Health inequality

Study objective-The debate on health inequalities has shifted from the consequences of occupational position, as expressed in the Registrar General's classification, to consequences of material living conditions. This change in interest occurred without comparative analyses of diVerent sources of health inequalities. Thus this study investigated the relative contribution of "material resources" (income), "qualification" and "occupational position" for explaining social diVerentials in mortality. Design and setting-Analyses were performed with records from a statutory health insurance in West Germany. The analyses were performed with data of 84 814 employed men and women between 25 and 65 years of age who were insured between 1987 and 1995 for at least 150 days. Results-The three indicators were statistically associated, but not strong enough to warrant the conclusion that they share the same empirical content. The relative risk (hazard rate) for income by controlling for occupational position and gender for the highest as compared with the lowest category was 1.99 (95% CI 1.66, 2.39). The corresponding relative risk for income by controlling for qualification and gender was 2.03 (95% CI 1.68, 2.46). In both multivariate analyses, the eVects of occupational position and qualification were no longer interpretable because of large confidence intervals. In sum, income related relative mortality risks were the comparably highest, while qualification and occupational position were no longer substantial. Conclusions-The results emphasise the present discussion on the consequences of material living conditions. Income on the one hand and qualification and occupational position on the other are largely independent. Mortality related eVects of income override those of the other socioeconomic status indicators. However, seen in a time perspective, qualification may still have a placement function at least for the first occupational position.

Study objective-The debate on health inequalities has shifted from the consequences of occupational position, as expressed in the Registrar General's classification, to consequences of material living conditions. This change in interest occurred without comparative analyses of diVerent sources of health inequalities. Thus this study investigated the relative contribution of "material resources" (income), "qualification" and "occupational position" for explaining social diVerentials in mortality. Design and setting-Analyses were performed with records from a statutory health insurance in West Germany. The analyses were performed with data of 84 814 employed men and women between 25 and 65 years of age who were insured between 1987 and 1995 for at least 150 days. Results-The three indicators were statistically associated, but not strong enough to warrant the conclusion that they share the same empirical content. The relative risk (hazard rate) for income by controlling for occupational position and gender for the highest as compared with the lowest category was 1.99 (95% CI 1.66, 2.39). The corresponding relative risk for income by controlling for qualification and gender was 2.03 (95% CI 1.68, 2.46). In both multivariate analyses, the eVects of occupational position and qualification were no longer interpretable because of large confidence intervals. In sum, income related relative mortality risks were the comparably highest, while qualification and occupational position were no longer substantial. Conclusions-The results emphasise the present discussion on the consequences of material living conditions. Income on the one hand and qualification and occupational position on the other are largely independent. Mortality related eVects of income override those of the other socioeconomic status indicators. However, seen in a time perspective, qualification may still have a placement function at least for the first occupational position.

Introduction: This article presents patient and public involvement and engagement (PPIE) work undertaken to explore FGM
survivors' and stakeholders' views on reconstructive surgery, potential service models, care pathways, barriers to access and other
support needs. The aim was to set research priorities, identify key themes and help inform subsequent research in the field.
Methods: A national research collective was established comprising over 20 stakeholders, including FGM survivors/women
with lived experience, healthcare professionals, academics and advocacy groups. The group undertook two discussion workshops with FGM survivors (n = 11 participants), two national stakeholder events (n = 142 attendees) and significant advocacy
and partnership‐building activities.
Results: Key insights were that FGM survivors would value reconstructive surgery to address body image concerns, genital pain
and sexual difficulties. Potential barriers to surgery included stigma, safeguarding concerns, lack of awareness and fear.
Significant gaps were identified around women's knowledge of clitoral anatomy, FGM types and specialist services. Survivors
and stakeholders emphasised the need to complement surgical reconstruction with a comprehensive care pathway including
trauma counselling and psychosexual therapy. Conclusion: This study highlights the importance of a survivor‐led approach to FGM service development, as often the voices
of FGM survivors are not included. The exercise demonstrated that, with the right approach, it is possible to engage ‘minoritised
communities/individuals from the global majority’ and communities dispayed considerable willingness to participate in this
sensitive research field. It also emphasises an urgent need for accessible, high‐quality FGM care informed by the voices of those
affected, to improve outcomes and support for FGM survivors in the United Kingdom.
Patient or Public Contribution: Women with lived experience of FGM and women from FGM‐affected communities, as well
as other national stakeholders (including Non Government Organisation's and charities working with FGM survivors, academics, artists and campaigners were involved in the design and conduct of this study, analysis and interpretation of the data
and preparation of the manuscript.

