No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Social determinants of health, universal health coverage, and sustainable development: Case studies from Latin American countries
Abstract
Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies.
... Despite variations in geographical and economic size, the study results indicate that the SDoH exerts a comparable impact on LE models in both Oman and Qatar. 89 The comparison showed that all relationships involving socioeconomic aspects (H 1 , H 2 , H 3 , H 4 , and H 5 ) exhibit strong and significant effects. Interestingly, both countries show that the total effect of HSR on LE is stronger than that of ME (H 3 ) or SD (H 5 ). ...
... This contrasts with previous research on LE in Bahrain. 3 Furthermore, in addition to being supported by other research, socioeconomic development proves to be more important than health-related factors in the long run. 89 This is confirmed through a comparison between the 2 countries, suggesting that policymakers should prioritize enhancing socioeconomic development to achieve positive long-term outcomes for LE. 89 Considering that both countries have a vision for transitioning from fossil fuels, economic diversification may strengthen the positive socioeconomic effect on LE. 41 While not undermining the importance of public health, it is understandable that a relatively stable and powerful socioeconomic capacity can guide the population toward better health choices even without intervention by the local authority. ...
... 89 This is confirmed through a comparison between the 2 countries, suggesting that policymakers should prioritize enhancing socioeconomic development to achieve positive long-term outcomes for LE. 89 Considering that both countries have a vision for transitioning from fossil fuels, economic diversification may strengthen the positive socioeconomic effect on LE. 41 While not undermining the importance of public health, it is understandable that a relatively stable and powerful socioeconomic capacity can guide the population toward better health choices even without intervention by the local authority. 89,90 As a lesson for the other GCC members, economic diversification and policies that can strengthen socioeconomic performance may elevate their rankings in terms of LE compared to other developed countries with higher LE. 90 When comparing the models of Oman and Qatar, Qatar showed a slightly stronger overall effect in terms of the influence of SD, ME, and HSR on LE. ...
In an era marked by a sweeping pandemic and the encroaching shadow of an energy crisis, the well-being and lifespan of global populations have become pressing concerns for every nation. This research zeroes in on life expectancy (LE), a powerful indicator of societal health in Oman and Qatar. Our study juxtaposes 3 key factors affecting LE: health status and resources (HSR), macroeconomics (ME), and sociodemographic (SD) factors. To achieve this, we tapped into a comprehensive data set from the World Bank, encompassing a transformative 3-decade span from 1990 to 2020. The intricate interplay between these factors and LE was deciphered through robust Structural Equation Modeling (SEM). Our findings construct a compelling narrative: ME has an indirect yet considerable influence on LE-manifesting with an effect of 0.602 for Oman and 0.676 for Qatar. This influence is mediated by SD and HSR components. Similarly, SD elements impact LE indirectly-with an effect of 0.653 for Oman and 0.759 for Qatar-this effect is mediated by HSR. In contrast, HSR themselves wield a robust and direct influence on LE, indicated by an effect of 0.839 for Oman and 0.904 for Qatar. All these aforementioned effects were statistically substantial (P < .001). Our research magnifies the robust direct influence of HSR on LE in both Oman and Qatar, simultaneously highlighting the noteworthy indirect role of ME and SD factors. This emphasizes the significance of adopting an integrated policy approach that considers all the SD, ME, and HSR factors to improve the population health in both countries, which are also crucial for promoting LE growth in the Gulf Cooperation Council region.
... In the Latin American context, these countries segregate the population into two groups within the health system: a suitable social security system for enough-income workers and a public system that serves the least favored and vulnerable people. This segregation has become a barrier to implementing the right to universal health care as it perpetuates the economic, social, and health inequality that characterizes Latin America [12,13]. For this reason, some countries have implemented measures to address the social determinants that generate inequalities; for example, poverty alleviation, support for disadvantaged children, and development of education and employability programs, among others [13]. ...
... This segregation has become a barrier to implementing the right to universal health care as it perpetuates the economic, social, and health inequality that characterizes Latin America [12,13]. For this reason, some countries have implemented measures to address the social determinants that generate inequalities; for example, poverty alleviation, support for disadvantaged children, and development of education and employability programs, among others [13]. Thus, studying social determinants becomes especially relevant to implement strategies that correct the challenges and ultimately contribute to the efficient implementation of UHC policies [5]. ...
... As for the migrant population, they are more likely not to access the GES both because of trust in the physician/facility and because of lack of knowledge or lack of information, consistent with previous findings that indicate that this group is disadvantaged in terms of health programs [10,20]. Critical to understanding this dichotomy, which, on the one hand, indicates that there is a capacity for saving or indebtedness to choose and, on the other hand, suggests a lack of information, is to understand the structural inequalities in Latin America [12,13]. ...
Introduction
The public policy called Explicit health guarantees (GES) could serve as a basis for the future implementation of universal health coverage in Chile. An improvement in the quality of health of the Chilean population has been observed since the launching of the GES, which has a high adherence (84% of the beneficiary population uses this health program). This work seeks the social determinants related to a portion of the remaining 16% of people who do not use the GES.
Methods
This secondary analysis study used a sample of GES recipients (n = 164,786) from the National Socioeconomic Characterization Survey (CASEN) 2020. The GES recipients included in the study responded that they had been under medical treatment for 20 of the 85 pathologies included in the GES, and they had not had access to such policy due to “trust in physician/facility,“ “decided not to wait,“ or “lack of information.” The CASEN survey chose the 20 pathologies. The Average Marginal Effects of social determinants of the non-use of the GES health plan were predicted using multivariable and panel multinomial probit regression analyses, where the outcome variable assumed three possible values (the three reasons for not accessing) while taking those variables reported in previous studies as independent variables.
Results
A higher probability of non-access due to distrust in the physician/facility among adults with higher economic income was found. Among those who prefer not to wait are vulnerable groups of people: women, people with a lower-middle income, those who belong to groups with longer waiting times, and ethnic groups. The people who least access the GES due to lack of information correspond to part of the migrant population and those belonging to the lowest income group.
Conclusions
The GES policy must necessarily improve the timeliness and quality of the services to make them attractive to groups that currently do not have access to them, managing waiting times rather than referrals and using patient-centered evaluations, especially in those most vulnerable groups that do not access GES because they choose not to wait or lack the necessary information, thereby improving their health literacy.
... Chile is notorious in Latin America as a country with comprehensive programs aimed at reducing poverty and increasing access to educational opportunities and health. For example, the program Chile Crece Contigo (Chile Grows with You) has been internationally recognized as a model intersectoral program for promoting universal health coverage and sustainable development (Molina Milman et al., 2018;Monteiro de Andrade et al., 2015). However, despite remarkable progress in the area of health promotion, there is extremely limited availability in the country of evidence-based PT prevention programs. ...
... The objective of the meeting was to bring together developers and cultural adapters of evidence-based PT interventions, as well as government and private sector leaders from Central and South America. According to Latin American presenters, even though remarkable success has been achieved in certain countries in the areas of health promotion, with Chile serving as a model country (Monteiro de Andrade et al., 2015), the dissemination of PT prevention programs in the Latin American context remains scarce. ...
... We consider that the foundation's leadership in all facets of this collaboration has been key to ensuring the contextual and cultural relevance of this initiative for the Chilean context. This collaboration resembles previous intersectoral research alliances in Chile that have resulted in large-scale health care promotion initiatives (Monteiro de Andrade et al., 2015). ...
Child exposure to maltreatment and neglect constitutes a significant public health problem throughout Latin American and Caribbean (LAC) countries. Although evidence‐based parent training (PT) interventions constitute an empirically demonstrated alternative to prevent child maltreatment and neglect, multiple implementation barriers have prevented the large‐scale dissemination of evidence‐based PT interventions across LAC countries. This selective prevention study consisted of an exploratory quasi‐experimental design implemented in Chile, aimed at examining the initial impact of a culturally adapted version of the evidence‐based PT intervention known as GenerationPMTO©. The parenting intervention was adapted in a previous pilot study, according to a rigorous model of cultural adaptation. Based on self‐reports completed by 281 caregivers, when compared to baseline measurements, significant improvements at intervention completion were observed in the majority of caregivers' parenting practices, as well as child internalizing and externalizing problematic behaviors. This study provides promising initial empirical evidence that efficacious PT interventions developed in the US can be transported to Latin American contexts, as long as they are thoroughly adapted to achieve high contextual and cultural relevance. The rates of child maltreatment across LAC countries constitute an urgent and permanent call for strongly promoting this line of prevention research.
... (8,9) Los DSS son especialmente importantes en los países de América Latina, que se caracterizan por disparidades socioeconómicas e inequidades en salud. (10,11) En la actualidad, el complejo panorama económico y político internacional ha dejado en evidencia el deficiente estado de los sistemas de salud en muchos países del mundo. (12) La región latinoamericana constituye un claro exponente de esa situación, a pesar de implementar políticas desarrollistas enfocadas al crecimiento económico sostenido a fin de obtener bienestar e incremento en la calidad de vida de las personas. ...
... (15) Con el propósito de reanimar la discusión sobre los determinantes a nivel mundial, la OMS creó en 2005 la Comisión sobre Determinantes Sociales de la Salud; esta analizaría la problemática y construiría a partir de aportes conceptuales una propuesta para alcanzar la equidad sanitaria en el mundo, pues la reducción de las inequidades en salud requerirá soluciones que aborden sus causas profundas. (3,10) El ya mencionado enfoque de los determinantes sociales de la salud reviste una serie de implicaciones conceptuales y metodológicas para su implementación. (13,16) La comisión de los DSS sirvió como instrumento unificador de las distintas corrientes que existían hasta aquel momento respecto al tema, al precisar la importancia del análisis de determinantes estructurales de la salud (DES) y determinantes intermedios de la salud (DIS) que condicionan el estado de salud de una población. ...
Introduction: In older adults, the social determinants of health directly influence the health-disease process; oral health is no exception. Objective: Determine the behavior of social determinants and oral health conditions in older adults. Methods: A descriptive cross-sectional study was carried out on 221 individuals aged 60 years and over from office 19, La Demajagua, in June 2024. Questioning and clinical examination of the oral cavity were used, with prior informed consent of the participants and caregivers. The variables studied were: age, sex, occupation, economic well-being, family functioning, housing conditions, eating habits and oral health conditions. Results: The most represented age group was 60 to 74 years old with 72,8 %, with a predominance of males. Only 32,6 % of older adults worked and 11,8 % had good oral health conditions. 56,1 % of those examined reported not having economic well-being, and 73,8 % presented a regular oral health condition. Dysfunctional families predominated in 56,6 %, 46,2 % living in homes with regular conditions and 58,8 % with inadequate eating habits. Conclusions: The unfavorable behavior of the analyzed determinants reveals their negative influence on the oral health condition of older adults.
... Studies, such as those conducted by Ulrich, demonstrate that elements like nature scenes, soothing music, and interactive art installations can significantly improve patient outcomes by lowering blood pressure, reducing the perception of pain, and improving overall mood. The implementation of positive distractions within healthcare settings has been shown to alleviate patients' stress and improve their mood, consequently promoting the process of recovery, although it can yield positive effects on the physical and mental health of individuals [5,22,28]. As a result, design processes can be modified to more effectively integrate positive distraction features that permit and calm occupants, as opposed to the outcomes produced by bare walls and small windows. ...
