representative sample of 16,488 citizens in 19 developed democracies drawn from the World Values Surveys of 1990 and 2005. Self-reported health is the dependent variable. Age, gender, education, employment status, self-mastery, income, autonomy at work, ties to family and friends, subjective social status, associational memberships and sense of national belonging are considered., Results: At baseline, risk ratios reflecting movement from the 25th to 75th percentile in the distribution of the variable indicate that increases in income reduce the likelihood of poor health (0.78; 0.73-0.82) as does higher autonomy at work (0.90; 0.85-0.94) but so does access to social resources reflected in ties to family and friends (0.89; 0.86-0.92), associational memberships (0.93; 0.89-0.98), subjective social status (0.77; 0.54-0.90) while the absence of feelings of national belonging increases the likelihood of poor health (1.14; 1.06-1.23)., Conclusion: The results suggest that population health is dependent on the distribution of social as well as economic resources along the dimensions predicted by a capabilities model. Governments should be attentive to the impact of policy on the distribution of social, as well as economic, resources., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
42. Our zip code may be more important than our genetic code: social determinants of health, law and policy.
- Author
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Ritchie D
- Subjects
- Genetic Code, Humans, Public Health, Rhode Island, Health Policy legislation & jurisprudence, Social Determinants of Health legislation & jurisprudence
- Published
- 2013
43. Wellness incentives in the workplace: cost savings through cost shifting to unhealthy workers.
- Author
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Horwitz JR, Kelly BD, and DiNardo JE
- Subjects
- Cost Allocation economics, Cost Allocation legislation & jurisprudence, Cost Savings economics, Cost Savings legislation & jurisprudence, Employee Incentive Plans legislation & jurisprudence, Health Promotion legislation & jurisprudence, Health Status Disparities, Humans, Motivation, Patient Protection and Affordable Care Act economics, Patient Protection and Affordable Care Act legislation & jurisprudence, Patient Protection and Affordable Care Act organization & administration, Randomized Controlled Trials as Topic, Social Determinants of Health economics, Social Determinants of Health legislation & jurisprudence, Social Discrimination legislation & jurisprudence, United States, Workplace legislation & jurisprudence, Employee Incentive Plans economics, Employee Incentive Plans organization & administration, Health Behavior, Health Promotion economics, Health Promotion organization & administration, Health Status, Workplace economics, Workplace organization & administration
- Abstract
The Affordable Care Act encourages workplace wellness programs, chiefly by promoting programs that reward employees for changing health-related behavior or improving measurable health outcomes. Recognizing the risk that unhealthy employees might be punished rather than helped by such programs, the act also forbids health-based discrimination. We reviewed results of randomized controlled trials and identified challenges for workplace wellness programs to function as the act intends. For example, research results raise doubts that employees with health risk factors, such as obesity and tobacco use, spend more on medical care than others. Such groups may not be especially promising targets for financial incentives meant to save costs through health improvement. Although there may be other valid reasons, beyond lowering costs, to institute workplace wellness programs, we found little evidence that such programs can easily save costs through health improvement without being discriminatory. Our evidence suggests that savings to employers may come from cost shifting, with the most vulnerable employees--those from lower socioeconomic strata with the most health risks--probably bearing greater costs that in effect subsidize their healthier colleagues.
- Published
- 2013
- Full Text
- View/download PDF
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