Earlier studies have found large and increasing with time differences in mortality by education and marital status in post-Soviet countries. Their results are based on independent tabulations of population and deaths counts (unlinked data). The present study provides the first census-linked estimates of group-specific mortality and the first comparison between census-linked and unlinked mortality estimates for a post-Soviet country. The study is based on a data set linking 140,000 deaths occurring in 2001-2004 in Lithuania with the population census of 2001. The same socio-demographic information about the deceased is available from both the census and death records. Cross-tabulations and Poisson regressions are used to compare linked and unlinked data. Linked and unlinked estimates of life expectancies and mortality rate ratios are calculated with standard life table techniques and Poisson regressions. For the two socio-demographic variables under study, the values from the death records partly differ from those from the census records. The deviations are especially significant for education, with 72-73%, 66-67%, and 82-84% matching for higher education, secondary education, and lower education, respectively. For marital status, deviations are less frequent. For education and marital status, unlinked estimates tend to overstate mortality in disadvantaged groups and they understate mortality in advantaged groups. The differences in inter-group life expectancy and the mortality rate ratios thus are significantly overestimated in the unlinked data. Socio-demographic differences in mortality previously observed in Lithuania and possibly other post-Soviet countries are overestimated. The growth in inequalities over the 1990s is real but might be overstated. The results of this study confirm the existence of large and widening health inequalities but call for better data.

Since the nineteen seventies, high-and low-income countries have undergone a pattern of transnational economic and cultural integration known as globalization. The weight of the available evidence suggests that the effects of globalization on labor markets have increased economic inequality and various forms of economic insecurity that negatively affect workers' health. Research on the relation between labor markets and health is hampered by the social invisibility of many of these health inequalities. Empirical evidence of the impact of employment relations on health inequalities is scarce for low-income countries, small firms, rural settings, and sectors of the economy in which ''informality'' is widespread. Information is also scarce on the effectiveness of labor market interventions in reducing health inequalities. This pattern is likely to continue in the future unless governments adopt active labor market policies. Such policies include creating jobs through state intervention, regulating the labor market to protect employment, supporting unions, and ensuring occupational safety and health standards.

This paper juxtaposes changes over the last forty years in income growth and distribution with the mortality changes recorded at the aggregate level in about 170 countries and at the individual level in 21 countries with at least two Demographic and Health Surveys covering the last twenty years. Over the 1980s-and 1990s, the infant-mortality rate (IMR), under-5 mortality rate (U5MR) and Life Expectancy at Birth (LEB) mostly continued the favourable trends that characterized the 1960s and 1970s. Yet, especially, the 1990s the pace of health improvement was slower than that recorded during the prior decades. In addition, the distribution between countries of aggregate health improvements became markedly more skewed. These trends are in part explained by the negative changes recorded in Sub-Saharan Africa and Eastern Europe, but are robust to the removal of the two regions from the sample. This tendency is observed also at the intra-regional level, with the exception of Western Europe. Thirdly, DHS data for 21 developing countries point to a frequent divergence over time in the within-country distribution of gains in IMR and U5MR among children living in urban vs. rural areas and belonging to families part of different quantiles of the asset distribution, while IMR differentials by level of education of the mother show mixed trends The paper concludes by underscoring the similarities and linkages between changes in income inequality and health inequality and suggests some tentative explanations of these trends without, however, formally testing them.

Background: Understanding health care utilization by neighbourhood is essential for optimal allocation of resources, but links between neighbourhood immigration and health have rarely been explored. Our objective was to understand how immigrant composition of neighbourhoods relates to health outcomes and health care utilization of individuals living with diabetes. Methods: This is a secondary analysis of administrative data using a retrospective cohort of 111,556 patients living with diabetes without previous cardiovascular diseases (CVD) and living in the metropolitan region of Montreal (Canada). A score for immigration was calculated at the neighbourhood level using a principal component analysis with six neighbourhood-level variables (% of people with maternal language other than French or English, % of people who do not speak French or English, % of immigrants with different times since immigration (<5 years, 5-10 years, 10-15 years, 15-25 years)). Dependent variables were all-cause death, all-cause hospitalization, CVD event (death or hospitalization), frequent use of emergency departments, frequent use of general practitioner care, frequent use of specialist care, and purchase of at least one antidiabetic drug. For each of these variables, adjusted odds ratios were estimated using a multilevel logistic regression. Results: Compared to patients with diabetes living in neighbourhoods with low immigration scores, those living in neighbourhoods with high immigration scores were less likely to die, to suffer a CVD event, to frequently visit general practitioners, but more likely to visit emergency departments or a specialist and to use an antidiabetic drug. These differences remained after controlling for patient-level variables such as age, sex, and comorbidities, as well as for neighbourhood attributes like material and social deprivation or living in the urban core. Conclusions: In this study, patients with diabetes living in neighbourhoods with high immigration scores had different health outcomes and health care utilizations compared to those living in neighbourhoods with low immigration scores. Although we cannot disentangle the individual versus the area-based effect of immigration, these results may have an important impact for health care planning.

