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Healthcare
Special Issues
Social, Economic and Political Determinants of Health and Health Equity
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Social, Economic and Political Determinants of Health and Health Equity

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Community Care".

Deadline for manuscript submissions: closed (30 November 2024) | Viewed by 13497

Special Issue Editor

Dr. Mina Silberberg

E-Mail Website
Guest Editor
Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC 27708, USA
Interests: community health; program evaluation; social drivers of health; health equity; community mobilization; public policy

Special Issue Information

Dear Colleagues, 

Population health and patterns of health inequity are predominantly driven by social, economic, and political factors. The likelihood of exposure to infectious disease, the ease of incorporating walking into daily routines, who has access to healthcare, the distribution of chronic stress, and other proximate determinants of health have their roots in social, economic, and political conditions. This is a reality of societies across time and across geographic boundaries. Recently, there have been notable innovations aimed at improving health and health equity through changes in social, economic, and political factors. However, many aspects of healthcare, health research, and health policy remain unaffected by our growing awareness of the importance of these factors. 

This Special Issue of Healthcare is dedicated to articles that provide new insights into the ways that social, economic, and political factors affect health and health equity, research on innovations to address these factors, and new ideas about what can be done. We welcome submissions that address health and health equity around the globe at present, in the past, and in the future. We also welcome submissions reflecting a variety of disciplines as well as perspectives, and ask authors to provide the background necessary to make their work accessible to a diverse readership. 

Dr. Mina Silberberg
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • population health
  • health inequity
  • health equity
  • healthcare
  • health research
  • health policy
  • community health
  • social drivers of health
  • community mobilization
  • public policy
  • health disparities

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (7 papers)

