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Reducing Health Inequities: Social Epidemiology Insights for Public Health and Social Policy

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 41655

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Special Issue Editors

Dr. Alison K. Cohen

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Chief Guest Editor

Public and Nonprofit Administration, School of Management, University of San Francisco, 2130 Fulton Street, San Francisco, CA, 94117, USA
Interests: community-based participatory research; environmental health; epidemiology; health disparities; health equity; public health; social epidemiology

Dr. Stephanie R. Carroll

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Guest Editor

Department of Community, Environment, & Policy, Mel & Enid Zuckerman College of Public Health; Udall Center for Studies in Public Policy; Native Nations Institute; Center for Indigenous Environmental Health Research, University of Arizona, 1295 N. Martin Avenue, PO Box 245210, Tucson, AZ 85724, USA
Interests: environmental health; Indigenous data sovereignty; Native American health; public health; social factors

Dr. Catherine dP. Duarte

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Guest Editor

Division of Epidemiology, School of Public Health, University of California Berkeley2121 Berkeley Way West, Berkeley, CA, 94720, USA
Interests: epidemiology; health equity; racism; education; school discipline; criminal legal system; policy; structural factors; intersectionality

Special Issue Information

Dear Colleagues,

This Special Issue welcomes all papers that are studying issues of health equity using methods from social epidemiology. We expect papers to thoughtfully characterize the social factors studied and discuss the potential mechanisms by which they could affect the health outcomes measured, drawing from previous theoretical and/or empirical research. Papers must also include in the discussion section clear implications for how the research can inform public health actions and/or social policies.
This Special Issue will include both original research articles and literature reviews. Original research articles should thoroughly describe the population and measures. We encourage studies of and with populations underrepresented in the public health literature, including community-based participatory research studies. Literature reviews should be systematic literature reviews or explain why a systematic literature review was not possible. We will do a rapid editorial review of any papers that are analyzing COVID-19-related data. Papers that conduct rigorous analyses that lead to null findings are also welcome.

Dr. Alison K. Cohen
Dr. Stephanie R. Carroll
Dr. Catherine dP. Duarte
Guest Editors

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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. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly 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 2500 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

community-based participatory research
COVID-19
epidemiology
health disparities
health equity
population health
public health
public policy
social epidemiology
social factors
social policy

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Published Papers (10 papers)

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17 pages, 658 KiB

Open AccessArticle

Women-Reported Barriers and Facilitators of Continued Engagement with Medications for Opioid Use Disorder

by Alice Fiddian-Green, Aline Gubrium, Calla Harrington and Elizabeth A. Evans

Int. J. Environ. Res. Public Health 2022, 19(15), 9346; https://doi.org/10.3390/ijerph19159346 - 30 Jul 2022

Cited by 12 | Viewed by 2549

Abstract

Opioid-related fatalities increased exponentially during the COVID-19 pandemic and show little sign of abating. Despite decades of scientific evidence that sustained engagement with medications for opioid use disorders (MOUD) yields positive psychosocial outcomes, less than 30% of people with OUD engage in MOUD. Treatment rates are lowest for women. The aim of this project was to identify women-specific barriers and facilitators to treatment engagement, drawing from the lived experience of women in treatment. Data are provided from a parent study that used a community-partnered participatory research approach to adapt an evidence-based digital storytelling intervention for supporting continued MOUD treatment engagement. The parent study collected qualitative data between August and December 2018 from 20 women in Western Massachusetts who had received MOUD for at least 90 days. Using constructivist grounded theory, we identified major themes and selected illustrative quotations. Key barriers identified in this project include: (1) MOUD-specific discrimination encountered via social media, and in workplace and treatment/recovery settings; and (2) fear, perceptions, and experiences with MOUD, including mental health medication synergies, internalization of MOUD-related stigma, expectations of treatment duration, and opioid-specific mistrust of providers. Women identified two key facilitators to MOUD engagement: (1) feeling “safe” within treatment settings and (2) online communities as a source of positive reinforcement. We conclude with women-specific recommendations for research and interventions to improve MOUD engagement and provide human-centered care for this historically marginalized population. Full article

(This article belongs to the Special Issue Reducing Health Inequities: Social Epidemiology Insights for Public Health and Social Policy)