... Data were entered and statistically analyzed using the Statistical Package for the Social Sciences (IBM SPSS 28) software. An analysis of variance (ANOVA) was conducted to assess differences in perceptions across various demographic and work-related variables, including gender, age, working hours, length of service in the hospital, and department or unit. ...
In recent years, a broader perspective has viewed the use of therapeutic environments in healthcare, transforming the hospital’s environment into an energizing atmosphere that benefits both employees and patients. Scientists found that exposure to natural elements like nature scenes, sunlight, art, calming colors, and soothing sounds significantly sped up healing and created a more relaxed hospital environment. This research emphasized the importance of healthcare settings’ interior design in promoting patient well-being through beneficial distractions. The motivation for this investigation came from the need to develop an understanding of positive distractions in the cancer care environment and showed how this understanding could be used to enhance the space experience to promote health and well-being. This research adopted a mixed-methods approach. First, a qualitative method using a critical review of the literature was used to effectively present, analyze, and synthesize literature from diverse sources, followed by a quasi-experimental research method. This research is intended to focus on the attributes of positive distraction as one of the psychosocially and psychologically supportive healthcare design aspects that evoke positive feelings in children’s cancer center experiences.
... The Universal Health Coverage (UHC) is all about ensuring that all citizens have access to the quality health services they need with minimum contributions [20], which the South African NHI system tries to align with. According to [10], it can also ensure the availability of sufficient resources that are effective. ...
... The health sector on its own struggle to improve the quality and access to healthcare services, which negatively affect health of the citizens of the country. According to [20], this has prompted external stakeholders, such as the government and other sectors, to get involved in some countries. According to [38] lack of infrastructure can influence the effectiveness and efficiency of healthcare services delivered to the citizens. ...
... Along with other countries in Latin America and the Caribbean, Brazil has a long legacy of colonialism and persistent socioeconomic inequalities that have diminished during the last couple of decades (1)(2)(3). This improvement has been attributed to the establishment of cross-sector welfare policies, labor formalization, increasing education access and other distributive policies (1,3). ...
... Along with other countries in Latin America and the Caribbean, Brazil has a long legacy of colonialism and persistent socioeconomic inequalities that have diminished during the last couple of decades (1)(2)(3). This improvement has been attributed to the establishment of cross-sector welfare policies, labor formalization, increasing education access and other distributive policies (1,3). The welfare policies established after the country's redemocratization were strengthened during the first decade of the 2000s and include the creation of the SUS (Sistema Único de Saúde), a unified healthcare system based on the principles of universality, equity, integrality and social participation (4). ...
The disruption caused by the COVID-19 pandemic on health services around the world boosted interest over telehealth models of care. In Brazil, where abortion is heavily restricted, abortion seekers have long relied on international telehealth services to access abortion pills. We conducted a cross-sectional multilevel study to assess the effect of individual and contextual social factors on utilization of one such service. For the individual-level, we analyzed data from the records of abortion seekers contacting this feminist international telehealth organization during 2019 ( n = 25,920). Individual-level variables were age, race, education level and pregnancy length. Contextual-level units were states, for which we used data from the national Demographic Census and Household Surveys. Contextual-level variables were household income per capita, adjusted net school attendance rate, percentage of racialized women and income Gini Index. We fitted five multilevel Poisson Mixed-effects models with robust variance to estimate prevalence ratios (PR) of service utilization, which was defined as receiving abortion pills through the service. We found that only 8.2% of requesters got abortion pills through the service. Utilization was higher among women who were older, white, more educated and 5–8-weeks pregnant. Independently of this, service utilization was higher in states with higher income and education access, with lower proportions of racialized women, and located in the South, Southeast and Central-West regions. We concluded that while feminist telehealth abortion initiatives provide a life-saving service for some abortion seekers, they are not fully equipped to overcome entrenched social inequalities in their utilization, both at individual and contextual levels.
... Chile has achieved remarkable progress with regard to expanding health care services for underserved populations. For example, Chile Crece Contigo (i.e., Chile Grows with You, ChCC), constitutes an internationally recognized health promotion program focused on family health and well-being, family preservation, education, and community development (Monteiro de Andrade et al., 2015). ...
... The cultural relevance and linguistic appropriateness of intervention materials were also reviewed by the adapters of GenerationPMTO for Mexico City (Amador Buenabad et al., 2019) and Latino/a immigrant populations in Utah . This approach to co-leadership goes in line with a history of successful participatory research experiences in Chile, such as those related to the promotion of health care initiatives among underserved Chilean populations (Monteiro de Andrade et al., 2015). ...
The dissemination of evidence‐based parent training (PT) interventions remains extremely limited in Latin American countries. This is concerning when considering the high prevalence of child maltreatment associated with punitive parenting practices across countries in the region. Furthermore, efforts to disseminate PT interventions must be conducted by adhering to the core parenting components that have established effectiveness for such interventions, while ensuring contextual and cultural relevance for focus populations. In this manuscript, we describe the cultural adaptation of an evidence‐based PT intervention in the context of Chile. This initial phase of adaptation was informed by the theoretical tenets of the Ecological Validity Model of cultural adaptation (Bernal et al., J. Abnorm. Child Psychol., 23, 1995, 67). According to findings from a qualitative thematic analysis conducted with five interventionists in training, therapists perceived that the intervention's core components were relevant to Chilean caregivers who participated in the parenting program. Interventionists also provided specific suggestions to enhance the intervention's contextual and cultural relevance. This investigation illustrates the importance of culturally adapting evidence‐based interventions according to comprehensive cultural adaptation frameworks, prior to engaging in large‐scale dissemination of adapted interventions in Latin American contexts.
... This makes it difficult for families to consent to organ donation when their loved ones appear alive in intensive care units. This lack of awareness is especially problematic in low-and middleincome areas comprising most of Chile's population (de Andrade, 2015). Without adequate education and knowledge of complex medical concepts such as end-of-life decision-making and brain death, it can be challenging for individuals to comprehend and make informed decisions about organ donation. ...
Organ transplantation presents a promising opportunity to enhance quality of life and extend life expectancy in patients with end-stage chronic organ failure. Although the societal benefits of transplantation are clear, the shortage of organs donated in Latin America poses a significant barrier to accessing this life-saving treatment, resulting in high waitlist mortality rates and prolonged time on the waitlist. To address the problem of organ donation hesitancy, we thoroughly analyzed the behavioral factors by applying concepts from the Socioecological Model, the PRECEDE/PROCEDE framework, and Health Behavior Theories. We identified various personal, interpersonal, and community factors that may explain low donation rates and hinder the effectiveness of current strategies, highlighting the lack of information, the spread of myths about donation, the emotional burden for families, and the lack of sufficient human and technical resources. We propose a 10-step evidence-based intervention recommendation that involves focusing on increasing donation rates in the population, improving knowledge about donation and its process, preparing health professionals, developing strategies to promote donation with a focus on the young adult population, implementing specialized teams in transplants and the massification of preservation technologies. In summary, developing countries or countries with low organ donation rates must design evidence-based public policies. This article provides readily accessible information for the public, decision makers and relevant stakeholders.
... This shows the critical influence accrediting bodies have on the content of medical curricula. As the United Nations (UN) stated in 2015, low-and middle-income countries face triple the burden of health issues and, therefore, creating a well-trained healthcare force and robust health system performance will decrease social disparities [62,63]. ...
Background
The social determinants of health (SDH) play a key role in the health of individuals, communities, and populations. Academic institutions and clinical licensing bodies increasingly recognize the need for healthcare professionals to understand the importance of considering the SDH to engage with patients and manage their care effectively. However, incorporating relevant skills, knowledge, and attitudes relating to the SDH into curricula must be more consistent. This scoping review explores the integration of the SDH into graduate medical education training programs.
Methods
A systematic search was performed of PubMed, Ovid MEDLINE, ERIC, and Scopus databases for articles published between January 2010 and March 2023. A scoping review methodology was employed, and articles related to training in medical or surgical specialties for registrars and residents were included. Pilot programs, non-SDH-related programs, and studies published in languages other than English were excluded.
Results
The initial search produced 829 articles after removing duplicates. The total number of articles included in the review was 24. Most articles were from developed countries such as the USA (22), one from Canada, and only one from a low- and middle-income country, Kenya. The most highly represented discipline was pediatrics. Five papers explored the inclusion of SDH in internal medicine training, with the remaining articles covering family medicine, obstetrics, gynecology, or a combination of disciplines. Longitudinal programs are the most effective and frequently employed educational method regarding SDH in graduate training. Most programs utilize combined teaching methods and rely on participant surveys to evaluate their curriculum.
Conclusion
Applying standardized educational and evaluation strategies for SDH training programs can pose a challenge due to the diversity of the techniques reported in the literature. Exploring the most effective educational strategy in delivering these concepts and evaluating the downstream impacts on patient care, particularly in surgical and non-clinical specialties and low- and middle-income countries, can be essential in integrating and creating a sustainable healthcare force.
... These identities are based to a large degree on descent as well as physical characteristics [55]. Economic status appears to be a greater determinant of health than race in LATAM, but it may be that economic status is secondary to race or at least impacted by race [56]. Poverty is a greater social determinant of health in LATAM, but race may contribute to poverty [57]. ...
In “graying” populations with extended lifespans and survivable forms of cancer, palliative services become increasingly important but may be difficult to introduce into public discourse, public policy, and healthcare systems. Latin America (LATAM) faces many challenges as it introduces and, in some cases, develops its palliative care programs; though the challenges faced here are in many ways universal ones, LATAM approaches may be unique and based on the region’s specific culture, politics, and economics. This narrative review based on a literature search identified 10 main themes that can be interpreted as challenges and opportunities for palliative care in LATAM. These challenges are integrating palliation into healthcare systems; public policy and funding; therapeutic obstinacy; changing demographics; access to services; analgesia; the role of religion, spirituality, and folk medicine; social determinants of palliative care; low health literacy; and limited clinician training. Some of the LATAM nations have palliative programs and palliative care training in place while others are developing these systems. Integrating this care into existing healthcare and reimbursement systems has been a challenge. A notable challenge in LATAM is also access to care since palliative programs tend to cluster in metropolitan areas and create hardships for rural citizens to access them. The better-defined role of familial caregivers and telehealth may be important factors in the expansion of palliative care in LATAM and beyond.
... This makes it difficult for families to consent to organ donation when their loved ones appear alive in intensive care units. This lack of awareness is especially problematic in low-and middleincome areas comprising most of Chile's population (de Andrade, 2015). Without adequate education and knowledge of complex medical concepts such as end-of-life decision-making and brain death, it can be challenging for individuals to comprehend and make informed decisions about organ donation. ...
Organ transplantation presents a promising opportunity to enhance quality of life and extend life expectancy in patients with end-stage chronic organ failure. Although the societal benefits of transplantation are clear, the shortage of organs donated in Latin America poses a significant barrier to accessing this life-saving treatment, resulting in high waitlist mortality rates and prolonged time on the waitlist. To address the problem of organ donation hesitancy, we thoroughly analyzed the behavioral factors by applying concepts from the Socioecological Model, the PRECEDE/PROCEDE framework, and Health Behavior Theories. We identified various personal, interpersonal, and community factors that may explain low donation rates and hinder the effectiveness of current strategies, highlighting the lack of information, the spread of myths about donation, the emotional burden for families, and the lack of sufficient human and technical resources. We propose a 10-step evidence-based intervention recommendation that involves focusing on increasing donation rates in the population, improving knowledge about donation and its process, preparing health professionals, developing strategies to promote donation with a focus on the young adult population, implementing specialized teams in transplants and the massification of preservation technologies. In summary, developing countries or countries with low organ donation rates must design evidence-based public policies. This article provides readily accessible information for the public, decision makers and relevant stakeholders.