Building on early animal studies, 20 th -century researchers increasingly explored the fact that early events -ranging from conception to childhood -affect a child's health trajectory in the long-term. By the 21st century, a wide body of research had emerged, incorporating the original 'Fetal Origins Hypothesis' into the 'Developmental Origins of Health and Disease'. Evidence from OECD countries suggests that health inequalities are strongly correlated with many dimensions of socio-economic status, such as educational attainment; and that they tend to increase with age and carry stark intergenerational implications. Different economic theories have been developed to rationalize this evidence, with an overarching comprehensive framework still lacking. Existing models widely rely on human capital theory, which has given rise to separate dynamic models of adult and child health capital, within a production function framework. A large body of empirical evidence has also found support for the developmental origins of inequalities in health. On the one hand, studies exploiting quasi-random exposure to adverse events have shown long-term physical and mental health impacts of exposure to early shocks, including pandemics or maternal illness, famine, malnutrition, stress, vitamin deficiencies, maltreatment, pollution and economic recessions. On the other hand, studies from the 20th century have shown that early interventions of various content and delivery format improve life course health. Further, given that the most socioeconomically disadvantaged groups show the greatest gains, such measures can potentially reduce health inequalities. However, studies of long-term impacts, as well as the mechanisms via which shocks or policies affect health, and the dynamic interaction amongst them, are still lacking. Mapping the complexities of those early event dynamics is an important avenue for future research.

Uvod: Osnovna pacientova pravica je pravica do zasebnosti, zato se upravičeno pričakuje, da bodo zaupnost pacientovih osebnih podatkov na eNapotnici dosledno varovali vsi, ki delujejo na področju zdravstva, in vsi, ki skrbijo za pacientovo dobrobit in so po zakonu dolžni varovati osebne podatke. Namen: V magistrski nalogi smo si postavili vprašanje, v kolikšni meri je varovanje osebnih podatkov, ki jih lahko vidimo na eNapotnici, vidno osebam, ki do pacientovih osebnih podatkov po zakonu ne smejo dostopati. Zanimalo nas je, ali pacienti prepoznajo kršitve pri posredovanju eNapotnice. Namen magistrske naloge je zavarovati pacientovo zasebnost in ohraniti varnost osebnih podatkov, ki so nam bili zaupani. Metode: Pri izdelavi raziskovalnega dela smo uporabili stratificiran vzorec. V raziskavi so sodelovali pacienti v endokrinološki ambulanti na polikliniki v Ljubljani. Anketirana starostna skupina je bila izbrana naključno. Glede na raziskovalno populacijo smo zbirali podatke s kvalita...

In this article, we study trends in self-reported health (general health and chronic conditions) and health inequality in the Netherlands between 1974 and 1998 using an age-period-cohort framework. We answer two questions: (1) to what extent can trends in self-reported health be explained by the current macro-context (period effect) and by infant mortality in year of birth (cohort effect)? And (2) do the effects of period and cohort differ for educational groups? Health indicators are self-reported poor health and chronic conditions. The use of 26 Dutch cross-sectional surveys makes it possible to estimate largely unbiased effects of period and cohort simultaneously (controlled for age effects) and thus to adequately describe trends in social inequality in health. Our results give rise to four conclusions. First, for men poor health has been more or less stable, for women there has been an increase. The prevalence of chronic conditions has increased for both sexes. Second, adding cohort specific experiences to a model including age and period effects is only relevant for women's poor health. Decreasing infant mortality in year of birth leads to better health and consequently the period effect initially found for women appears to be slightly underestimated. Third, we found no trends in social inequalities in self-reported health due to period effects. Fourth, our analyses do show socially unequal trends in health as a result of cohort specific experiences. Contrary to our hypothesis, we found that decreased infant mortality in year of birth makes for a stronger impact of educational differences on self-reported poor health. Concerning chronic conditions no trends for educational groups were found.

This study analyses the importance of partner status and partner's education, adjusted for own education, on selfassessed health, smoking and excessive alcohol consumption. The relationship between socio-economic factors and health-related outcomes is traditionally studied from an individual perspective. Recently, applying social-ecological models that include socio-economic factors on various social levels is becoming popular. We argue that partners are an important influence on individual health and health-related behaviour at the household level. Therefore, we include partners in the analysis of educational health inequalities. Using data of almost 40,000 individuals (with almost 15,000 Dutch cohabiting couples), aged 25-74 years, who participated in the Netherlands Health Interview Survey between 1989 and 1996, we test hypotheses on the importance of own and partner's education. We apply advanced logistic regression models that are especially suitable for studying the relative influence of partners' education. Controlled for own education, partner's education is significantly associated with self-assessed health and smoking, for men and women. Accounting for both partners' education the social gradient in self-assessed health and smoking is steeper than based on own or partner's education alone. The social gradient in health is underestimated by not considering partner's education, especially for women.

This paper explores the physicians' perspective regarding the potential of computerised Cognitive Behavioural Therapies (cCBTs) to overcome inequalities in the context of mental health care provision. The main benefits were related to the ability of cCBTs to provide care in a convenient and efficient manner, enhancing its accessibility. These aspects were perceived more important than cost-effectivity of treatment, which is often claimed to be the key benefit of cCBTs. Age and general acceptance of CBT were the most significant individual-level separators of perceptions, while the sector in which the physician works was seen as the main structural-level separator.