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13 pages, 1446 KiB

Open AccessArticle

Monitoring Health Inequalities in 12 European Countries: Lessons Learned from the Joint Action Health Equity Europe

by Pi Högberg, Göran Henriksson, Carme Borrell, Marius Ciutan, Giuseppe Costa, Irene Georgiou, Rafal Halik, Jens Hoebel, Katri Kilpeläinen, Theopisti Kyprianou, Tina Lesnik, Indre Petrauskaite, Annemarie Ruijsbroek, Silvia Gabriela Scintee, Milena Vasic and Gabriella Olsson

Int. J. Environ. Res. Public Health 2022, 19(13), 7663; https://doi.org/10.3390/ijerph19137663 - 23 Jun 2022

Cited by 6 | Viewed by 2322

Abstract

To raise awareness about health inequalities, a well-functioning health inequality monitoring system (HIMS) is crucial. Drawing on work conducted under the Joint Action Health Equity Europe, the aim of this paper is to illustrate the strengths and weaknesses in current health inequality monitoring based on lessons learned from 12 European countries and to discuss what can be done to strengthen their capacities. Fifty-five statements were used to collect information about the status of the capacities at different steps of the monitoring process. The results indicate that the preconditions for monitoring vary greatly between countries. The availability and quality of data are generally regarded as strong, as is the ability to disaggregate data by age and gender. Regarded as poorer is the ability to disaggregate data by socioeconomic factors, such as education and income, or by other measures of social position, such as ethnicity. Few countries have a proper health inequality monitoring strategy in place and, where in place, it is often regarded as poorly up to date with policymakers’ needs. These findings suggest that non-data-related issues might be overlooked aspects of health inequality monitoring. Structures for stakeholder involvement and communication that attracts attention from policymakers are examples of aspects that deserve more effort. Full article

(This article belongs to the Special Issue Reducing Health Inequities: Social Epidemiology Insights for Public Health and Social Policy)

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12 pages, 493 KiB

Open AccessArticle

Reclaiming Indigenous Health in the US: Moving beyond the Social Determinants of Health

by Stephanie Russo Carroll, Michele Suina, Mary Beth Jäger, Jessica Black, Stephen Cornell, Angela A. Gonzales, Miriam Jorgensen, Nancy Lynn Palmanteer-Holder, Jennifer S. De La Rosa and Nicolette I. Teufel-Shone

Int. J. Environ. Res. Public Health 2022, 19(12), 7495; https://doi.org/10.3390/ijerph19127495 - 18 Jun 2022

Cited by 23 | Viewed by 5803

Abstract

The lack of literature on Indigenous conceptions of health and the social determinants of health (SDH) for US Indigenous communities limits available information for Indigenous nations as they set policy and allocate resources to improve the health of their citizens. In 2015, eight scholars from tribal communities and mainstream educational institutions convened to examine: the limitations of applying the World Health Organization’s (WHO) SDH framework in Indigenous communities; Indigenizing the WHO SDH framework; and Indigenous conceptions of a healthy community. Participants critiqued the assumptions within the WHO SDH framework that did not cohere with Indigenous knowledges and epistemologies and created a schematic for conceptualizing health and categorizing its determinants. As Indigenous nations pursue a policy role in health and seek to improve the health and wellness of their nations’ citizens, definitions of Indigenous health and well-being should be community-driven and Indigenous-nation based. Policies and practices for Indigenous nations and Indigenous communities should reflect and arise from sovereignty and a comprehensive understanding of the nations and communities’ conceptions of health and its determinants beyond the SDH. Full article

(This article belongs to the Special Issue Reducing Health Inequities: Social Epidemiology Insights for Public Health and Social Policy)

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22 pages, 2262 KiB

Open AccessArticle

Efficiency Analysis in Brazil’s Sao Paulo State Local Unified Health System (SUS): From Gender-Ethnicity-Power Inequities to the Dissolution of Health Effectiveness

by Simone Schenkman, Aylene Bousquat and Maria Paula Ferreira

Int. J. Environ. Res. Public Health 2022, 19(5), 2990; https://doi.org/10.3390/ijerph19052990 - 4 Mar 2022