... The agency can then work to identify specific accelerators and with implementing ministries. Examples of this include Chile's Crece Contigo (ChCC) programme that provides 'a universal platform to support early child development for all [under-fives] and for all pregnant women' (de Andrade et al., 2015) through both targeted and universal benefits (Torres et al., 2018). The key ministries involved in ChCC are health, education and social development, with The Ministry of Social Development (MDS) as the co-ordinating body (Torres et al., 2018). ...
The multiple domains of development covered by the SDGs present a practical challenge for governments. This is particularly acute in highly resource-constrained settings which use a sector-by-sector approach to structure financing and prioritisation. One potentially under-prioritized solution is to implement interventions with the potential to simultaneously improve multiple outcomes across sectors, what UNDP refer to as development ‘accelerators’. An increasing number of accelerators are being identified in the literature. There are, however, challenges associated with the evaluation and implementation of accelerators. Firstly, as accelerators have multiple benefits, possibly in different sectors, they will be undervalued if priority setting is conducted sector-by-sector. Secondly, even if their value is recognised, accelerators may not be adopted if doing so clashes with any of the multiple competing interests policymakers consider, of which efficiency/social desirability is but one. To illustrate the first challenge, and outline a possible solution, we conduct a cost-effectiveness analysis comparing the implementation of three sector-specific interventions to an accelerator, first using a sector-by-sector planning perspective, then a whole of government approach. The case study demonstrates how evaluating the cost-effectiveness of interventions sector-by-sector can lead to sub-optimal efficiency rankings and overlook interventions that are efficient from a whole of government perspective. We then examine why recommendations based on a whole of government approach to evaluation are unlikely to be heeded. To overcome this second challenge, we outline a menu of existing and novel financing mechanisms which aim to address the mismatch between political incentives and logistical constraints in priority setting and the economic evaluation evidence for cost-effective accelerators. These approaches to financing accelerators have the potential to improve efficiency, and in doing so, progress towards the SDGs, by aligning political incentives more closely with recommendations based on efficiency rankings.
... Older adults with high levels of intrinsic capacity tend to have positive functional coping and higher levels of control over active lifestyle and health management, influencing their functional ability to some extent (Ma et al. 2021); In addition, studies have demonstrated that older adults living in rural areas have relatively lower levels of education, less social participation, and poorer levels of residential environment, transportation, and health services, which may have a negative impact on the cognitive abilities and social interactions of rural older adults, and are not conducive to promoting the performance of older adults' functions (Wu and Sheng 2018). Evidence from the research literature shows that health inequities emerge from factors such as environmental exposure that contribute to disease burden at both the individual and population levels (Andrade et al. 2015). Physical and social environments are associated with healthy lifestyles, preventive health care utilisation, chronic disease management, social support, social participation, etc., among older adults. ...
Ageing is an important global public health problem, while understanding and discussion of healthy ageing is diverse. The aim of this review is to analyze the concept, measurement, and determinants of healthy ageing from the perspective of functional ability based upon the World Health Organization framework for healthy ageing.
Eight databases, grey literature, and reference lists were searched from 2015 to 2022. Two reviewers independently screened and analyzed the available literature, and data from eligible studies were extracted. The concepts, determinants, and measurement indicators for healthy ageing were extracted from the included articles, and the World Health Organization International Classification of Functioning, Disability, and Health framework was applied to identify the domain related to the functional ability of older adults.
In conclusion, a total of 22 articles of literature were incorporated into this study. The concept of functional ability of older adults is varied, and the corresponding measurement indicators and measurement methods are also different. Multiple factors, including individual factors (demographic characteristics, intrinsic capacity, and health characteristics), social factors, and environmental factors, impact the functional ability of older adults.
Based on the available evidence, we identified three dimensions of the determinants of older adults' functional ability, including individual, social, and environmental factors, but the concept and measurement methods have not been standardized. In the future, it is necessary to develop a comprehensive evaluation system from the perspective of functional ability according to the conceptual framework of healthy ageing.
... The research design was that of conducting a case study, and in academia there has been a wellestablished history and practice of using the case study method as an investigative tool when conducting research into public health institutional 9,10 leadership .Case studies have been shown to be useful in elucidating multiple contextual factors and 11 in the interpretation of complex phenomena .This research was located within the theoretical framework of Health Policy and Systems Research 12 (HPSR) . This research examinedthe institutional 13,14 level or meso-level of the healthcare system , by investigating and interrogating the leadership of a public health institution that has been key to Zimbabwe's public health sector, being a central government hospital. ...
Introduction and Background: This paper presents a case study from Sally Mugabe Central Hospital; that examines the interactions of public health organisational leadership with its environment, within the context of Zimbabwe's unique social, economic and political circumstances. Objective: To investigate how the local context and local environment of Zimbabwe's unique social, economic and political situation have interacted with the leadership of Sally Mugabe Central Hospital as a Zimbabwean public health institution. Methods: A combination of semi-structured interviews and document analysis were used to conduct the research. Purposive sampling and expert sampling were used to select respondents for interviews. Content analysis of relevant administrative and management documents kept at the participating institution was carried out. This research is located within the theoretical framework of Health Policy and Systems Research (HPSR); and examines the institutional level or meso-level of the healthcare system. Results and Discussion: Research findings are discussed under subheadings that correspond to the interactions of social, economic and political factors with public health institutional leadership. Recommendations: Based on the research findings of this case study, recommendations are made on relevant and effective changes to practice, for the leadership of Zimbabwean public health institutions, recommendations that may have some applicability elsewhere as well, on the basis of lessons learnt. Conclusion: The problem of chronic underfunding; as well as the social, economic and political challenges that have been experienced at the institutional level in the Zimbabwean public health system; require innovative and adaptive public health leadership that can confront adversity in a complex environment.
... Besides people's socio-economic status and social stratification, political context determines people's access to resources and structural and functional aspects of a social system that influence health opportunities and vulnerabilities to NCDs (De Andrade et al. 2015). The policy decisions influenced by the political context to structure the society according to race, gender and age-based hierarchies during the South African apartheid government left enduring effects of differences in access to healthcare services and health outcomes between black and white people, and the rich and poor (Coovadia et al. 2009). ...
Background: The South African government has developed many policies for the prevention and control of non-communicable diseases. However, non-communicable diseases remain among the major causes of morbidity and mortality in South Africa. Although these diseases are linked to interaction of multiple risk factors, many of which are modifiable, they continue to cause much suffering particularly among the marginalised and people from the lower socio-economic status.
Objectives: The objective of this research was to explore and present the inclusion of social determinants of health in the policies meant for the prevention and control of non-communicable diseases in South Africa.
Method: The qualitative document analysis approach was used to conduct policy analysis of purposefully selected policies for prevention and control of cancers, obesity and mental and behavioural disorders in South Africa.
Results: The analysis revealed that policies for prevention and control of cancers, obesity and mental and behavioural disorders included policy intervention activities that focused on five social determinants of health: (1) governance, (2) social policies, (3) public policies, (4) material circumstances and (5) health system.
Conclusion: Excluding most of the important social determinants of health in the policies for prevention and control of non-communicable diseases means that these policies would continue to fail in preventing these diseases from the root causes.
Contribution: This article points out weaknesses in the policies meant for prevention and control of obesity, cancers and mental and behavioural disorders. This article further suggests policy improvement strategies that may be considered to effectively address these diseases.
... The role of living conditions (being richer) leads to a greater demand, coincides with what was found in India(22), and Latin America on determinants of health (23), although in Chile the probabilities are slightly higher to carry out preventive examinations than the poorest people(9); It already implies an important challenge to face, since it is a structural variable that implies solutions that go beyond health policies, and an opportunity to integrate it with other types of public actions. Likewise, belonging to a social group (ethnic group) with a Peruvian native language other than Quechua or Aymarain Peru there are 47 native languages including Quechua and Aymara(24)-, implies being in a population group with more barriers and little integration to the benefits achieved by society; thus this population, according to the estimated results, has a higher probability of no demand. ...
Introduction. The preventive services of health are very important like investment in the health of the people. If the secondary preventive services are examined to face the cervical cancer (CCU) in Peru, its access and demands are not equitable. In this article, the determining factors of the demand of services of Pap smear screening (services PAP) are identified and measured. Methods. One studied to a population of women of 30 to 49 years, with data of the Demographic Survey and of Family Health (ENDES) of years 2016 to 2019. A logistic model was used to explore the relationship between demand of services PAP and variables of decision, socioeconomics and of health of the people. The predictability of the model based on the machine learning was examined. Results. The factors with the greatest probability of demand PAP services were having hypertension (OR = 4.76; 95% CI: 4.03-5.66) and belonging to the "richest" socioeconomic stratum (OR = 3.39, 95% CI: 2.96-3.87). On the contrary, with less probability of demand they were, living in small cities (OR = 0.27; 95% CI: 0.24-0.30), in Villages (OR = 0.26; 95% CI: 0.23-0.30) and in the High Andean Saw. (OR = 0.46, 95% CI: 0.41-0.51). Conclusions. The structural factors, living conditions and place of residence are the main determinants of the demand for PAP preventive services in Peru, which implies greater efforts in health policy and the need to coordinate with other sectors.
... 16,17 Progress towards this healthy aging ideal is likely to be governed by access to health care, as well as social and economic driversthe inequalities of gender, income, education, race, ethnicity, and other social factors. 18 The extent to which longer lives are lived in good health or with illness is fundamentally important for health system planners, who must understand the healthcare implications of an aging population with potentially longer-term illness and complex multimorbidity. 19 In this analysis we summarize aging patterns across the Americas and explore to what extent aging offsets national efforts to reduce the burden of illhealth due to NCDs. ...
Background:
Public health progress in the Americas has reduced the burden of many infectious diseases, helping more people live longer lives. At the same time, the burden of non-communicable diseases (NCDs) is increasing. NCD prevention rightly focuses on lifestyle risk factors, social, and economic determinants of health. There is less published information on the importance of population growth and aging to the regional NCD burden.
Methods:
For 33 countries in the Americas, we used United Nations population data to describe rates of population growth and aging over two generations (1980-2060). We used World Health Organization estimates of mortality and disability (disability-adjusted life years, DALYs) to describe changes in the NCD burden between 2000 and 2019. After combining these data resources, we decomposed the change in the number of deaths and DALYs to estimate the percentage change due to population growth, due to population aging, and due to epidemiological advances, measured by changing mortality and DALY rates. In a supplement, we provide a summary briefing for each country.
Findings:
In 1980, the proportion of the regional population aged 70 and older was 4.6%. It rose to 7.8% by 2020 and is predicted to rise to 17.4% by 2060. Across the Americas, DALY rate reductions would have decreased the number of DALYs by 18% between 2000 and 2019 but was offset by a 28% increase due to population aging and a 22% increase due to population growth. Although the region enjoyed widespread reductions in rates of disability, these improvements have not been sufficiently large to offset the pressures of population growth and population aging.