Purpose: to measure, describe and analyse regional differences in health-related quality of life measured by EQ-5D in China. Data were obtained via face-to-face interviews on a national representative sample (n=120,703, 15-103 years). The EQ-5D instrument was used to measure health status. Results: Rural areas had worse health status than urban areas. Health status was worst in western areas and best in eastern areas, and such disparities were profounder in rural areas. In urban areas, health status was best in middle-sized cities. In rural areas, health status increased with the economic development level of a county. Conclusion: Our study enhances understanding of the urban-rural differences and east-middle-west differences in health and sheds light on inequalities in health status between different city categories in the urban areas and county categories in the rural areas.

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The article deals with patients’ rights and stresses the right of autonomy as one of fundamental patient’s rights in holistic individual patient treatment. In the first part, some concepts like ethics, morale, autonomy, advocacy, informing, patient’s consent are discussed. The second part presents a research project of the Nurses and Nursing Technicians Association Ljubljana Nursing care and Ethics. The author tried to find an answer to the question: What is patient’s autonomy? Gathered data were analysed with a qualitative method and classified into 20 categories from which the first five cover the majority of answers. In the author’s opinion, the field of nursing ethics in Slovenia requires further interpretation and, above all, transfer of ethical principles into

In our changing times health and social care are of vital importance for comprehensive treatment of individuals and groups. Aging of the population and reducing resources for health, as well as social care of healthy and sick requires a rational attitude to maintaining healthy life style of the population. The article deals with care as the basis of health care centering around a holistic concept of the individual, together with his/her choice of life style, ethic values and good practice, represneted also by the carriers of the profession, i.e. nurses, nursing technicians, midwives and nursing aides. Indicated is the need for the combination of health and social care so that they will be acting in unison for the same goals – happy individual, family and community.

The article presents the model of supervision of quality enhancement and its results in specialist out patient nursing care at the University Medical Centre Ljubljana with special stress on nursing care and partly also health administration as an indivisible part of holistic health care of patients. The article presents questionnaires on internal professional supervision. The goal of the model was to enhance the quality for the clients, for employees and for management by means of predetermined visits and in the form of counseling and monitoring of quality enhancement. With certain additions, the questionnaire could serve for professional, organizational and management supervision of the complete outpatient activities field: it also offers opportunities for a unified supervision system in specialist (and basic health) clinics in Slovenia.

EXPERT STOMA CARE NURSING po dodatnih znanjih in povezovanju. Leta 1987 smo ustanovile Sekcijo medicinskih sester v enterostomalni terapiji pri Zvezi društev medicinskih sester Slovenije (sedanja Zbornica zdravstvene in babiške nege Slovenije -Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije) in leta 1992 nas je prvih pet (Renata Batas, Boža Hribar, Darinka Klemenc, Loredana Makovec in Marija Smolič) zaključilo šolo enterostomalne terapije v Kliničnem centru Ljubljana. Šola je bila priznana s strani Izobraževalnega komiteja Svetovnega združenja enterostomalnih terapevtov WCET. Čas ustanovitve strokovne sekcije sovpada z začetkom organiziranega združevanja ljudi s stomo -stomistov, najprej v Mariboru, potem v Ljubljani in drugih večjih mestih po Sloveniji. Pobudnica Nevenka Gračner je v prizadevanjih za čim bolj normalno življenje ljudi s spremenjeno telesno podobo oz. s stomo in za boljšo oskrbo z ortopedskimi pripomočki storila izjemno delo -prebila je zvočni zid molka, v medijih se je pojavila s temo, ki je do tedaj veljala za čisti tabu, kot nekaj, o čemer se, razen v strokovnih krogih, ni govorilo. Dala je pobudo za ustanovitev združenja stomistov. Medicinske sestre smo pomagale od vsega začetka, tako smo skupaj odstirali tančice molka, sramu, nepreskrbljenosti s pripomočki. Med drugim smo dopovedovale zavarovalnici, da ljudje brez pripomočkov ne morejo živeti, da potrebujejo več in boljše -ne samo kožne podloge in vrečke, tudi kakovost življenja nasploh. Počasi se je začelo premikati na bolje. Nenehno izobraževanje medicinskih sester, ozaveščanje stomistov, informiranje strokovne in splošne javnosti so postali stalnica našega delovanja. Na področju bivše Jugoslavije smo se pričeli srečevati medicinske sestre in zdravniki na prvih skupnih strokovnih srečanjih, ki so jih organizirali prvi zastopniki firm, ki so oskrbovale stomiste. Na prehojeno pot in opravljeno delo se lahko oziramo z zadovoljstvom: stalna večkrat letna izobraževanja, izvedba izobraževanj -šole enterostomalne terapije v Univerzitetnem kliničnem centru Ljubljana, sodelovanje pri domačih, evropskih in svetovnih strokovnih dogodkih, slovenska predstavnica v vodstvu Evropskega združenja -European Council of Enterostomal Therapy (ECET), večletno sodelovanje slovenske predstavnice v Izobraževalnem komiteju pri WCET, redna zasedba z mednarodnimi delegatkami v WCET so le delčki, ki jih nizamo na seznam opravljenega dela. In seveda, sodelovanje s stomisti, predstavniki firm, člani zdravstvenih