Cited by 2 | Viewed by 2250

Abstract

Health equity is cross sectioned by the reproduction of social relations of gender, ethnicity and power. The purpose of this article is to assess how intersectional health equity determines societal health levels, in a local efficiency analysis within Brazil’s Unified Health System (SUS), among Sao Paulo state municipalities. Fixed Panel Effects Model and Data Envelopment Analysis techniques were applied, according to resources, health production and intersectoral dimensions. The effect variables considered were expectation of life at birth and infant mortality rates, in 2000 and 2010, according to local health regions (HR) and regionalized healthcare networks (RRAS). Inequity was assessed both socioeconomically and culturally (income, education, ethnicity and gender). Both methods demonstrated that localities with higher inequities (income and education, gender and ethnicity oriented), associated or not to vulnerability (young and low-income families, in subnormal urban agglomerations), were the least efficient. Health production contributes too little to health levels, especially at the local level, which is highly correlated to the intersectoral dimension. Intersectional health equity, reinforced in its intertwining with ethnicity, gender and social position, is essential in order to achieve adequate societal health levels, beyond health access or sanitary and clinical efficacy. Full article

(This article belongs to the Special Issue Reducing Health Inequities: Social Epidemiology Insights for Public Health and Social Policy)

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13 pages, 8611 KiB

Open AccessArticle

Knowledge into the Practice against COVID-19: A Cross-Sectional Study from Ghana

by Prince Yeboah, Dennis Bomansang Daliri, Ahmad Yaman Abdin, Emmanuel Appiah-Brempong, Werner Pitsch, Anto Berko Panyin, Emmanuel Bentil Asare Adusei, Afraa Razouk, Muhammad Jawad Nasim and Claus Jacob

Int. J. Environ. Res. Public Health 2021, 18(24), 12902; https://doi.org/10.3390/ijerph182412902 - 7 Dec 2021

Cited by 10 | Viewed by 4921

Abstract

The COVID-19 pandemic has affected populations globally, including Ghana. Knowledge of the COVID-19 disease, and the application of preventive public health interventions are pivotal to its control. Besides a lockdown, measures taken against the spread of the virus include the wearing of face masks, social distancing, regular hand washing with soap and, more recently, vaccination against the virus. In order to establish a possible link between the knowledge of the disease and compliance with preventive measures, including vaccination, a cross-sectional study employing an interview-structured questionnaire was conducted in six regions of Ghana (n = 1560). An adequate level of knowledge of COVID-19 (69.9%) was reported. The linear multiple regression analysis further explicated the differences in the knowledge of COVID-19 among the respondents by their knowledge of cholera and influenza (adjusted R-Square = 0.643). Despite this profound knowledge of the illness, two thirds of the respondents were unwilling to follow basic preventive measures and only 35.3% were willing to be vaccinated. Amazingly, neither knowledge of COVID-19 nor the socio-demographic characteristics had any meaningful influence on the practice of preventive measures. Personal attitude leading to efficient public compliance with preventive measures, therefore, is a critical issue demanding special attention and effective interventions by the government and locals with authority to curb the spread of the pandemic which surpasses the traditional channels of public health communication. This includes a roll-out of persuasion, possibly including public figures and influencers, and in any case, a balanced and open discussion addressing the acceptance of the COVID-19 vaccine in order to avoid new variants and comparable problems currently facing many countries of Western Europe. Indeed, a profound hesitancy against vaccination may turn African countries such as Ghana for many years into hotspots of new viral variants. Full article

(This article belongs to the Special Issue Reducing Health Inequities: Social Epidemiology Insights for Public Health and Social Policy)

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14 pages, 960 KiB

Open AccessArticle

Investigating the Feasibility of a Restaurant Delivery Service to Improve Food Security among College Students Experiencing Marginal Food Security, a Head-to-Head Trial with Grocery Store Gift Cards

by Ryan J. Gamba, Lana Mariko Wood, Adianez Ampil, Alina Engelman, Juleen Lam, Michael T. Schmeltz, Maria M. Pritchard, Joshua Kier Adrian Santillan, Esteban S. Rivera, Nancy Ortiz, Darice Ingram, Kate Cheyne and Sarah Taylor

Int. J. Environ. Res. Public Health 2021, 18(18), 9680; https://doi.org/10.3390/ijerph18189680 - 14 Sep 2021