Interpretation:
The region of the Americas is aging and the pace of this aging is predicted to increase. The demographic realities of population growth and population aging should be factored into healthcare planning, to understand their implications for the future NCD burden, the health system needs, and the readiness of governments and communities to respond to those needs.
Funding:
This work was funded in part by the Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health.
... Current models considered that successful networks of aligned interests were created by recruiting a sufficient body of allies and translating their interests into the thinking and acting that maintained the network (Bilodeau et al, 2019;Ceballos-Higuita & Otálvaro-Castro, 2021;Okeyo et al., 2020;Potvin et al., 2005). Likewise, Andrade et al. (2015) and Holt et al. (2018) found that abstract rhetoric could diffuse responsibility without priorities rather than directly addressing the challenges. ...
An integrated intersectoral care model promises to meet complex needs to promote early child development and address health determinants and inequities. Nevertheless, there is a lack of understanding of actors' interactions in producing intersectoral collaboration networks. The present study aimed to analyze the intersectoral collaboration in the social protection network involved in promoting early child growth and development in Brazilian municipalities. Underpinned by the tenets of actor-network theory, a case study was conducted with data produced from an educational intervention, entitled "Projeto Nascente." Through document analysis (ecomaps), participant observation (in Projeto Nascente seminars), and interviews (with municipal management representatives), our study explored and captured links among actors; controversies and resolution mechanisms; the presence of mediators and intermediaries; and an alignment of actors, resources, and support. The qualitative analysis of these materials identified three main themes: (1) agency fragility for intersectoral collaboration, (2) attempt to form networks, and (3) incorporation of fields of possibilities. Our findings revealed that intersectoral collaboration for promoting child growth and development is virtually non-existent or fragile, and local potential is missed or underused. These results emphasized the scarcity of action by mediators and intermediaries to promote enrollment processes to intersectoral collaboration. Likewise, existing controversies were not used as a mechanism for triggering changes. Our research supports the need to mobilize actors, resources, management, and communication tools that promote processes of interessement and enrollment in favor of intersectoral collaboration policies and practices for child development.
... Sachs [9], like Griggs [10], point to 6 goals and the United Nations to 17 [11]. The number of proposed indicators for assessing sustainable development ranges from the 56 mentioned by Hassini [12], to the 130 indicated by Andrada [13] and even the 220 indicated in the Rio Declaration [14]. Some authors link sustainable development to specific topics, such as 30 energy indicators as in the case of work Very and Langloisa [15]. ...
Energy security affects the functioning of countries politically, economically, and socially. Energy is an important factor in sustainable development efforts. Hence, countries are assessing their energy systems for compatibility with sustainable development goals by creating new concepts for energy development. Combining the concepts of energy security and sustainable energy consumption, an analysis of the differentiation of EU countries in terms of selected indicators indicated in Goal 7 of Agenda 2030 was carried out in dynamic terms. Two groups of indicators were distinguished. One group of indicators was selected to represent the changes in energy demand reported by final consumers, taking into account the use of energy obtained from renewable sources. The second group of indicators represents those relating to the security of supply of raw materials, i.e., energy dependency indicators broken down by major energy commodities and an energy productivity indicator. The analysis uses the coefficient of relative proximity of the facility to the ideal facility proposed in the TOPSIS method. The analyses carried out do not indicate that there is a relationship between the level of sustainable energy consumption and energy productivity or energy import dependency. A statistically significant correlation was observed between energy import dependency by oil and petroleum products and primary energy consumption, and between the share of renewable energy in gross final energy consumption and total energy import dependency.
... 1 The SDOH and their effects are well documented around the world. [2][3][4][5][6][7] The time to address health equity is now. This paper, aimed at neonatal clinicians, researchers and policy makers, summarises what we know regarding health equity in the neonatal intensive care unit (NICU) setting and provides a practical path towards improvement. ...
Differences in race/ethnicity, gender, income and other social factors have long been associated with disparities in health, illness and premature death. Although the terms ‘health differences’ and ‘health disparities’ are often used interchangeably, health disparities has recently been reserved to describe worse health in socially disadvantaged populations, particularly members of disadvantaged racial/ethnic groups and the poor within a racial/ethnic group. Infants receiving disparate care based on race/ethnicity, immigration status, language proficiency, or social class may be discomforting to healthcare workers who dedicate their lives to care for these patients. Recent literature, however, has documented differences in neonatal intensive care unit (NICU) care quality that have contributed to racial and ethnic differences in mortality and significant morbidity. We examine the within-NICU and between-NICU mechanisms of disparate care and recommend approaches to address these disparities.
Background
As intrinsic capacity (IC) declines, older adults are at a significantly increased risk of frailty, care dependency, and death. Currently, the research on IC among older adults in China was still insufficient. We aimed to identify the status quo and influencing factors among community-dwelling older adults in China and explore the relationship between IC, external environment, and social network.
Methods
A convenience sampling method was used to collect 312 older people from May 2023 to February 2024 in five communities in Chengdu, Sichuan Province. Data were collected using the general information questionnaire, Integrated Care of the Elderly (ICOPE) screening tool, World Health Organization Quality of live scale (WHOQOL-100), and Social Network Scale (LSNS-6).
Results
The IC score among Chinese community-dwelling older adults was 3.39 ± 1.60, and the prevalence of IC decline was 86.9%. Marital status, age, number of chronic diseases, social network, and external environment were influencing factors of IC, which explained 35.7% of the total variance. External environment and social network were positively correlated with IC.
Conclusions
Chinese community-dwelling older adults had low IC scores and a high prevalence of IC decline. The government should focus on IC for older adults, especially those who are older, not married or widowed, and suffering from multiple chronic diseases. In addition, the richer the external resources available to older adults, the more social support they received, and the better the IC. These findings could provide a theoretical basis for managing and improving IC in older adults.
Este livro, na forma de coletânea, é uma publicação pioneira que tem por objetivo servir de base de referência na formação de graduandos e pós-graduandos, além de professores, pesquisadores, gestores públicos e formadores de opinião, visando contribuir para a produção, a disseminação e o compartilhamento de conhecimentos em saúde, ambiente e sustentabilidade (SAS), voltados para o fortalecimento e a consolidação do Sistema Único de Saúde (SUS) e a promoção da saúde e da qualidade de vida da população brasileira.
One Health (OH) is an integrative approach to human, animal, and environmental health and can be used as a comprehensive indicator for comparative purposes. Although an OH index has been proposed for comparing cities, states, and countries, to date, no practical study has compared countries using this approach. Accordingly, this study aimed to assess OH initiatives using a survey with a veterinary public health focus. The questionnaire contained 104 quantitative questions and was sent to representatives of governmental institutions of 32 countries in the Americas. After exclusion criteria were considered, a total of 35 questionnaires from 17 countries were analyzed, with country names remaining undisclosed during the statistical analyses to protect potentially sensitive information. Principal component analysis (PCA) of health parameters in Latin America and the Caribbean (LAC) as a function of country perception (self-vector) showed that food safety was ranked higher than public policies (p = 0.009), and that both (p = 0.003) were ranked higher than institutional routines related to zoonosis programs. National policies in accordance with international standards, regulations, recommendations, and guidelines was considered the standout topic for public policy, with higher-ranking topics including standard. Meanwhile, challenging topics included tools, preparedness, governance, and research. Food safety showed both strengths and challenges in the coordination of its activities with other sectors. Food safety communication was scored as a strength, while foodborne diseases prevention was ranked as a challenge. Institutional routines for zoonosis maintained both strong and challenging topics in the execution and implementation of attributions and daily routine. Thus, the survey showed that topics such as access to and compliance with international guidelines and intercountry integration were ranked higher than in-country articulation, particularly among food safety, zoonoses, and environmental institutions.
A significant number of studies on program evaluations in Latin America have limited, if any, information on procedures, impact, and sustainability. Scholarly work emphasizes how evaluation designs must be deeply cognizant of socioeconomic, ecological, and resource contexts to be effective. The purpose of this article is to bring together research findings from three types of knowledge centered on evaluation processes and practices for working within Latin American countries. A scan of the empirical literature, expert interviews, and a case study are triangulated to assess the barriers and impacts of program evaluations in economically disadvantaged Latin American countries. We conclude by describing long‐standing principles and guidelines for evaluation procedures to promote community engagement and human capital development in all evaluation collaborations. Lessons learned reinforce the tenets of culturally responsive evaluation (CRE) procedures as critical to reproduce interventions that improve the lives of communities. Equity, contextual knowledge, and equal partnership are driving forces in centering social problems and developing human capital and the betterment of community conditions in our partnering countries.
Background
There is a dearth of research combining geographical big data on medical resource allocation and growth with various statistical data. Given the recent achievements of China in economic development and healthcare, this study takes China as an example to investigate the dynamic geographical distribution patterns of medical resources, utilizing data on healthcare resources from 290 cities in China, as well as economic and population-related data. The study aims to examine the correlation between economic growth and spatial distribution of medical resources, with the ultimate goal of providing evidence for promoting global health equity.
Methods
The data used in this study was sourced from the China City Statistical Yearbook from 2001 to 2020. Two indicators were employed to measure medical resources: the number of doctors per million population and the number of hospital and clinic beds per million population. We employed dynamic convergence model and fixed-effects model to examine the correlation between economic growth and the spatial distribution of medical resources. Ordinary least squares (OLS) were used to estimate the β values of the samples.
Results
The average GDP for all city samples across all years was 36,019.31 ± 32,029.36, with an average of 2016.31 ± 1104.16 doctors per million people, and an average of 5986.2 ± 6801.67 hospital beds per million people. In the eastern cities, the average GDP for all city samples was 47,672.71 ± 37,850.77, with an average of 2264.58 ± 1288.89 doctors per million people, and an average of 3998.92 ± 1896.49 hospital beds per million people. Cities with initially low medical resources experienced faster growth (all β < 0, P < 0.001). The long-term convergence rate of the geographic distribution of medical resources in China was higher than the short-term convergence rate (|βi + 1| > |βi|, i = 1, 2, 3, …, 9, all β < 0, P < 0.001), and the convergence speed of doctor density exceeded that of bed density (bed: |βi| >doc: |βi|, i = 3, 4, 5, …, 10, P < 0.001). Economic growth significantly affected the convergence speed of medical resources, and this effect was nonlinear (doc: βi < 0, i = 1, 2, 3, …, 9, P < 0.05; bed: βi < 0, i = 1, 2, 3, …, 10, P < 0.01). The heterogeneity between provinces had a notable impact on the convergence of medical resources.
Conclusions
The experiences of China have provided significant insights for nations worldwide. Governments and institutions in all countries worldwide, should actively undertake measures to actively reduce health inequalities. This includes enhancing healthcare standards in impoverished regions, addressing issues of unequal distribution, and emphasizing the examination of social determinants of health within the domain of public health research.
Aging is a complex multidimensional, progressive remodeling process affecting multiple organ systems. While many studies have focused on studying aging across multiple organs, assessment of the contribution of individual organs to overall aging processes is a cutting-edge issue. An organ's biological age might influence the aging of other organs, revealing a multiorgan aging network. Recent data demonstrated a similar yet asynchronous inter-organs and inter-individuals progression of aging, thereby providing a foundation to track sources of declining health in old age. The integration of multiple omics with common clinical parameters through artificial intelligence has allowed the building of organ-specific aging clocks, which can predict the development of specific age-related diseases at high resolution. The peculiar individual aging-trajectory, referred to as ageotype, might provide a novel tool for a personalized anti-aging, preventive medicine. Here, we review data relative to biological aging clocks and omics-based data, suggesting different organ-specific aging rates. Additional research on longitudinal data, including young subjects and analyzing sex-related differences, should be encouraged to apply ageotyping analysis for preventive purposes in clinical practice.
