Addressing Health Equity in Public Health Practice: Frameworks, Promising Strategies, and Measurement Considerations

Liburd, Leandris; Hall, Jeffrey E.; Mpofu, Jonetta J.; Williams, Sheree Marshall; Bouye, Karen; Penman-Aguilar, Ana

doi:10.1146/annurev-publhealth-040119-094119

Cited by 82 publications

(81 citation statements)

References 60 publications

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“…The present study’s results should be interpreted in light of these generalizability restrictions. There is a plethora of evidence showing how the current medical systems in place disproportionately negatively affect certain marginalized populations ( Liburd et al, 2020 ). The present work generally fails to include these populations, and more research is indicated to better understand the impact of the pandemic within these populations.…”

Section: Discussionmentioning

confidence: 99%

Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder

et al. 2021

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ObjectiveThe novel coronavirus (2019; CV-19) is linked to increases in emotional distress and may be particularly problematic for those with pre-existing mental and physical conditions, such as chronic pain and posttraumatic stress disorder (PTSD). However, little empirical research has been published on resilience factors in these individuals. The present study aims to examine authenticity as a resilience factor among those with chronic pain and/or PTSD.MethodsPrior to the national response to the pandemic (January 10-24, 2020), participants were screened for pain-related disability (Oswestry Disability Index; ODI) and PTSD symptoms (Posttraumatic Checklist for DSM-5; PCL-5), and on the basis of those responses were categorized into one of four groups: healthy, chronic pain only, PTSD only, or comorbid chronic pain and PTSD. During the CV-19 pandemic (May 5-May 13, 2020), participants responded again to the ODI and PCL-5, in addition to the Wood Authenticity Scale, Brief Pain Inventory, and items related to the CV-19 pandemic.ResultsA total of 110 participants (54.55% women), aged 42.19 (SD = 13.16), completed the survey during the pandemic. The comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Authenticity moderated this relationship relevant to CV-19 Threat among those in the chronic pain only group, and not in any other group.ConclusionThe comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Importantly, greater authenticity was associated with less CV-19 Threat in the chronic pain only group, and not in any other group. The present study also highlights the importance of engaging authentically for those with chronic pain during the pandemic.

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Section: Discussionmentioning

confidence: 99%

Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder

et al. 2021

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“…Moreover, this highlights the need for formal adoption of a health equity lens at the systems level to anchor all aspects of the health equity agenda, including the critical aspect of prioritization. This must be a comprehensive lens that operates through recognition of and attention to the multiple intersecting sources of oppression and enactment of these within institutional structures that create inequities, as well as recognition of how power and privilege operate within health systems prioritization [24,62,63].…”

Section: Discussionmentioning

confidence: 99%

“…Careful consideration of how economic arguments, including costs effectiveness analyses, might be structured to explicitly weigh health equity is a potential strategy for attempting to counter this [ 58 – 60 ]. Development of health equity indicators and surveillance measures, including those related to structural determinants, are needed to demonstrate burden and gradients in health outcomes [ 61 , 62 ]. Moreover, this highlights the need for formal adoption of a health equity lens at the systems level to anchor all aspects of the health equity agenda, including the critical aspect of prioritization.…”

Section: Discussionmentioning

confidence: 99%

Values are not enough: qualitative study identifying critical elements for prioritization of health equity in health systems

Roode

Pauly

Marcellus

et al. 2020

Int J Equity Health

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Background Health system policies and programs that reduce health inequities and improve health outcomes are essential to address unjust social gradients in health. Prioritization of health equity is fundamental to addressing health inequities but challenging to enact in health systems. Strategies are needed to support effective prioritization of health equity. Methods Following provincial policy recommendations to apply a health equity lens in all public health programs, we examined health equity prioritization within British Columbia health authorities during early implementation. We conducted semi-structured qualitative interviews and focus groups with 55 senior executives, public health directors, regional directors, and medical health officers from six health authorities and the Ministry of Health. We used an inductive constant comparative approach to analysis guided by complexity theory to determine critical elements for prioritization. Results We identified seven critical elements necessary for two fundamental shifts within health systems. 1) Prioritization through informal organization includes creating a systems value for health equity and engaging health equity champions. 2) Prioritization through formal organization requires explicit naming of health equity as a priority, designating resources for health equity, requiring health equity in decision making, building capacity and competency, and coordinating a comprehensive approach across levels of the health system and government. Conclusions Although creating a shared value for health equity is essential, health equity - underpinned by social justice - needs to be embedded at the structural level to support effective prioritization. Prioritization within government and ministries is necessary to facilitate prioritization at other levels. All levels within health systems should be accountable for explicitly including health equity in strategic plans and goals. Dedicated resources are needed for health equity initiatives including adequate resourcing of public health infrastructure, training, and hiring of staff with equity expertise to develop competencies and system capacity.

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“…Liburd Leandris C (2020) et al supposed that government public health plays a core role in promoting the realization of the highest level of health for all people, including seeking fair access to high-quality health facilities, drugs, commodities and services. All functional departments of the public health system can strengthen cooperation to increase the opportunity for citizens to obtain the best health [17]. Xueshan Sun (2018) et al measured health equity from the perspective of health demand and medical seeking behavior [18].…”

Section: Introductionmentioning

confidence: 99%

Can health service equity alleviate the health expenditure poverty of Chinese patients? Evidence from the CFPS and China health statistics yearbook

Tang

Yao

et al. 2021

BMC Health Serv Res

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Objectives To comprehend the relationship between various indicators of health service equity and patients’ health expenditure poverty in different regions of China, identify areas where equity in health service is lacking and provide ideas for improving patients’ health expenditure poverty. Method Data from China Family Panel Studies (CFPS) in 2018 and the HFGT index formula were used to calculate the health expenditure poverty index of each province. Moreover, Global Moran’s I and Local Moran’s I test are applied to measure whether there is spatial aggregation of health expenditure poverty. Finally, an elastic net regression model is established to analyze the impact of health service equity on health expenditure poverty, with the breadth of health expenditure poverty as the dependent variable and health service equity as the independent variable. Results In the developed eastern provinces of China, the breadth of health expenditure poverty is relatively low. There is a significant positive spatial agglomeration. “Primary medical and health institutions per 1,000 population”, “rural doctors and health workers per 1,000 population”, “beds in primary medical institutions per 1,000 population”, “proportion of government health expenditure” and “number of times to participate in medical insurance (be aided) per 1,000 population” have a positive impact on health expenditure poverty. “Number of health examinations per capita” and “total health expenditure per capita” have a negative impact on health expenditure poverty. Both effects passed the significance test. Conclusion To enhance the fairness of health resource allocation in China and to alleviate health expenditure poverty, China should rationally plan the allocation of health resources at the grassroots level, strengthen the implementation of hierarchical diagnosis and treatment and encourage the investment in business medical insurance industry. Meanwhile, it is necessary to increase the intensity of medical assistance and enrich financing methods. All medical expenses of the poorest should be covered by the government.

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Addressing Health Equity in Public Health Practice: Frameworks, Promising Strategies, and Measurement Considerations

Cited by 82 publications

References 60 publications

Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder

Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder

Values are not enough: qualitative study identifying critical elements for prioritization of health equity in health systems

Can health service equity alleviate the health expenditure poverty of Chinese patients? Evidence from the CFPS and China health statistics yearbook

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