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Research

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15 pages, 256 KiB  
Article
Racial and Ethnic (In)equity in Development of Power Through Place-Based Initiatives
by Mina Silberberg, Matthew E. Dupre, James Moody, Meera Patel, Anika Vemulapalli and Douglas Easterling
Healthcare 2024, 12(23), 2486; https://doi.org/10.3390/healthcare12232486 - 9 Dec 2024
Viewed by 457
Abstract
Background: Place-based initiatives (PBIs) invest in a geographic area and often build community power to improve well-being. However, there can be differences in results for different groups within a community. Methods: In six communities, we measured differences in “power to” by [...] Read more.
Background: Place-based initiatives (PBIs) invest in a geographic area and often build community power to improve well-being. However, there can be differences in results for different groups within a community. Methods: In six communities, we measured differences in “power to” by race/ethnicity at two points for the first phase of the PBI Healthy Places North Carolina (HPNC) using five indicators: (1) representation in network of actors collaborating to improve health, (2) leadership attributes, (3) perceived change in attributes due to HPNC, (4) network centrality, and (5) perceived change in network ties due to HPNC. Results: Latine populations were underrepresented. In four (majority White) communities, there were indications of White advantage. In one, White centrality was greater than non-White. In another, White actors consistently rated themselves higher for leadership attributes. In two, a gap in leadership attributes favoring White actors appeared at Wave 2. In two counties with African American majorities, non-White attributes ranked higher than White. Conclusions: Each indicator provided unique insight. Results provide new evidence of measurement validity and reliability. Results indicate that when PBIs designed to address the needs of low-resource communities do not proactively concern themselves with racial/ethnic equity and power (as HPNC would do in the years after this study), they may result in greater White benefit from PBI or failure to close existing gaps. Findings aligned with the “political reality” model of the correspondence between the size of African American population and their perceived self-efficacy. Changes over time and inter-county differences confirm need for early measurement of power differences and changes. Full article
(This article belongs to the Special Issue Social, Economic and Political Determinants of Health and Health Equity)
14 pages, 878 KiB  
Article
Impact of Education as a Social Determinant on the Risk of Type 2 Diabetes Mellitus in Korean Adults
by Mi-Joon Lee, Bum-Jeun Seo and Yeon-Sook Kim
Healthcare 2024, 12(14), 1446; https://doi.org/10.3390/healthcare12141446 - 19 Jul 2024
Viewed by 1659
Abstract
Education is correlated with health literacy, which is a combination of reading and listening skills, data analysis, and decision-making during the necessary health situations. This study aims to evaluate the effect of education on the risk of type 2 diabetes mellitus (T2DM). This [...] Read more.
Education is correlated with health literacy, which is a combination of reading and listening skills, data analysis, and decision-making during the necessary health situations. This study aims to evaluate the effect of education on the risk of type 2 diabetes mellitus (T2DM). This is a population-based cross-sectional study using the 2019 nationwide survey data in Korea. There were 3951 study subjects, after excluding participants with missing data for key exposures and outcome variables. Descriptive statistics, χ2 (chi-square) test, and logistic regression were performed to analyze the data. The prevalence of T2DM was associated with educational attainment, sex, age, smoking status, physical activity, carbohydrate intake, and obesity. In the logistic regression model, the odds ratio (OR) of having T2DM was much lower among people educated in college or higher (OR = 0.49, 95% confidence interval [95% CI] = 0.34–0.64) than those with only or without primary education after adjusting for biological factors (sex, age) and health behaviors (smoking status, physical activity, carbohydrate intake, and obesity). This study shows that educational attainment is a significant social determinant influencing health outcomes both directly and indirectly. Therefore, it is necessary to develop policies to reduce the health inequity of T2DM caused by differences in educational attainment. Full article
(This article belongs to the Special Issue Social, Economic and Political Determinants of Health and Health Equity)
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<p>Flow chart for study population selection.</p> Full article ">Figure 2
<p>Model for health equity in T2DM.</p> Full article ">Figure 3
<p>Prevalence of T2DM by educational attainment.</p> Full article ">
19 pages, 887 KiB  
Article
Immigrant Perspectives of Social Connection in a Nontraditional Migration Area
by Farrah Jacquez, Lisa M. Vaughn and Jamie Hardy-Besaw
Healthcare 2024, 12(6), 686; https://doi.org/10.3390/healthcare12060686 - 19 Mar 2024
Cited by 1 | Viewed by 1462
Abstract
Social connection is a core dimension of health and wellness among all populations, yet the experience of moving to and living in a new country makes social and community-level influences particularly salient for immigrants. We interviewed 38 Latino immigrants living in a nontraditional [...] Read more.