Colonialism’s enduring impact on Brazil has had significant implications for health and oncology outcomes. This historical essay delves into the profound changes brought about by the transatlantic slave trade from Africa to the Americas, particularly in terms of its influence on the economy, sociocultural habits, and health outcomes. This essay explores the enduring connections between the colonial period’s operational dynamics in Brazil and the current epidemiological panorama of head and neck cancer (HNC). The examination provides original insights on the role of tobacco and alcohol production and consumption, alongside the investigation of structural racism, which contributes to disparities in access to diagnosis, treatment, and prognosis for patients with HNC. This article presents novel visions and an analysis of evidence-based strategies to disrupt the adverse impact of colonialism’s legacy on the epidemiology of HNC in Brazil.
Após a institucionalização da saúde com a criação do Sistema Único de Saúde (SUS), na Constituição Federal de 1988, o atendimento gratuito e integral passou a ser objetivo principal do atendimento à saúde, abrangendo desde a consulta até a entrega de medicamentos à população atendida. O Amazonas, por ser uma região extremamente peculiar pela sua localização e heterogeneidade, que tem como sua característica marcante, ter como principal via, a hidroviária, encontra dificuldades no cumprimento de tal objetivo, principalmente no que se refere a distribuição medicamentosa, por questões logísticas e pela quantidade de itens necessários para suprir a demanda, dificultando a integralidade do atendimento.
Link to open access full text PDF:
https://www.sciencedirect.com/science/article/pii/S2666560323000968?via%3Dihub
Background
There is a growing evidence base which shows that community development can make an important contribution to reducing health inequalities, but embedding community development as a mainstream approach into local systems is challenging. The literature relevant to the question of how to embed community development approaches is reviewed in this paper.
Methods
Using guidance from the Joanna Briggs Institute, a scoping review was carried out to identify relevant literature. Systematic searches were carried out across multiple databases, experts in the field were contacted and references of included studies were screened. Search results were screened against exclusion criteria. The Consolidated Framework for Implementation Research was used as a framework to identify factors hindering or supporting embedding.
Findings
The review identified thirty-five documents which described embedded, or attempts to embed, community development approaches in fourteen different countries. The most common community development approaches were strength-based or co-production. Four studies reported primary research on the embedding process or systems change. Several barriers and facilitators to embedding were identified including those related to funding arrangements, organizational and system culture, building trust with communities and the need for training and support for staff.
Conclusion
Using an implementation science framework, this scoping review has assessed the nature of the evidence base on how to embed community development. While the evidence base uncovered is currently limited, barriers and facilitators to embedding identified in the review can be used to both inform future attempts to embed community development and provide the building blocks for future primary research.
This article provides a description of integrated primary healthcare strategies in five Latin American countries to assess options for the implementation of a healthcare system based on Primary Care. Based on a document review of scientific articles and official documents from multilateral organisations, ministries, or health entities, it was possible to synthesise the Primary Health Care strategies that had been implemented to derive the main proposals that were potentially transferable. Argentina, Chile, Colombia, and Mexico have Primary Health Care actions aimed at promoting health and preventing diseases; Cuba is highlighted as a reference because of its family health model. The main difficulties are from healthcare system based on the neoliberal model and segmentation and fragmentation of healthcare services.This study provides important aspects of Primary Health Care, in terms of the need to revitalise with a family and community approach, integrating health services at three levels of primary prevention, intersectoral factors, community empowerment, resource allocation and training in human skills, as well as strengthening mental health and sexual health programmes. It concludes with suggestions for a more integrated Primary Health Care based on the strategies implemented and the local needs of the countries under study.
Achieving sustainable rural development is essential for countries worldwide to balance development between urban and rural areas; especially, sustainable social development is crucial. In the face of rapid urbanization in China, the withdrawal of rural homesteads (WRH) has become the core policy for attaining sustainable rural development. Compared with the literature that focuses on the economic or environmental impacts of the policy, few studies have evaluated how social sustainability is accomplished through such land-reform policies. Given the consensus that exploring sustainability emphasizes complex causal relationships between multiple dimensions, assessment models must further consider interdependencies. Based on Chinese expertise and perspective, this study proposes a hybrid multi-attribute decision analysis model to evaluate the contribution of WRH policies toward social sustainability. First, the Delphi method was used to build evaluation criteria covering four dimensions—the socio-ecological environment, social welfare, social equity, and social inclusion—and 20 criteria were based on the existing literature. Second, influential network relations maps (INRMs) were constructed based on the fuzzy decision-making trial and evaluation laboratory (DEMATEL), considering complex causal relationships between dimensions and criteria to further identify the key evaluation criteria for the social sustainability of the homestead exit policy. The results show that the five subdimensions are key to achieving sustainable social development through WRH. Based on our results, we propose certain policy recommendations.
The World Health Organization (WHO) defines the Social Determinants of Health (SDOH) as the non-medical factors influencing health outcomes. SDOH is associated with conditions in which people are born, grow, work, and live. Medical schools and licensing bodies are increasingly recognizing the need for doctors and healthcare professionals to be aware of their patient's social context and how it impacts their states of health and disease. However, there is considerable variation in the approaches of different institutions and countries to incorporating SDOH into their curricula. In order to allow clinicians to adopt a holistic approach to patient health, equipping them with extensive knowledge of SDOH would give learners the confidence, skills, knowledge, and attitudes needed to effectively engage with patients and their families . This approach aids health professionals with knowledge of the influence of the social context and cultural factors that affect patients' behaviors in relation to health. Incorporating the SDOH in medical and health professional school curricula would contribute towards adequately preparing future healthcare practitioners to provide effective, comprehensive, and equitable care, especially to marginalized and underserved populations. The Guide will take an evidence-based approach grounded in the available contemporary literature and case studies. The focus will be on integrating SDOH into undergraduate and postgraduate medical curricula to promote an understanding of the social factors that influence patients' and communities' health. Ultimately, this guide seeks to contribute to the reduction of inequalities in health.
Scholars and practitioners have described how investing in health care earlier rather than later can be beneficial, from how "biomarkers" offer promise for early disease detection to healthcare system "incentives" that can promote early preventive medicine. Work by health economists has also made clear that the "health capital" of an individual depreciates over time in the absence of investments in health. Yet, our current policy makers and healthcare system continue prioritizing care of late-stage complex symptomatic illness, often when cure is impossible and disease reversal is improbable, thus exacerbating public health burdens. Critically missing are predicates to address this challenge include the following: first, identifying and validating the specific set of presymptomatic biomarkers that will inform the most appropriate intervention timing for those medical conditions amenable to early intervention; second, shifting fundamental health economic incentives to influence the appropriate disease prevention market; and third, formulating and executing a viable economic framework of reimbursement. We examine these predicates and propose actionable policy recommendations that may help align stakeholder interests to improve public health.
Background
Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems.
Methods
We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley’s realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level).
Results
A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals’ social determinants of health.
Conclusion
Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health.
2023 marks the 20-year anniversary of the creation of Mexico's System of Social Protection for Health and the Seguro Popular, a model for the global quest to achieve universal health coverage through health system reform. We analyse the success and challenges after 2012, the consequences of reform ageing, and the unique coincidence of systemic reorganisation during the COVID-19 pandemic to identify strategies for health system disaster preparedness. We document that population health and financial protection improved as the Seguro Popular aged, despite erosion of the budget and absent needed reforms. The Seguro Popular closed in January, 2020, and Mexico embarked on a complex, extensive health system reorganisation. We posit that dismantling the Seguro Popular while trying to establish a new programme in 2020–21 made the Mexican health system more vulnerable in the worst pandemic period and shows the precariousness of evidence-based policy making to political polarisation and populism. Reforms should be designed to be flexible yet insulated from political volatility and constructed and managed to be structurally permeable and adaptable to new evidence to face changing health needs. Simultaneously, health systems should be grounded to withstand systemic shocks of politics and natural disasters.
“Leaving no one behind” is the fundamental objective of the 2030 Agenda for Sustainable Development. Latin America and the Caribbean is marked by social inequalities, whilst its total population is projected to increase to almost 760 million by 2050. In this context, contemporary and spatially detailed datasets that accurately capture the distribution of residential population are critical to appropriately inform and support environmental, health, and developmental applications at subnational levels. Existing datasets are under-utilised by governments due to the non-alignment with their own statistics. Therefore, official statistics at the finest level of administrative units available have been implemented to construct an open-access repository of high-resolution gridded population datasets for 40 countries in Latin American and the Caribbean. These datasets are detailed here, alongside the ‘top-down’ approach and methods to generate and validate them. Population distribution datasets for each country were created at a resolution of 3 arc-seconds (approximately 100 m at the equator), and are all available from the WorldPop Data Repository.
Background:
Barriers to neurosurgery training and practice in Latin American and Caribbean countries (LACs) have been scarcely documented. The World Federation of Neurosurgical Societies Young Neurosurgeons Forum (YNF) survey sought to identify young neurosurgeons' needs, roles, and challenges. We present the results focused on Latin America and the Caribbean.
Methods:
In this cross-sectional study, we analyzed the YNF survey responses from LACs, following online survey dissemination through personal contacts, social media, and neurosurgical societies' emailing lists between April and November 2018. Data analysis was performed using Jamovi version 2.0 and STATA version 16.
Results:
There were 91 respondents from LACs. 3 (3.3%) respondents practiced in High-Income Countries, 77 (84.6%) in Upper Middle-Income Countries, 10 (11%) in Lower Middle-Income Countries, and 1 (1.1%) in an unclassified country. 77 (84.6%) of respondents were male, and 71 (90.2%) were under 40. Access to basic imaging modalities was high, with access to computed tomography (CT) scan universal among the survey respondents. However, only 25 (27.5%) of respondents reported having access to imaging guidance systems (navigation), and 73 (80.2%) reported having access to high-speed drills. A high GDP per capita was associated with increased availability of high-speed drills and more time dedicated to educational endeavors in neurosurgery, such as didactic teaching and topic presentation (p< 0.05).
Conclusions:
This survey found that neurosurgery trainees and practitioners of Latin America and the Caribbean face many barriers to practice. These include inadequate state-of-the-art neurosurgical equipment, a lack of standardized training curricula, few research opportunities, and long working hours.
