Setareh Rouhani’s research while affiliated with University of Ottawa and other places

The ongoing health crisis in the Ukraine has persisted for 48 years with a clear division of gender-based outcomes as seen in the decline of male life expectancy and stagnation of female longevity. The purpose of this paper is to investigate differences in self-rated health and system barriers to health care applicable to gender and its intersections because of the differing negative health outcomes for men and women. Intersectionality theory provides an analytic framework for interpreting our results. Utilizing a nationwide sample of the Ukrainian population (N = 1908), we found that low socioeconomic status (SES) women rate their health worse than men generally and any other socioeconomic group. Yet women also face the greatest barriers to health care until older ages when the ailments of men cause them to likewise face the obstacles. In reviewing the barrier to health care scale, one barrier—that of health care services being too expensive—dominated the responses with some 52.5 percent of the sample reporting it. Consequently, the greatest problem in Ukraine with respect to health reform reported by the population is the out-of-pocket costs for care in a system that is officially free. These costs, constituting some 40 percent of all national health expenditures, affect women and the aged the most.

Background: The paper presents the results of community consultations about the health needs and healthcare experiences of the population of Ukraine. The objective of community consultations is to engage a community in which a research project is studying, and to gauge feedback, criticism and suggestions. It is designed to seek advice or information from participants directly affected by the study subject of interest. The purpose of this study was to collect first-hand perceptions about daily life, health concerns and experiences with the healthcare system. This study provides policy-makers with additional evidence to ensure that health reforms would include a focus not only on health system changes but also social determinants of health (SDH). Methods: The data collection consisted of the 21 community consultations conducted in 2012 in eleven regions of Ukraine in a mix of urban and rural settings. The qualitative data was coded in MAXQDA 11 software and thematic analysis was used as a method of summarizing and interpreting the results. Results: The key findings of this study point out the importance of the SDH in the lives of Ukrainians and how the residents of Ukraine perceive that health inequities and premature mortality are shaped by the circumstances of their daily lives, such as: political and economic instability, environmental pollution, low wages, poor diet, insufficient physical activity, and unsatisfactory state of public services. Study participants repeatedly discussed these conditions as the reasons for the perceived health crisis in Ukraine. The dilapidated state of the healthcare system was discussed as well; high out-of-pocket (OOP) payments and lack of trust in doctors appeared as significant barriers in accessing healthcare services. Additionally, the consultations highlighted the economic and health gaps between residents of rural and urban areas, naming rural populations among the most vulnerable social groups in Ukraine. Conclusion: The study concludes that any meaningful reforms of the health sector in Ukraine must include a broad range of factors, including the healthcare system but importantly, must extend to SDH approach and include the prioritization of health promotion, limiting alcohol and tobacco availability and enforcing environmental protection.

BACKGROUND: This study focuses on a variety of social determinants of alcohol and tobacco consumption , which have been reported as an alarming epidemic in the post-Soviet Ukraine. Authors look at the intersections of social determinants of tobacco and alcohol use in Ukraine as perceived by the study participants, and their perception of structural effects of economic and cultural transition on the prevalence of these harmful lifestyles. METHODS: This study is part of a mixed-methods research, informed by an intersectional framework , focusing on complex health and health care experiences of Ukrainians. This study uses findings from 21 community consultations in 11 regions, corresponding to Ukraine's diverse demographics, culture, and geography. At these consultations, participants discussed their health, experiences in seeking healthcare and provided recommendations for healthcare reforms. RESULTS: The study identifies the important demographic factors like age, gender, SES, and place of residence, and how their intersections influence tobacco and alcohol consumption in Ukraine. People of lower SES have reportedly higher rates of consuming alcohol and tobacco, but younger individuals of low SES are most affected by these unhealthy lifestyles. The study also points to broader structural factors, such as stress, unemployment, poor law enforcement, poor social support, lack of health promotion, features of the built environment , and tobacco and alcohol availability, which affect the uptake of unhealthy behaviors. CONCLUSIONS: The community consultations revealed people's perceptions about the complex nature of tobacco and alcohol consumption in the post-Soviet setting. People shared their concern about the vulnerability of certain social groups to using alcohol and tobacco, and their understanding of the detrimental effects these substances have on the health of these groups. This intersectionality-based study concludes that there is a need to look beyond individual demographics and consider how social factors intersecting between themselves , as well as individual demographic factors, affect outcomes.

Health inequalities are by definition a quantitative concept: the absence of equality or parity in health-related outcomes. The presence of numeric inequality across social groups is often of interest with regard to inequity (injustice), particularly where those social groups represent categories embedded in a context of historical and social marginalization. Originating in Black feminist scholarship, an intersectionality framework offers the potential to document health inequalities at intersections of social identity or location, address interactions between macro-, meso- or micro-level causes in creating and reinforcing such inequalities, and develop or evaluate interventions that work within the intersectional contexts of communities. However, to date it has been applied primarily in qualitative research. We present ten guidelines for researchers about the design and conduct of quantitative intersectionality research addressing health inequalities. Important considerations include theoretical conceptualization, study design, measurement, statistical analysis, research process, knowledge translation, and interpretation of research results.