The growing size and changing composition of the foreign-born population in the USA highlights the importance of examining the health consequences of living in neighborhoods with higher proportions of immigrants. Using data from the Multi-ethnic Study of Atherosclerosis in four US cities, we examined whether neighborhood immigrant composition was associated with health behaviors (diet, physical activity) among Hispanic and Chinese Americans (n ¼ 1902). Secondarily we tested whether neighborhoods with high proportions of immigrants exhibited better or worse neighborhood quality, and whether these dimensions of neighborhood quality were associated with healthy behaviors. Neighborhood immigrant composition was defined based on the Census 2000 tract percent of foreign-born from Latin-America, and separately, percent foreign-born from China. After adjustment for age, gender, income, education, neighborhood poverty, and acculturation, living in a tract with a higher proportion of immigrants was associated with lower consumption of high-fat foods among Hispanics and Chinese, but with being less physically active among Hispanics. Residents in neighborhoods with higher proportions of immigrants reported better healthy food availability, but also worse walkability, fewer recreational exercise resources, worse safety, lower social cohesion, and lower neighborhood-based civic engagement. Associations of neighborhood immigrant composition with diet persisted after adjustment for reported neighborhood characteristics, and associations with physical activity were attenuated. Respondent-reported neighborhood healthy food availability, walkability, availability of exercise facilities and civic participation remained associated with behaviors after adjusting for immigrant composition and other covariates. Results show that living in an immigrant enclave is not monolithically beneficial and may have different associations with different health behaviors.

The growing size and changing composition of the foreign-born population in the USA highlights the importance of examining the health consequences of living in neighborhoods with higher proportions of immigrants. Using data from the Multi-ethnic Study of Atherosclerosis in four US cities, we examined whether neighborhood immigrant composition was associated with health behaviors (diet, physical activity) among Hispanic and Chinese Americans (n ¼ 1902). Secondarily we tested whether neighborhoods with high proportions of immigrants exhibited better or worse neighborhood quality, and whether these dimensions of neighborhood quality were associated with healthy behaviors. Neighborhood immigrant composition was defined based on the Census 2000 tract percent of foreign-born from Latin-America, and separately, percent foreign-born from China. After adjustment for age, gender, income, education, neighborhood poverty, and acculturation, living in a tract with a higher proportion of immigrants was associated with lower consumption of high-fat foods among Hispanics and Chinese, but with being less physically active among Hispanics. Residents in neighborhoods with higher proportions of immigrants reported better healthy food availability, but also worse walkability, fewer recreational exercise resources, worse safety, lower social cohesion, and lower neighborhood-based civic engagement. Associations of neighborhood immigrant composition with diet persisted after adjustment for reported neighborhood characteristics, and associations with physical activity were attenuated. Respondent-reported neighborhood healthy food availability, walkability, availability of exercise facilities and civic participation remained associated with behaviors after adjusting for immigrant composition and other covariates. Results show that living in an immigrant enclave is not monolithically beneficial and may have different associations with different health behaviors.

This study investigates the impact of individual and community-level factors on health outcomes and equity in four selected communities in Akwa Ibom State. Despite its numerous health reforms, inequities in health outcomes persist in Nigeria, largely driven by education and socioeconomic disparities. Thus, this study examined how educational attainment and economic stability affect health outcomes and equity across four communities in Akwa Ibom State. A cross-sectional survey of 386 adults and multilevel statistical techniques were used; the analysis assessed individual and communitylevel interactions. The study draws on the Contextual Determinants of Health Equity Model (CoDHEM) to highlight structural and relational inequalities. Results showed that lower education and income were strongly associated with poor health, but these effects were moderated by community context. Urban areas like Uyo recorded higher clusters of inequity, indicating hidden vulnerabilities. Multilevel analysis revealed that contextual barriers often dilute personal advantages. The study recommends targeted investments in education, income-support programs, and community-based health infrastructure. These findings support the need for equity-focused, place-based health policies to address the root causes of disparity.