Background: Due to rapid socioeconomic development and epidemiological transition, socioeconomic inequality of underweight, overweight, and obesity are becoming a public health concern in Bangladesh. There is a need for country-specific evidence of nutrition inequalities in Bangladesh. Aim: The aim of the study was to measure socioeconomic inequality and decomposition analysis along with the sex differences in underweight, overweight, and obesity among the adult population. Methods: A secondary data analysis was performed in the Bangladesh Demographic and Health Survey (BDHS) 2017-18, a cross-sectional survey used a multi-stage cluster sampling technique. Sociodemographic variables including age, sex, education, socioeconomic status, marital status, and anthropometric data of height and weight were considered for analysis. Body mass index was used for defining underweight, overweight, and obesity. Concentration index (CI) and decomposition analysis were performed for underweight, overweight, and obesity. Results: The proportion of underweight was 15.0%, overweight (23.0%), and obese (5.0%). Underweight was higher in males, whereas overweight and obesity were higher in females. The CI of underweight was -0.121 (p < 0.001), indicating socioeconomic inequality concentrated on lowering socioeconomic status; living in rural areas contributed 14.2% to this inequality. The CI of overweight and obesity was 0.213 (p < 0.001) and 0.142 (p < 0.001), respectively, indicating that inequalities of overweight and obesity concentrated in higher socioeconomic status; urban residency contributed 14.1% and 18.0% to socioeconomic inequality of overweight and obesity. Conclusion: Underweight remains a significant problem for poor people in rural areas, but overweight and obesity were highly prevalent in the higher socioeconomic status of urban areas. Education level and young age group significantly contribute to the socioeconomic inequality of malnutrition. A more detailed epidemiological study is required to understand the causes of socioeconomic disparities of nutritional status in Bangladesh.
Social determinants of health (SDoH) play an essential role in the risk of developing diseases or medical disorders. Conducting a comprehensive retrospective analysis is necessary to better understand the development status, research hotspots, and development trends of SDoH research. The bibliometric analysis method is applied based on CiteSpace and VOS viewer to quantitatively analyze and visually review the articles published in the field of SDoH from Web of Science core databases from 2000 to 2021. We quantitatively analyzed the author, institution, and other basic information to probe the development of SDoH and then visually investigated the high-frequency keywords, burst keywords, and keyword clusters to understand better the evolution of hotspots and development directions of SDoH during the study period. Health inequality is the main keyword of the SDoH field, and disease burden is expected to maintain a hotspot in recent years. Further, research methodologies could be improved to explain how upstream SDoH influences human lived experience. Additionally, the SDoH field needs to utilize the horizons of the multidisciplinary approach to consider and discuss sustainable development issues to offer implications for health improvement policy and interventions.
Resumen La participación en salud ha generado una gran cantidad de publicaciones alrededor del mundo. Para conocer las especificidades de esta producción en las Américas, se realizó un análisis bibliométrico de artículos en inglés, español y portugués. Se realizaron búsquedas en la BVS, Pubmed, SCOPUS, WOS y SciELO, consolidando una base de datos con 641 referencias. Con la ayuda del software VOSviewer, analizamos los patrones de citación, la coautoría y la distribución cronológica por países e idiomas. Se pudo verificar el crecimiento de la producción, la relevancia cuantitativa y el impacto de los diferentes países. El análisis indicó que EE.UU. concentra el mayor número de citas y Brasil, a pesar de ser el primero en número de publicaciones, es el tercero en número de citas. En los diez artículos más citados se descartan trabajos desarrollados en EE.UU. y Canadá. El análisis de coautoría indicó que la Universidad de Toronto, Fiocruz y la Universidad de Harvard tienen las colaboraciones más formales con otras organizaciones. Concluimos que existen desigualdades de impacto, visibilidad e internacionalización en este campo, indicando obstáculos para el desarrollo científico y las políticas de salud.
Resumo A participação em saúde tem gerado um grande número de publicações em todo o mundo. Para conhecer as especificidades dessa produção nas Américas, foi realizada uma análise bibliométrica de artigos em inglês, espanhol e português. Foram realizadas buscas na BVS, PubMed, SCOPUS, WOS e SciELO, consolidando uma base de dados com 641 referências. Com auxílio do software VOSviewer, analisamos padrões de citação, coautoria e a distribuição cronológica por países e idiomas. Foi possível verificar o crescimento da produção, a relevância quantitativa e o impacto dos diferentes países. A análise indicou que os EUA concentram o maior número de citações, e o Brasil, apesar de ser o primeiro em número de publicações, é o terceiro em número de citações. O mesmo ocorre com os periódicos brasileiros que, com o maior número de artigos, caem no ranking dos mais citados. Nos dez artigos mais citados, descatam-se trabalhos desenvolvidos nos EUA e Canadá. A análise de coautoria indicou que a Universidade de Toronto, a Fiocruz e a Universidade de Harvard são as que mais têm colaborações formais com outras organizações. Concluímos que existem desigualdades de impacto, visibilidade e internacionalização neste campo, indicando obstáculos para o desenvolvimento científico e das políticas de saúde.
Participation in health has generated a large number of publications around the world. In order to know the specificities of this production in the Americas, a bibliometric analysis of articles in English, Spanish and Portuguese was carried out. Searches were carried out in the VHL, PubMed, SCOPUS, WOS and SciELO, consolidating a database with 641 references. With the help of the VOSviewer software, we analyzed citation patterns, co-authorship and the chronological distribution by countries and languages. It was possible to verify the growth of production, the quantitative relevance and the impact of the different countries. The analysis indicated that the USA concentrates the largest number of citations and Brazil, despite being the first in number of publications, is the third in number of citations. The same occurs with Brazilian journals that, with the largest number of articles, fall in the ranking of the most cited. The co-authorship analysis indicated that the University of Toronto, Fiocruz and Harvard University have the most formal collaborations with other organizations. We conclude that there are inequalities of impact, visibility and internationalization in this field, indicating obstacles to scientific development and health policies.
Background:
In this manuscript, we aim to systematically estimate the pooled prevalence and incidence of primary headaches and its subtypes (migraine, tension-type headache, and chronic headaches) in Latin America and the Caribbean, describing its epidemiological profile and associated factors.
Methods:
We systematically searched PubMed/MEDLINE, Scopus, and LILACS (From conception to March 2021), for populational studies reporting the epidemiology of primary headaches and their associated factors in Latin America and the Caribbean. The data extraction was conducted independently. We performed random-effect model meta-analysis of prevalence (overall primary headaches and by subtypes) and associated factors, assessed potential sources of heterogeneity, the risk of bias, publication bias, and the evidence certainty (GRADE methodology).
Results:
We included 32 populational studies (38 subpopulations, n = 63,813). The prevalence of primary headaches was 41.4% (95% CI 31.1-52.2%; n = 54,357), 15% for migraine (95% CI 12.0-18.3; n = 53,658 individuals), 20.6% for tension-type headache (95% CI 12.4-30.2; n = 25,840), and 6% for chronic headaches (95% CI 3.3-9.6; n = 21,720), with high between-study heterogeneity. No incidence data was found. Female sex, white ethnicity, high BMI, comorbid mental health disorders, and low-back pain were associated with higher prevalence of primary headaches. The prevalence was less in rural areas.
Conclusion:
In Latin America and the Caribbean, primary headaches are highly prevalent affecting young females disproportionally. The prevalence of chronic headaches is higher than in other systematic global and regional estimations. The presence of comorbidities as modifiable risk factors should encourage their integration as targets for community-based preventive and therapeutic interventions.
Protocol registration number:
CRD42018105116.
Parent training (PT) interventions constitute an empirically demonstrated alternative to promote effective parenting practices and prevent child behavioral and mental health problems. However, the dissemination of evidence‐based PT interventions across Latin America remains scarce. This qualitative study had the primary objective of evaluating the level of acceptability of a culturally adapted version of the PT intervention known as GenerationPMTO©, adapted for the Chilean context. According to qualitative reports provided by 24 Chilean caregivers exposed to the culturally adapted parenting intervention, the intervention was perceived by caregivers as useful for their parenting practices, as well as contextually and culturally relevant. Current qualitative findings indicate that the culturally adapted PT intervention holds promise for larger dissemination in the Chilean context.
Background
To achieve improved outcomes for children and adolescents with disabilities, it is central to have universal health coverage (UHC) and universal access to education. This study investigates whether a disability-targeted cash transfer (CT) program is associated with improved access to healthcare and education for children and adolescents with disabilities.
Methods
We used nationwide survey data of two million children and adolescents living with disabilities, who aged 8–15 years when entering the cohort between January 1, 2015, and December 31, 2019. With a quasi-experimental study design, we compared the outcomes between CT beneficiaries who newly received CT benefits during the study period and non-beneficiaries who were disabled but never received CT using logistic regressions after propensity score matching with a 1:1 ratio. Outcomes of interest were utilization of rehabilitation services in the past year, medical treatment if the individual had illness in the past two weeks, school attendance if not in school at the start of the study, and reported financial hardship to access these services.
Findings
Of the total cohort, 368,595 children and adolescents fit the inclusion criteria, including 157,707 new CT beneficiaries and 210,888 non-beneficiaries. After matching, CT beneficiaries showed 2.27 (95% confidence interval [CI]: 2.23, 2.31) higher odds of utilizing rehabilitation services and 1.34 (95% CI: 1.23, 1.46) higher odds of getting medical treatment compared to non-beneficiaries. CT benefits were also significantly associated with less report of financial barrier to access rehabilitation services (odds ratio [OR]: 0.63, 95% CI: 0.60, 0.66) and medical treatment (OR: 0.66, 95% CI: 0.57, 0.78). Moreover, CT program was associated with higher odds of school attendance (OR: 1.99, 95% CI: 1.85, 2.15) and lower odds of reporting financial difficult to access education (OR: 0.41, 95% CI: 0.36, 0.47).
Interpretation
Our results suggest that the receipt of CT was associated with improved access to health and educational resources. This finding provides supporting evidence for the identification of efficient and feasible interventions to move toward UHC and universal education under the Sustainable Development Goals.
Funding
This research was supported by Sanming Project of Medicine in Shenzhen (NO.SZSM202111001), China National Natural Science Foundation (Grant/Award Number: 72274104, 71904099) and Tsinghua University Spring Breeze Fund (20213080028).
Introduction:
Latin America has the second-highest adolescent birth rate (ABR) worldwide. Variation between urban and rural areas and evidence linking country development to ABR points towards upstream factors in the causal pathway. We investigated variation in ABR within and between cities, and whether different features of urban social environments are associated with ABR.
Methods:
We included 363 cities in 9 Latin American countries. We collected data on social environment at country, city and subcity levels and birth rates among adolescents (ages 15-19). We investigated variation in ABR within and between countries and cities along with associations between social environment and ABR by fitting three-level negative binomial models (subcities nested within cities nested within countries).
Results:
The median subcity ABR was 58.5 per 1000 women 15-19 (IQR 43.0-75.3). We found significant variability in subcity ABR between countries and cities (37% of variance between countries and 47% between cities within countries). Higher homicide rates and greater population growth in cities were associated with higher ABR (rate ratio (RR) 1.09; 95% CI 1.06 to 1.12 and RR 1.02; 95% CI 1.00 to 1.04, per SD, respectively), while better living conditions and educational attainment in subcities were associated with lower ABR after accounting for other social environment characteristics (RR 0.95; 95% CI 0.92 to 0.98 and 0.78; 95% CI 0.76 to 0.79, per SD, respectively).
Conclusions:
The large heterogeneity of ABR found within countries and cities highlights the key role urban areas have in developing local policies. Holistic interventions targeting education inequalities and living conditions are likely important to reducing ABR in cities.