Cited by 6 | Viewed by 4269

Abstract

Restaurant delivery services have gained in popularity among college students; however, students participating in the Supplemental Nutrition Assistance Program (SNAP) are not allowed to redeem their benefits via restaurant delivery services. This mixed-methods head-to-head crossover trial assessed whether college students experiencing marginal food security prefer benefits via a grocery store gift card (as a proxy for traditional SNAP benefits) or via a restaurant delivery service gift card of equivalent value, and which type of benefit is more effective at improving food security status. Thirty college students experiencing marginal food security were recruited to receive $80 in cash equivalent benefits to spend over a two-month period in the form of grocery store gift cards and restaurant delivery service gift cards. Participants completed surveys and interviews to measure their food security status and share their experiences with each benefit type. After four months of benefits, 48.3% of participants improved their food security status. However, neither type of benefit was statistically better at improving food security status. Most participants preferred grocery store benefits (89.7%) over restaurant delivery service benefits (10.3%). However, more research is needed to explore whether allowing SNAP recipients to redeem their benefits with restaurant delivery services is a viable mechanism to address food challenges among college students experiencing marginal food security. Full article

(This article belongs to the Special Issue Reducing Health Inequities: Social Epidemiology Insights for Public Health and Social Policy)

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13 pages, 1723 KiB

Open AccessArticle

Food Insecurity and Eating Pathology in Adolescents

by Brittany H. Kim, Lisa Ranzenhofer, Jill Stadterman, Yvette G. Karvay and Natasha L. Burke

Int. J. Environ. Res. Public Health 2021, 18(17), 9155; https://doi.org/10.3390/ijerph18179155 - 30 Aug 2021

Cited by 16 | Viewed by 5242

Abstract

Adolescence is a critical period for the emergence of eating disorders, and food insecurity may be related to eating pathology and weight, as evidenced in adults. However, little is known about food insecurity and eating pathology during this developmental period, and associations between food insecurity and body mass index (BMI) are mixed. Therefore, we examined associations between food insecurity and BMI percentile, self-reported eating-related pathology and binge eating, and subgroup differences by race/ethnicity. In a subset, we examined the relationship between food insecurity and real-world hunger, food craving, and loss-of-control eating using ecological momentary assessment (EMA). Fifty-eight adolescents at two sites (clinical sample, n = 38, BMI percentile ≥ 70th; community sample, n = 20, all BMI strata) completed self-report questionnaires. Adolescents were 15.2 ± 2.1 years old, 62% female, 50% Black, 34.5% Hispanic, with BMI percentile = 80.5 ± 25.8 (range 4–99). In the full sample, food insecurity was associated with greater BMI (p < 0.01), higher shape/weight overvaluation (p = 0.04), and greater number of binge eating episodes among those reporting at least one binge episode (p < 0.01), with significant relationships for BMI percentile, shape/weight overvaluation, body dissatisfaction, and binge episode frequency among Hispanic adolescents only (each p < 0.01). As in adults, food insecurity may be a risk factor for eating pathology, particularly for Hispanic teens. Full article

(This article belongs to the Special Issue Reducing Health Inequities: Social Epidemiology Insights for Public Health and Social Policy)

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11 pages, 1316 KiB

Open AccessArticle

The Influence of Sociodemographic Heterogeneity on the Perceptions of COVID-19: A Countrywide Survey Study in the USA

by Pritish Mondal, Ankita Sinharoy, Binu-John Sankoorikal, Roopa Siddaiah, Lauren Mazur and Gavin Graff

Int. J. Environ. Res. Public Health 2021, 18(17), 8922; https://doi.org/10.3390/ijerph18178922 - 25 Aug 2021

Cited by 6 | Viewed by 3391

Abstract

Background: Sociodemographic factors such as age, race, education, family income, and sex have been reported to influence COVID-related perceptions, reflected by knowledge, stress, and preventive behavior. We conducted a US-based survey to estimate the difference in COVID-related perceptions among diverse sociodemographic groups and the influence of sociodemographic heterogeneity on COVID-related perceptions. Methods: The survey enquired about sociodemographic parameters and relevant information to measure knowledge, stress, and preventive behavior. COVID-perception scores among sociodemographic subgroups were compared with ANOVA (Bonferroni). The general linear model (GLM) was used to estimate the association among sociodemographic factors and COVID-related perceptions. Results: Females (75%) and White participants (78%) were the predominant (N = 3734). Females, White participants, wealthy, and educated participants demonstrated better knowledge, while participants of minority races, younger ages, low incomes, and females experienced high stress. Females, African-Americans, and educated participants better adopted preventive behaviors. Race, family income, and sex were the highest contributors to the predictive model. Sociodemographic determinants had statistically significant associations with knowledge (F-score = 7.72, p < 0.001; foremost predictor: race), stress (F-score = 16.46, p < 0.001; foremost predictor: income), and preventive behavior (GLM: F-score = 7.72, p < 0.001, foremost predictor: sex). Conclusion: Sociodemographic heterogeneity significantly influenced COVID-related perceptions, while race, family income, and sex were the strongest determinants of COVID-related perceptions. Full article