Social connection is a core dimension of health and wellness among all populations, yet the experience of moving to and living in a new country makes social and community-level influences particularly salient for immigrants. We interviewed 38 Latino immigrants living in a nontraditional migration area to explore the social and community foundations of health and wellness. Using hybrid (inductive/deductive) qualitative analysis, we identified seven domains of social connection from the perspective of the interviewed participants: (1) lens of the individual; (2) immigrant experience; (3) interpersonal support; (4) community belonging; (5) community capital; (6) community navigation; and (7) social acceptance. Social connection domains generated by participants are consistent with the scientific literature, but this study identifies the specific social factors that immigrants describe as most salient to their own health and wellness. Our community-generated understanding of social connection can be used by healthcare providers to reduce risks and build on assets that will improve the health of immigrants living in nontraditional migration areas. Additionally, these results might serve as a foundation for a quantitative measure that can be used by providers to more accurately and comprehensively assess the social connection of their patients and by researchers to evaluate the effectiveness of community-level interventions for immigrants. Full article
(This article belongs to the Special Issue Social, Economic and Political Determinants of Health and Health Equity)
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<p>Map of the Cincinnati metropolitan area.</p> Full article ">Figure 2
<p>Illustrated summary of qualitative results.</p> Full article ">
12 pages, 255 KiB  
Article
Audiological Service Delivery and Uptake in New Zealand Regional Areas
by Helen Boseley, David Welch and Ravi Reddy
Healthcare 2023, 11(23), 3054; https://doi.org/10.3390/healthcare11233054 - 28 Nov 2023
Viewed by 1183
Abstract
Background: In New Zealand, as in many places, a significant proportion of the population lives outside the main urban centres. People living in regional areas have similar needs for audiological services as those living in urban centres; however, economic and geographical barriers can [...] Read more.
Background: In New Zealand, as in many places, a significant proportion of the population lives outside the main urban centres. People living in regional areas have similar needs for audiological services as those living in urban centres; however, economic and geographical barriers can be a barrier to accessible services. The objective of this research was to explore factors that influence equitable audiological service provision and user uptake of services in regional areas of New Zealand. Methods: Fifteen participants who represented either audiological service users living in rural or non-urban areas (regional) or audiological service providers in these areas were recruited. Semi-structured interviews were conducted virtually and on average took forty minutes to complete. The interviews were transcribed and analysed using thematic analysis to identify themes and subthemes related to audiological service delivery and uptake. Results: Seven themes were identified. These are related to service provision, geographical barriers, and cultural appropriateness. Conclusions: This study provides a basis for understanding the challenges of delivering and accessing audiological services in non-urban areas in New Zealand, and in principle elsewhere. There is scope for future research to further understand policy directions needed to achieve equitable audiological service provision in regional areas. Full article
(This article belongs to the Special Issue Social, Economic and Political Determinants of Health and Health Equity)
38 pages, 791 KiB  
Article
Wealth Status and Health Insurance Enrollment in India: An Empirical Analysis
by Preshit Nemdas Ambade, Joe Gerald and Tauhidur Rahman
Healthcare 2023, 11(9), 1343; https://doi.org/10.3390/healthcare11091343 - 7 May 2023
Cited by 1 | Viewed by 2444
Abstract
Since 2005, health insurance (HI) coverage in India has significantly increased, largely because of the introduction of government-funded pro-poor insurance programs. As a result, the determinants of HI enrollment and their relative importance may have changed. Using National Family Health Survey (NFHS)-4 data, [...] Read more.
Since 2005, health insurance (HI) coverage in India has significantly increased, largely because of the introduction of government-funded pro-poor insurance programs. As a result, the determinants of HI enrollment and their relative importance may have changed. Using National Family Health Survey (NFHS)-4 data, collected in 2015–2016, and employing a Probit regression model, we re-examine the determinants of household HI enrollment. Then, using a multinomial logistic regression model, we estimate the relative risk ratio for enrollment in different HI schemes. In comparison to the results on the determinants of HI enrollment using the NFHS data collected in 2005–2006, we find a decrease in the wealth gap in public HI enrollment. Nonetheless, disparities in enrollment remain, with some changes in those patterns. Households with low assets have lower enrollments in private and community-based health insurance (CBHI) programs. Households with a higher number of dependents have a higher likelihood of HI enrollment, especially in rural areas. In rural areas, poor Scheduled Caste and Scheduled Tribe households are more likely to be enrolled in public HI than the general Caste households. In urban areas, Muslim households have a lower likelihood of enrollment in any HI. The educational attainment of household heads is positively associated with enrollment in private HI, but it is negatively associated with enrollment in public HI. Since 2005–2006, while HI coverage has improved, disparities across social groups remain. Full article
(This article belongs to the Special Issue Social, Economic and Political Determinants of Health and Health Equity)
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<p>Statewide health insurance enrollment in India 2015–2016.</p> Full article ">Figure 2
<p>Rural–urban distribution of health insurance programs in India 2015–2016.</p> Full article ">