Latin America continues to segregate different social groups into separate health-system segments, including two separate public sector blocks: a well resourced social security for salaried workers and their families and a Ministry of Health serving poor and vulnerable people with low standards of quality and needing a frequently impoverishing payment at point of service. This segregation shows Latin America's longstanding economic and social inequality, cemented by an economic framework that predicted that economic growth would lead to rapid formalisation of the economy. Today, the institutional setup that organises the social segregation in health care is perceived, despite improved life expectancy and other advances, as a barrier to fulfilling the right to health, embodied in the legislation of many Latin American countries. This Series paper outlines four phases in the history of Latin American countries that explain the roots of segmentation in health care and describe three paths taken by countries seeking to overcome it: unification of the funds used to finance both social security and Ministry of Health services (one public payer); free choice of provider or insurer; and expansion of services to poor people and the non-salaried population by making explicit the health-care benefits to which all citizens are entitled.
Comment in The Lancet Series on "Universal health coverage in Latin America".
Cuba is located among a group of countries with high dengue incidence. Following several epidemics in the last 10 years, the country designed, implemented, and evaluated a participatory strategy based on the Ecohealth approach. The aim was to promote inter-sector ecosystem management to decrease Aedes aegypti infestation and prevent dengue transmission in the municipality of Cotorro, in Havana city. The study adopted a participatory research methodology. The strategy ensured active participation by the community, diverse sectors, and government in the production of healthy ecosystems. Timely and integrated measures for prevention and control were developed, thereby decreasing the risk of vector proliferation and local dengue transmission. The approach allowed holistic problem analysis, priority setting, and administration of solutions. The strategy has been sustained two years after concluding the process.
Background:
In the past 15 years, Brazil has undergone notable social and public health changes, including a large reduction in child mortality. The Bolsa Familia Programme (BFP) is a widespread conditional cash transfer programme, launched in 2003, which transfers cash to poor households (maximum income US18 to $175 per month, depending on the income and composition of the family. We aimed to assess the effect of the BFP on deaths of children younger than 5 years (under-5), overall and resulting from specific causes associated with poverty: malnutrition, diarrhoea, and lower respiratory infections.
Methods:
The study had a mixed ecological design. It covered the period from 2004-09 and included 2853 (of 5565) municipalities with death and livebirth statistics of adequate quality. We used government sources to calculate all-cause under-5 mortality rates and under-5 mortality rates for selected causes. BFP coverage was classified as low (0·0-17·1%), intermediate (17·2-32·0%), high (>32·0%), or consolidated (>32·0% and target population coverage ≥100% for at least 4 years). We did multivariable regression analyses of panel data with fixed-effects negative binomial models, adjusted for relevant social and economic covariates, and for the effect of the largest primary health-care scheme in the country (Family Health Programme).
Findings:
Under-5 mortality rate, overall and resulting from poverty-related causes, decreased as BFP coverage increased. The rate ratios (RR) for the effect of the BFP on overall under-5 mortality rate were 0·94 (95% CI 0·92-0·96) for intermediate coverage, 0·88 (0·85-0·91) for high coverage, and 0·83 (0·79-0·88) for consolidated coverage. The effect of consolidated BFP coverage was highest on under-5 mortality resulting from malnutrition (RR 0·35; 95% CI 0·24-0·50) and diarrhoea (0·47; 0·37-0·61).
Interpretation:
A conditional cash transfer programme can greatly contribute to a decrease in childhood mortality overall, and in particular for deaths attributable to poverty-related causes such as malnutrition and diarrhoea, in a large middle-income country such as Brazil.
Funding:
National Institutes of Science and Technology Programme, Ministry of Science and Technology, and Council for Scientific and Technological Development Programme (CNPq), Brazil.
This chapter documents the pattern of the rise and fall of income inequality in Latin America and comments on some plausible explanatory factors. After an overview of the regional trends and comparisons with other regions of the world, it focuses on three countries for which substantial analysis is available: Argentina, Brazil, and Mexico. The second section is an overview of the main characteristics and patterns of Latin America's income distribution. The third section discusses the plausible determinants of the inequality changes in the region. The fourth section provides an in-depth analysis of the three country cases. The fifth section offers some concluding remarks.
This paper documents patterns and recent developments on income inequality in Latin America (LA). New comparative international evidence confirms that LA is a region of high inequality, although maybe not the highest in the world. Income inequality has fallen in the 2000s, suggesting a turning point from the substantial increases of the 1980s and 1990s. The fall in inequality is significant and widespread, but it does not seem to be based on strong fundamentals.
This study aims to analyze the effects of income inequality on economic growth in Latin American countries as well as test the hypotheses of the theoretical models that address the indirect effects of inequality on economic growth rates. The models like the political economy, imperfect credit markets, social conflict and the fertility model are important to understand these indirect effects of inequality. The methodology used was the econometric technique of panel data by different specifications to additionally test the hypothesis of convergence of income and non-linearity in the relationship between growth and inequality. With regard to the indirect effects of inequality on growth, a negative and statistically significant effect of the development of the financial system and fertility it was found. Therefore, it was not possible to reject the assumptions of the models of imperfect credit markets and fertility.
This book was commissioned by the Department of Ethics, Equity, Trade and Human Rights as part of the
work undertaken by the Priority Public Health Conditions Knowledge Network of the Commission on Social
Determinants of Health, in collaboration with 16 of the major public health programmes of WHO: alcohol-related disorders, cardiovascular diseases, child health, diabetes, food safety, HIV/AIDS, maternal health, malaria, mental health, neglected tropical diseases, nutrition, oral health, sexual and reproductive health, tobacco and health, tuberculosis, and violence and injuries.
The book received first prize in Public Health Category in British Medical Journals Award, 2011.
Link to the full publication: https://apps.who.int/iris/bitstream/handle/10665/44289/9789241563970_eng.pdf?sequence=1&isAllowed=y
Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens—with defined and enlarged benefits packages—and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage.
I examined the combined effects of access to primary care through the Family Health Program (FHP) and conditional cash transfers from the Bolsa Familia Program (BFP) on postneonatal infant mortality (PNIM) in Brazil.
I employed longitudinal ecological analysis using panel data from 4583 Brazilian municipalities from 1998 to 2010, totaling 54 253 observations. I estimated fixed-effects ordinary least squares regressions models with PNIM rate as the dependent variable and FHP, BFP, and their interactions as the main independent variables of interest.
The association of higher FHP coverage with lower PNIM became stronger as BFP coverage increased. At the means of all other variables, when BFP coverage was 25%, predicted PNIM was 5.24 (95% confidence interval [CI] = 4.95, 5.53) for FHP coverage = 0% and 3.54 (95% CI = 2.77, 4.31) for FHP coverage = 100%. When BFP coverage was 60%, predicted PNIM was 4.65 (95% CI = 4.36, 4.94) when FHP coverage = 0% and 1.38 (95% CI = 0.88, 1.89) when FHP coverage = 100%.
The effect of the FHP depends on the expansion of the BFP. For impoverished, underserved populations, combining supply- and demand-side interventions may be necessary to improve health outcomes.
Between 2000 and 2010, the Gini coefficient declined in 13 of 17 Latin American countries. The decline was statistically significant and robust to changes in the time interval, inequality measures, and data sources. In-depth country studies for Argentina, Brazil, and Mexico suggest two main phenomena underlie this trend: a fall in the premium to skilled labor and more progressive government transfers. The fall in the premium to skills resulted from a combination of supply, demand, and institutional factors. Their relative importance depends on the country.
We evaluate the effects of a large nutrition programme in rural Colombia. The intervention we study is a community nursery programme that provides nutrition and child care for the children of poor households. In the first part of the paper, we use an Instrumental Variable approach to estimate the impacts of the programme on children's nutritional status and female employment. In the second part, we frame these results within a model in which the community nurseries are seen as an input in the production function of human capital that poor households can choose along side other inputs. The theoretical framework serves several purposes. First, it justifies the use of the specific instrument we use. Second, it provides an interpretation for the results we obtain. With the help of the model we point out that, because some of the alternative inputs in the process of human capital accumulation might be unobserved, we need relatively strong assumption to give our impact estimates a sensible interpretation, even when the instruments we use are 'exogenous'. We find that the programme has very large and positive impacts. Dealing with the endogeneity of treatment is crucial, as the children with otherwise worse nutritional status tend to select into the programme. We also validate our evaluation strategy by considering the effect of the programme on pre-intervention variables. Further, we explore the heterogeneity of the impact of the programme. Finally, our structural estimates show that the programme has important direct effects, over and above the indirect effects that might arise through the large effects observed on female employment.
Conditional cash transfer programs are innovative social safety-net programs that aim to relieve poverty. They provide a regular source of income to poor families and are "conditional" in that they require poor families to invest in the health and education of their children through greater use of educational and preventive health services. Brazil's Bolsa Família conditional cash transfer program, created in 2003, is the world's largest program of its kind. During the first five years of the program, it was associated with a significant 9.3 percent reduction in overall infant mortality rates, with greater declines in postneonatal mortality rates than in mortality rates at an earlier age and in municipalities with many users of Brazil's Family Health Program than in those with lower use rates. There were also larger effects in municipalities with higher infant mortality rates at baseline. Programs like Bolsa Família can improve child health and reduce long-standing health inequalities. Policy makers should review the adequacy of basic health services to ensure that the services can respond to the increased demand created by such programs. Programs should also target vulnerable groups at greatest risk and include careful monitoring and evaluation.
The importance of participation in voluntary formal associations for enhancing health is supported by four kinds of evidence. (1) Seven prospective studies of social relations and mortality show the independent effect of formal social participation, net of informal ties. (2) Conceptual analysis demonstrates that voluntary formal associations constitute a separate class of social causation. (3) Our factor analysis of data from a sample of 629 nonmetropolitan elderly identified two types of formal social participation: 'instrumental,' as in associations that are community oriented, and 'expressive,' as in those that exist for the benefit of the members. (4) Regression analysis showed that the instrumental participation factor is linked, net of controls, to the perceived health of both men and women, whereas the expressive factor predicts for women only.
Empirical studies show that health improvements provide a significant boost to economic growth in developing countries. This leads to the view that health, like education, is a fundamental component of human capital, and suggests the notion of health-led growth. Better health leads to higher income, but there is also a positive feedback effect, giving rise to a beneficial situation where health and income improvements are mutually reinforcing.
Cuba is located among a group of countries with high dengue incidence. Following several epidemics in the last 10 years, the country designed, implemented, and evaluated a participatory strategy based on the Ecohealth approach. The aim was to promote inter-sector ecosystem management to decrease Aedes aegypti infestation and prevent dengue transmission in the municipality of Cotorro, in Havana city. The study adopted a participatory research methodology. The strategy ensured active participation by the community, diverse sectors, and government in the production of healthy ecosystems. Timely and integrated measures for prevention and control were developed, thereby decreasing the risk of vector proliferation and local dengue transmission. The approach allowed holistic problem analysis, priority setting, and administration of solutions. The strategy has been sustained two years after concluding the process.
Health service coverage is considered as a concept expressing the extent of interaction between the service and the people for whom it is intended, this interaction not being limited to a particular aspect of service provision but ranging over the whole process from resource allocation to achievement of the desired objective. For the measurement of coverage, several key stages are first identified, each of them involving the realization of an important condition for providing the service; a coverage measure is then defined for each stage, namely the ratio between the number of people for whom the condition is met and the target population, so that a set of these measures represents the interaction between the service and the target population. This definition of coverage allows for variations, which are called "specific coverage", by limiting the target population to specific subgroups differentiated by certain conditions related to service provision or by demographic or socioeconomic factors.The evaluation of coverage on the basis of these concepts enables management to identify bottlenecks in the operation of the service, to analyse the constraining factors responsible for such bottlenecks, and to select effective measures for service development.