This series presents research findings based either directly on data from the German Socio-Economic Panel Study (SOEP) or using SOEP data as part of an internationally comparable data set (e.g. CNEF, ECHP, LIS, LWS, CHER/PACO). SOEP is a truly multidisciplinary household panel study covering a wide range of social and behavioral sciences:

Background: Greenspace has the potential to be a vital resource for promoting healthy living for people in urban areas, offering both opportunities for physical activity and wellbeing. Much research has explored the objectively measurable factors within areas to the end of explaining the role of greenspace access in continuing health inequalities. This paper explores the subjective reasons why people in urban areas choose to use, or not use, local public greenspace. Methods: In-depth interviews with 24 people living in two areas of Glasgow, United Kingdom were conducted, supplemented with participant photography and participatory methods. Data was thematically categorised to explore subjectively experienced facilitators and barriers to greenspace use in urban areas. Results: From the perspective of current and potential urban greenspace users, access is revealed to be about more than the physical characteristics of neighbourhoods, greenspace resources or objectively measurable features of walkability and connectivity. Subjectively, the idea of walkability includes perceptions of social cohesion at a community level and the level of felt integration and inclusion by individuals in their communities. Individual's feelings of integration and inclusion potentially mitigate the effects of experiential barriers to urban greenspace access, such as evidence of anti-social behaviour. Conclusions: We conclude that improving access to greenspace for all in urban communities will require more than providing high quality resources such as parks, footpaths, activities and lighting. Physical availability interacts with community contexts already established and a holistic understanding of access is required. A key cultural component of areas and neighbourhoods is the level of social cohesion, a factor that has the potential to reinforce existing health inequalities through shaping differentiated greenspace access between subgroups of the local population.

This cross-sectional study examines the impact of socioeconomic status (SES) on cardiovascular health outcomes among adults aged 18 and above. Data were gathered using a structured online questionnaire assessing demographics, health behaviors, medical history, and access to healthcare services. Statistical analysis revealed a significant association between lower income levels and increased prevalence of hypertension. However, no significant link was found between educational attainment and cardiovascular disease. These findings highlight the critical role of income-related disparities in shaping cardiovascular health and underscore the need for targeted public health interventions that address economic inequities to improve health outcomes.

The imperative to reduce health inequalities whilst keeping within budget means that Health Authorities must prioritise to gain maximum benefit from available resources. Health Inequality Impact Assessment (HIIA) rapid appraisal has been developed by Bro Taf Health Authority to ensure that planning produces positive effects for disadvantaged people. HIIA rapid appraisal consists of assessing the effect of deprivation on the planning topic, examining the relevant evidence, defining opportunities for action and rating these relative to their likely impact on health inequalities. The process is best carried out by a multidisciplinary team including health authority, local authority, voluntary sector and community representatives. This paper describes a HIIA rapid appraisal process, that resulted in a Trust that serves a highly disadvantaged locality agreeing to try a new method of working and to collaborate in research on breaking the cycle of deprivation. Public Health (2001) 115, 272-276.

Global inequalities contribute to marked disparities in health and wellness of human populations. Many opportunities now exist to provide health care to all people in a person- and people-centered way that is effective, equitable, and sustainable. We review these opportunities and the scientific, historical, and philosophical considerations that form the basis for the International College of Person-centered Medicine’s 2014 Geneva Declaration on Person- and People-centered Integrated Health Care for All. Using consistent time-series data, we critically examine examples of universal healthcare systems in Chile, Spain, and Cuba. In a person-centered approach to public health, people are recognized to have intrinsic dignity and are treated with respect to encourage their developing health and happiness. A person-centered approach supports the freedom and the responsibility to develop one’s life in ways that are personally meaningful and that are respectful of others and the environment...

The current policy trend to have the reduction of health inequalities as a desired outcome indicates a serious attempt to deal with the complexity of social interactions. In New Zealand in recent years the landscape for government-community relationships has also changed significantly. The prescriptive contracting environment of the 1990s has been replaced, in many policy areas, by the rhetoric of partnership. In theory, partnership seems to offer policy makers a way to respond to complexity in a flexible manner, and is perhaps a way to cope with levels of uncertainty in implementing policy. This paper discusses the background to the rise of the concept and the practice of partnership in New Zealand and gives examples of how it is currently being used. This is followed by a discussion of common themes identified from an extensive literature review. These themes are: the connection between partnership and participation; the impact of trust and power in relationships; the importance of local knowledge to understanding the local context; and understanding the capacity of communities to change. The paper concludes with a discussion of these themes and their relevance within both community and government settings. It recommends that to do justice to ideas of working in partnership to address complex social problems, such as reducing health inequalities, the theory and practice need to be considered far more carefully than they have been so far.

Over 400,000 children die annually from neonatal sepsis, despite several RCTs finding that this can be prevented by chlorhexidine cord care (CHX) for only US$0.23 per dose. Unresolved heterogeneity in findings and other RCT scalability concerns contribute to slow CHX adoption. Studying the first national CHX roll-out — in Nepal — we find that CHX reduces neonatal mortality by 56 percent for births predicted to take place at home. We find no effect for predicted health facility births, which is consistent with heterogeneity in prior experimental estimates. Conditional on predicted place of delivery, there is little significant treatment effect heterogeneity.