Review

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12 pages, 361 KiB  
Review
Gender, Socioeconomic Status, Race, and Ethnic Disparities in Bystander Cardiopulmonary Resuscitation and Education—A Scoping Review
by Audrey L. Blewer, Blair L. Bigham, Samantha Kaplan, Marina Del Rios and Marion Leary
Healthcare 2024, 12(4), 456; https://doi.org/10.3390/healthcare12040456 - 10 Feb 2024
Cited by 3 | Viewed by 2401
Abstract
Background: Social determinants are associated with survival from out-of-hospital sudden cardiac arrest (SCA). Because prompt delivery of bystander CPR (B-CPR) doubles survival and B-CPR rates are low, we sought to assess whether gender, socioeconomic status (SES), race, and ethnicity are associated with lower [...] Read more.
Background: Social determinants are associated with survival from out-of-hospital sudden cardiac arrest (SCA). Because prompt delivery of bystander CPR (B-CPR) doubles survival and B-CPR rates are low, we sought to assess whether gender, socioeconomic status (SES), race, and ethnicity are associated with lower rates of B-CPR and CPR training. Methods: This scoping review was conducted as part of the continuous evidence evaluation process for the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care as part of the Resuscitation Education Science section. We searched PubMed and excluded citations that were abstracts only, letters or editorials, and pediatric studies. Results: We reviewed 762 manuscripts and identified 24 as relevant; 4 explored gender disparities; 12 explored SES; 11 explored race and ethnicity; and 3 had overlapping themes, all of which examined B-CPR or CPR training. Females were less likely to receive B-CPR than males in public locations. Observed gender disparities in B-CPR may be associated with individuals fearing accusations of inappropriate touching or injuring female victims. Studies demonstrated that low-SES neighborhoods were associated with lower rates of B-CPR and CPR training. In the US, predominantly Black and Hispanic neighborhoods were associated with lower rates of B-CPR and CPR training. Language barriers were associated with lack of CPR training. Conclusion: Gender, SES, race, and ethnicity impact receiving B-CPR and obtaining CPR training. The impact of this is that these populations are less likely to receive B-CPR, which decreases their odds of surviving SCA. These health disparities must be addressed. Our work can inform future research, education, and public health initiatives to promote equity in B-CPR knowledge and provision. As an immediate next step, organizations that develop and deliver CPR curricula to potential bystanders should engage affected communities to determine how best to improve training and delivery of B-CPR. Full article
(This article belongs to the Special Issue Social, Economic and Political Determinants of Health and Health Equity)
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<p>PRISMA Flow Diagram.</p> Full article ">
21 pages, 637 KiB  
Review
Structural Origins of Poor Health Outcomes in Documented Temporary Foreign Workers and Refugees in High-Income Countries: A Review
by Borum Yang, Clara Kelly, Isdore Chola Shamputa, Kimberley Barker and Duyen Thi Kim Nguyen
Healthcare 2023, 11(9), 1295; https://doi.org/10.3390/healthcare11091295 - 1 May 2023
Cited by 1 | Viewed by 2182
Abstract
Despite growing evidence of racial and institutional discrimination on minoritized communities and its negative effect on health, there are still gaps in the current literature identifying health disparities among minoritized communities. This review aims to identify health barriers faced by relatively less studied [...] Read more.
Despite growing evidence of racial and institutional discrimination on minoritized communities and its negative effect on health, there are still gaps in the current literature identifying health disparities among minoritized communities. This review aims to identify health barriers faced by relatively less studied migrant subgroups including documented temporary foreign workers and refugees residing in high-income Organisation for Economic Co-operation and Development (OECD) countries focusing on the structural origins of differential health outcomes. We searched Medline, CINAHL, and Embase databases for papers describing health barriers for these groups published in English between 1 January 2011 and 30 July 2021. Two independent reviewers conducted a title, abstract, and full text screening with any discrepancies resolved by consensus or a third reviewer. Extracted data were analyzed using an inductive thematic analysis. Of the 381 articles that underwent full-text review, 27 articles were included in this review. We identified housing conditions, immigration policies, structural discrimination, and exploitative labour practices as the four major emerging themes that impacted the health and the access to healthcare services of our study populations. Our findings highlight the multidimensional nature of health inequities among migrant populations and a need to examine how the broader context of these factors influence their daily experiences. Full article
(This article belongs to the Special Issue Social, Economic and Political Determinants of Health and Health Equity)
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<p>PRISMA flowchart of paper inclusion.</p> Full article ">
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