(This article belongs to the Special Issue Reducing Health Inequities: Social Epidemiology Insights for Public Health and Social Policy)

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11 pages, 508 KiB

Open AccessArticle

High School Composition and Health Outcomes in Adulthood: A Cohort Study

by Alison K. Cohen, Emily J. Ozer, David H. Rehkopf and Barbara Abrams

Int. J. Environ. Res. Public Health 2021, 18(7), 3799; https://doi.org/10.3390/ijerph18073799 - 6 Apr 2021

Cited by 2 | Viewed by 2947

Abstract

Background: A multitude of empirical evidence documents links between education and health, but this focuses primarily on educational attainment and not on characteristics of the school setting. Little is known about the extent to which aggregate characteristics of the school setting, such as student body demographics, are associated with adult health outcomes. Methods: We use the U.S. nationally representative National Longitudinal Survey of Youth 1979 cohort to statistically assess the association between two different measures of high school student composition (socioeconomic composition, racial/ethnic composition) and two different health outcomes at age 40 (self-rated health and obesity). Results: After adjusting for confounders, high school socioeconomic composition, but not racial/ethnic composition, was weakly associated with both obesity and worse self-rated health at age 40. However, after adding adult educational attainment to the model, only the association between high school socioeconomic composition and obesity remained statistically significant. Conclusions: Future research should explore possible mechanisms and also if findings are similar across other populations and in other school contexts. These results suggest that education policies that seek to break the link between socioeconomic composition and negative outcomes remain important but may have few spillover effects onto health. Full article

(This article belongs to the Special Issue Reducing Health Inequities: Social Epidemiology Insights for Public Health and Social Policy)

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9 pages, 305 KiB

Open AccessBrief Report

by Daniel Tzu-Hsuan Chen and Yi-Jen Wang

Int. J. Environ. Res. Public Health 2021, 18(3), 1014; https://doi.org/10.3390/ijerph18031014 - 24 Jan 2021

Cited by 30 | Viewed by 5711

Abstract

Background: Lower socioeconomic groups and disadvantaged populations across the world suffer disproportionately from the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to examine the impact of health- and social-inequality–related factors on well-being in order to further distinguish each of their effects during the pandemic. Methods: A nationally-representative sample of 5077 UK respondents aged 18 years or older was recruited through an online survey panel during the COVID-19 pandemic. Their subjective well-being was measured using the 11-point Cantril Ladder of Life Scale. The impact of inequality-related health and social factors (pre-existing medical conditions, household size and occupation), as well as COVID-19–related risk factors (symptoms, confirmed infections, and social distancing behaviours) on well-being were analysed using multiple linear regression models. The associations between the COVID-19–related risk factors and well-being according to the respondents’ household size and occupation were modelled in order to test the differences by their socioeconomic profile. Results: We identified inverted V-shaped associations between household size and subjective well-being during the COVID-19 pandemic. Compared to single-person households, respondents from households of two to four persons showed better well-being (β = 0.57; CI (0.44, 0.72)), whereas living in crowded households of five persons or more was associated with decreased well-being (β = −0.48; CI (−0.71, −0.25)). Furthermore, lower-skilled occupations (elementary occupations: β = −0.31; CI (−0.58, −0.03); logistics and transport services: β = −0.37; CI (−0.74, −0.01)) and chronic medical conditions (cardiometabolic or respiratory diseases: β = −0.25; CI (−0.41, −0.1); and mental health conditions: β = −1.12; CI (−1.28, −0.96)) were factors associated with reduced well-being during the pandemic. Interactions between a positive COVID-19 diagnosis, symptoms, and crowded households were identified (β = −0.95; CI (−1.76, −0.14) and β = −4.74; CI (−9.87, −1.61), respectively). Conclusions: In a national sample, the levels of general subjective well-being during the COVID-19 pandemic and lockdowns were disproportionately distributed across different groups within society. Preventive policies should explicitly focus on reaching lower socioeconomic groups; more emphasis should be placed on the coordination of multisectoral support in order to tackle existing health and social inequalities. Full article

(This article belongs to the Special Issue Reducing Health Inequities: Social Epidemiology Insights for Public Health and Social Policy)

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