Nevertheless, there is still a disparity in the availability of antiretroviral therapy (ART), especially in low-and middle-income nations, due to obstacles such as financial constraints, inadequate infrastructure,and on going social stigma. The future outlook for HIV management is optimistic, as current research is dedicated to exploring innovative treatment methods such as long-acting injectable, gene editing medicines, and therapeutic vaccinations. Furthermore, progress in preexposure prophylaxis (PrEP) and other preventive measures provide optimism for decreasing the number of new infections. Furthermore, it is crucial to make endeavors towards tackling societal factors that influence health outcomes, such as poverty, education, and gender inequality, as they play a vital role in attaining long-lasting advancements in HIV prevention and care. Notwithstanding these progressions, there are still obstacles to overcome, such as the rise of drug-resistant Review Article variations, deficiencies in testing and diagnosis, and enduring social obstacles. To tackle these difficulties, a comprehensive strategy is needed that combines biological, behavioral, and structural interventions, with a focus on fairness and human rights. To reduce the impact of HIV/AIDS on society and achieve the objective of ending the epidemic, it is important to continue investing in research, improving health systems, and promoting collaboration across all sectors.

Identifying mortality differentials between occupational classes requires information on a very large sample of people tracked over a long period. To study these differentials, in 1954, INSEE (National Institute for Statistics and Economic Studies) assembled an initial sample of nearly 500,000 men aged 30-69 (and their spouses) from all occupational classes in order to observe their subsequent mortality via the national register of physical individuals. The operation was repeated in the 1975 census for more than 800,000 men and women aged 30-64, and again in later censuses. The results show that mortality differentials by occupational class in France have not narrowed and are actually widening. One serious limitation of these studies is that they "freeze" people in an occupational class, without being able to measure the effect of occupational moves on mortality. Emmanuelle CAMBOIS and Caroline LABORDE partly overcome this limitation by using INSEE's permanent demographic sample (Échantillon démographique permanent, EDP) to identify earlier occupational moves by people aged 30-84 in 1975 and in 1999. The authors fi nd a strong correlation between these moves and subsequent mortality. "Downward" moves are most often associated with excess mortality, particularly for men, but also -in recent years -for women. * Institut national d'études démographiques, Paris. ** Attached to INED at the time of the study.

This paper investigates the distribution of well being among world citizens during the last two centuries. The estimates show that inequality of world distribution of income worsened from the beginning of the 19th century to World War II and after that seems to have stabilized or to have grown more slowly. In the early 19th century most inequality was due to differences within countries; later, it was due to differences between countries. Inequality in longevity, also increased during the 19th century, but then was reversed in the second half of the 20th century, perhaps mitigating the failure of income inequality to improve in the last decades.

Action for Children commissioned a research team at King’s College London to evaluate the impact of Action for Children Children’s Centres on outcomes for vulnerable children. The study took place during 2010-11. Within the wider context of early intervention to meet wider family support needs, the study also addressed key topics including health, inter-agency collaboration; access to services; and the role of outreach. The study period coincided with robust public and political debate around the allocation of public spending, alongside an extensive review of services and outcomes for children and young people, through five parallel reviews.1 Proposed developments in the configuration of community health services for children and their families, put a spotlight on the existing and potential contribution of Children’s Centres to undertake the co-ordination of services, as well as have a positive impact on child outcomes, alongside supporting workforce recruitment and retention; and t...

Objectives: Inequalities in health and educational outcomes in Scotland show a strong and persistent socioeconomic status gradient. Our aims were to provide policy-makers with a synthesis of international research evidence that assesses the effectiveness of early childhood interventions aimed at equitably promoting cognitive and social development and suggest potential areas for action in Scotland. Methods: A rapid review was conducted of review level studies of early childhood interventions with outcome measures relating to child cognitive-language or social-emotional development, subsequent academic and life achievement. Websites were searched and interviews were conducted to identify relevant interventions, policies and programmes delivered in Scotland. Results: Early childhood intervention programmes can reduce disadvantage due to social and environmental factors. Scottish health policy demonstrates a clear commitment to early childhood development but much work remains in terms of detail of policy implementation, identification of high risk children and families, and early childhood monitoring systems. Conclusions: Programmes should provide a universal seamless continuum of care and support from pregnancy through to school entry with the intensity of support graded according to need. The current information systems in Scotland would be inadequate for monitoring the effects of early childhood interventions especially in relation to cognitive-language and social-emotional development.

This study sought to ascertain whether disagreement between patients and physicians on the patients' health status varies according to patients' education level. INTERMEDE is a cross-sectional multicentre study. Data were collected from both patients and doctors via pre-and post consultation questionnaires at the GP's office over a two-week period in October 2007 in 3 regions of France. The sample consists of 585 eligible patients (61% women) and 27 GPs. A significant association between agreement/disagreement between GP and patient on the patient's health status and patient's education level was observed: 75% of patients with a high education level agreed with their GP compared to 50% of patients with a low level of education. Patients and GPs disagreed where patients with the lowest education level said that their health was worse relative to their doctor's evaluation 37% of the time, versus 16% and 14% for those with a medium or high education level respectively. A multilevel multivariate analysis revealed that patients with a low educational level and medium educational level respectively were at higher risk of being overestimated by GP's in respect of self-reported health even if controlling for confounders. These findings suggest that people with a lower education level who consider themselves to have poor health are less reliably identified as such in the primary care system. This could potentially result in lack of advice and treatment for these patients and ultimately the maintenance of health inequalities.