Background The 55th World Health Assembly declared dengue prevention and control a priority and urged Member States to develop sustainable intersectoral strategies to this end. To provide evidence for the reorientation of the dengue prevention policy in Cuba, we launched an intervention study to document the effectiveness of a local-level intersectoral approach.
We used a quasi-experimental design. Social scientists introduced participatory methods to facilitate dialogue in the biweekly meetings of the intersectoral Health Council of the intervention area. This council subsequently developed an intersectoral plan for dengue prevention, of which the core objective was to design and implement activities for communication and social mobilization. In the control area, routine dengue control activities continued without additional input. Knowledge, attitudes and perceptions of dengue, and entomological indices were compared inside and between the areas before and after the 1-year intervention period.
In the intervention area the Health Council elaborated an intersectoral plan for dengue prevention focused on source reduction. The Aedes aegypti control methods consisted in eliminating useless containers in the houses and surroundings, covering tanks, and cleaning public and inhabited areas. It was implemented through communication and social mobilization. The Health Council in the control area occasionally discussed dengue issues but did not develop a coordinated action plan. Good knowledge about breeding sites and disease symptoms increased significantly (by 49.7% and 17.1% respectively) in the intervention area as well as the proportion of respondents eliminating containers in and around their houses (by 44%). No changes were observed in the control area. The House Index in the intervention area was 3.72% at baseline and decreased to 0.61% after 1 year. In the control area it remained stable throughout the study period (1.31% and 1.65% respectively).
The introduction of a participatory approach by social scientists promotes changes in intersectoral management. This facilitates social mobilization which, in its turn, leads to significant changes in knowledge, attitudes and dengue-related practices in the population and eventually to more effective control of Ae. aegypti.
Decrease in income inequality in Latin America in the 2000s
- A Pellegrinni
Pellegrinni A. Decrease in income inequality in Latin America in the 2000s. Nov 22, 2012. http://dssbr.org/site/?p=11973&preview=true (accessed Dec 21, 2013; in Portuguese).
Institutions and economic development in Latin America United Nations Economic Commission for Latin America and the Caribbean (CEPAL)
- L Bértola
- Gerchunoff
Bértola L, Gerchunoff P. Institutions and economic development in Latin America. United Nations Economic Commission for Latin America and the Caribbean (CEPAL). 2011. http://www.eclac.cl/ publicaciones/xml/0/44960/Institucionalidad_y_desarrollo_fi nal. pdf (accessed Dec 22, 2013; in Spanish).
Zero to always. National Strategy for integral attention to early childhood
- Government
- Colombia
36 Government of Colombia. Zero to always. National Strategy for integral attention to early childhood. http://www.deceroasiempre. gov.co/QuienesSomos/Paginas/QuienesSomos.aspx (accessed Dec 22, 2013; in Spanish).
Sustainability of intersectoriality in Cuba
- Castell
Castell-Florit P. Sustainability of intersectoriality in Cuba. Havana: Ciencias Médicas, 2009 (in Spanish).
Surveillance secretariat of information on live births and mortality information system health-system. Indicators of basic data 2012. Rede Interagencial de Informação para a Saúde
- Brazil Ministry
- Health
32 Brazil Ministry of Health. Surveillance secretariat of information on live births and mortality information system health-system. Indicators of basic data 2012. Rede Interagencial de Informação para a Saúde. http://tabnet2.datasus.gov.br/cgi/idb2012/c16b.htm (accessed Dec 21, 2013; in Portuguese).
The intersectoral social practice. Havana: Ciencias Médicas Equity, social determinants and public health programmes
- Castell
Castell-Florit P. The intersectoral social practice. Havana: Ciencias Médicas, 2007 (in Spanish). 11 WHO. Blas E, Kurup AS, eds. Equity, social determinants and public health programmes. 2010. Geneva: World Health Organization, 2010.
Intersectorality in health. 7th global conference on health promotion. Promoting health and development: closing the implementation gap
- O Solar
- N Valentine
- M Rice
- D Albrecht
Solar O, Valentine N, Rice M, Albrecht D. Intersectorality in health.
7th global conference on health promotion. Promoting health and
development: closing the implementation gap; Nairobi, Kenya;
Health and the intersectoral collaboration dilemma. Doctoral thesis
- Lom Andrade
Andrade LOM. Health and the intersectoral collaboration dilemma.
Doctoral thesis. Aug 30, 2004. http://www.bibliotecadigital.
unicamp.br/document/?code=vtls000376076 (accessed Sept 10,
2014; in Portuguese).
Strategies and methodologies to promote social participation in the defi nition and implementation of policies public to combat inequities in health
- B Kliksberg
Kliksberg B. Strategies and methodologies to promote social
participation in the defi nition and implementation of policies public
to combat inequities in health. http://cmdss2011.org/site/wpcontent/uploads/2011/07/Participaci%C3%B3n-Social_Bernardo-Kliksberg.pdf (accessed April 12, 2013; in Portuguese).
Declining inequality in Latin America in the 2000s: the case of Argentina, Brazil and Mexico. The World Bank, Latin America and the Caribbean Region. Poverty, Equity and Gender Unit
- N Lustig
- L F Lopez-Calva
- E Ortiz-Juarez
Lustig N, Lopez-Calva LF, Ortiz-Juarez E. Declining inequality in
Latin America in the 2000s: the case of Argentina, Brazil and
Mexico. The World Bank, Latin America and the Caribbean Region.
Poverty, Equity and Gender Unit. October, 2012. http://www-wds.
worldbank.org/servlet/WDSContentServer/WDSP/IB/2012/10/23/0
Social participation in the health fi eld Revista Cubana Salud Pública
- G Ramos
Ramos G. Social participation in the health fi eld. Revista Cubana
Salud Pública 2004. http://scielo.sld.cu/scielo.php?script=sci_
arttext&pid=S0864-34662004000300005&lng=es (accessed
Dec 21, 2013; in Spanish).
The rise and fall of income inequality in Latin America. ECINEQ working paper series 2011–13
- L Gasparini
- N Lustig
Gasparini L, Lustig N. The rise and fall of income inequality in
Latin America. ECINEQ working paper series 2011–13. http://
www.ecineq.org/milano/wp/ecineq2011-213.pdf (accessed
Dec 21, 2013).
The intersectoral social practice. Havana: Ciencias Médicas
- P Castell-Florit
Castell-Florit P. The intersectoral social practice. Havana: Ciencias
Médicas, 2007 (in Spanish).
Chile Grows with Executive Secretariat, Department of Health Promotion and Citizenship MINSAL, Division of Healthy Public Policy and Health Promotion. 2010 Guidelines for the promotion of child development in local management. Children at the center of their community
- Government
- Chile
34 Government of Chile. Chile Grows with Executive Secretariat,
Department of Health Promotion and Citizenship MINSAL,
Division of Healthy Public Policy and Health Promotion. 2010
Guidelines for the promotion of child development in local
management. Children at the center of their community.
http://www.crececontigo.gob.cl/wp-content/uploads/2010/04/
Promocion-del-Desarrollo-Infantil.pdf (accessed Dec 21, 2013).
Universal health coverage with equity: what we know, don't know and need to know
- P Frenz
- J Vega
Frenz P, Vega J. Universal health coverage with equity: what we
know, don't know and need to know. First Global Symbosium on
Health Systems Research;
- Rio De Janeiro
- Brazil
Rio De Janeiro, Brazil, 19-21 October 2011. Geneva: World Health
Organization, 2011.
6
Policy forum: public health. The health and wealth of nations Declaration of Alma-Ata. International Conference on Primary Health Care
- De Bloom
- D Canning
Bloom DE, Canning D. Policy forum: public health. The health and
wealth of nations. Science 2000; 287: 1207–09.
4
WHO. Declaration of Alma-Ata. International Conference on Primary
Health Care. Kazakhstan, USSR: World Health Organisation, 1978.
5
WHO. Rio Political Declaration on Social Determinants of
Health. World Conference on Social Determinants of Health.
Social participation in the defi nition and implementation of public policies
- A Pellegrini
- M Rovere
Pellegrini A, Rovere M. Social participation in the defi nition and
implementation of public policies. Rio de Janeiro: Portal DSS Brazil;
2011. http://cmdss2011.org/site/2011/08/participacao-social-nadefi nicao-eimplantacao-de-politicas-publicas/ (accessed April 5, 2013).
Intersectorality in health. 7th global conference on health promotion. Promoting health and development: closing the implementation gap; Nairobi, Kenya; Oct 26–30, 2009.
- O Valentine
- N Rice
Veras-Soares F. Conditional cash transfers and health in Latin America
- S Cecchini
Cecchini S. Veras-Soares F. Conditional cash transfers and health in
Latin America. Lancet 2014; published online Oct 16. http://dx.doi.
org/10.1016/S0140-6736(14)61279-4.
United Nations Economic Commission for Latin America and the Caribbean (CEPAL)
- L Bértola
- P Gerchunoff
Bértola L, Gerchunoff P. Institutions and economic development in
Latin America. United Nations Economic Commission for Latin
America and the Caribbean (CEPAL). 2011. http://www.eclac.cl/
publicaciones/xml/0/44960/Institucionalidad_y_desarrollo_fi nal.
pdf (accessed Dec 22, 2013; in Spanish).
USSR: World Health Organisation, 1978. 5 WHO. Rio Political Declaration on Social Determinants of Health. World Conference on Social Determinants of Health
WHO. Declaration of Alma-Ata. International Conference on Primary
Health Care. Kazakhstan, USSR: World Health Organisation, 1978.
5
WHO. Rio Political Declaration on Social Determinants of
Health. World Conference on Social Determinants of Health.
Rio De Janeiro, Brazil, 19-21 October 2011. Geneva: World Health
Organization, 2011.
Surveillance secretariat of information on live births and mortality information system health-system. Indicators of basic data 2012
- Brazil Ministry
- Health
Brazil Ministry of Health. Surveillance secretariat of information on
live births and mortality information system health-system.
Indicators of basic data 2012. Rede Interagencial de Informação
para a Saúde. http://tabnet2.datasus.gov.br/cgi/idb2012/c16b.htm
(accessed Dec 21, 2013; in Portuguese).
Chile Grows with Executive Secretariat, Department of Health Promotion and Citizenship MINSAL, Division of Healthy Public Policy and Health Promotion
- Chile Government Of
Government of Chile. Chile Grows with Executive Secretariat,
Department of Health Promotion and Citizenship MINSAL,
Division of Healthy Public Policy and Health Promotion. 2010
Guidelines for the promotion of child development in local
management. Children at the center of their community.
http://www.crececontigo.gob.cl/wp-content/uploads/2010/04/
Promocion-del-Desarrollo-Infantil.pdf (accessed Dec 21, 2013).
Zero to always. National Strategy for integral attention to early childhood
- Colombia Government Of
Government of Colombia. Zero to always. National Strategy for
integral attention to early childhood. http://www.deceroasiempre.
gov.co/QuienesSomos/Paginas/QuienesSomos.aspx (accessed
Dec 22, 2013; in Spanish).
- Janeiro Rio De
Rio De Janeiro, Brazil, 19-21 October 2011. Geneva: World Health
Organization, 2011.