The way in which patients and their doctors interact is a potentially important factor in optimal communication during consultations as well as treatment, compliance and follow-up care. The aim of this multidisciplinary study is to use both qualitative and quantitative methods to explore the 'black box' that is the interaction between the two parties during a general practice consultation, and to identify factors therein that may contribute to producing health inequalities. This paper outlines the original multidisciplinary methodology used, and the feasibility of this type of study. The study design combines methodologies on two separate samples in two phases. Firstly, a qualitative phase collected ethnographical and sociological data during consultation, followed by in-depth interviews with both patients and doctors independently. Secondly, a quantitative phase on a different sample of patients and physicians collected data via several questionnaires given to patients and doctors consisting of specific 'mirrored' questions asked post-consultation, as well as collecting information on patient and physician characteristics. The design and methodology used in this study were both successfully implemented, and readily accepted by doctors and patients alike. This type of multidisciplinary study shows great potential in providing further knowledge into the role of patient/physician interaction and its influence on maintaining or producing health inequalities. The next challenge in this study will be implementing the multidisciplinary approach during the data analysis.

L’échantillon, un sous-groupe de la population de référence par lequel les résultats d’une enquête sont généralisés, fait intervenir des calculs arithmétiques. Les auteurs Cochran et Krejcie & Morgan proposent deux formules de calcul pour déterminer la taille d’un échantillon. Pour mettre en mouvement ces deux formules, nous optons pour deux approches dans quatre quartiers d’une commune de la ville de Yaoundé. Les calculs s’appuient sur des données censitaires et les proportions de la population-mère en adoptant par défaut une marge d’erreur de 5 % et un niveau de confiance de 95 %. La première approche obtient un échantillon des ménages pour identifier les modes de cuisson alimentaire. La finalité est de proposer des solutions de cuisson propre axés sur des Financements Basés sur des Résultats (FBR) de l’enquête et de l’analyse. La deuxième est relative à l’utilisation du mode de transport actif comme moyen de déplacement pour les personnes âgées entre 15 et 59 ans. La distribution de l’échantillon par quartier correspondant au poids démographique de chaque quartier s’obtient en trouvant un pourcentage de distribution. Ce dernier affecte à chaque quartier le nombre minimum de répondants au questionnaire issue de l’échantillon.

Editor-Torgerson and Gosden argue that eliciting public views on healthcare priority setting is a waste of money. 1 It is implicit in their argument that the many health economists who dabble in this allegedly inefficient activity should know better. As health economists and practitioners of the dark art of including the public in priority setting, we believe that we ought to respond to this charge. The problem with Torgerson and Gosden's argument is that it does not distinguish between facts and values. It seems reasonable to assume that patients normally know less than clinicians about the facts concerning the effects of different treatments. As Torgerson and Gosden argue, this form of asymmetric information is one reason why many British health economists believe that public funding of health care is more efficient than private funding, which provides clinicians with a profit motive for supplying unnecessary treatments to illinformed patients. Torgerson and Gosden assert that patients generally know less than specialists about the "facts" concerning the effects of alternative priority setting decisions, and they conclude that setting priorities on the basis of ill-informed opinions is inefficient. What Torgerson and Gosden do not recognise, however, is the possibility that patients generally know more than specialists about their own values concerning their health and the health of others. This kind of asymmetrical information can lead well meaning clinicians, managers, and policymakers to provide inefficient healthcare services, poorly in tune with patients' values. That is why health economists have devoted considerable energy to developing methods of valuing the effects of treatments from the patient's point of view. That is also why health economists are now devoting energy to developing methods of consulting patients about their values concerning priority setting. Asymmetrical information about facts can cause inefficiency in a private system, which is why we need a public system. Asymmetrical information about values can cause inefficiency in a public system, which is why we need to include the public in healthcare priority setting. Efficient decision making requires the use of best available information about facts and values. Our experience in conducting preference elicitation studies suggests that asking the taxpayer can be a fruitful source of information about the latter-and that public opinions are more sophisticated, and less predictable, than Torgerson and Gosden like to think.

The aim of this study is to investigate the relationships between social roles, social position and health in English women using theoretically derived measures of social position. Data are taken from the Health and Lifestyle Survey, carried out between 1984±1985, and the Health Survey for England of 1993. First the paper asks whether health inequality in women is still evident when theoretically derived measures (the Erikson±Goldthorpe schema and the Cambridge scale) are used. It goes on to explore the extent to which dierent combinations of family roles and employment circumstances might aect social variations in health. Finally, the paper shows that health dierences between women in dierent combinations of social roles were not the same in 1993 as in 1984 and examines some reasons why this change may have occurred.