Integrated Approaches to Address the Social Determinants of Health for Reducing Health Inequity

Barten, Francoise; Mitlin, Diana; Mulholland, Catherine; Hardoy, Ana; Stern, Ruth

doi:10.1007/s11524-007-9173-7

Cited by 46 publications

(21 citation statements)

References 21 publications

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“…Social and physical environments have been recognized as important determinants of health [ 1 , 2 ]. In Africa, rapid urbanization has changed disease patterns.…”

Section: Introductionmentioning

confidence: 99%

Urban Planning and Health Inequities: Looking in a Small-Scale in a City of Cape Verde

et al. 2015

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BackgroundThe lack of high-quality data to support evidence-based policies continues to be a concern in African cities, which present marked social, economic and cultural disparities that may differently impact the health of the groups living in different urban contexts. This study explores three urban units—formal, transition and informal—of the capital of Cape Verde, in terms of overweight/obesity, cardiometabolic risk, physical activity and other aspects related to the urban environment.MethodsQuantitative and qualitative research methods were used in this intra-urban study. A proportional stratified random sample (n = 1912 adults), based on geographical coordinates of private households, was selected to apply the UPHI-STAT questionnaire. In a second stage (n = 599), local nutritionists collected anthropometric measurements (e.g., height, waist circumference) and body composition by bioelectric impedance (e.g., body weight, body fat, muscle mass). In a third stage, pedometers were used to count study participants’ steps on working and non-working days for one week (n = 118). After a preliminary statistical analysis, a qualitative study was developed to complement the quantitative approach. Generalized linear models, among others, were used in the multivariate analysis.ResultsInsecurity was the main concern among survey respondents in the three units, notwithstanding with significant differences (p < 0.001) among units. About three-quarters (76.6%) of the participants of the informal unit emphasised the need for more security. The formal unit presents an older age structure (61.3% above 40 years old) and the transition unit a younger age structure (only 30.5% above 40 years old). Some health-related variables were analysed in each unit, revealing an excess of chronic conditions reported by inhabitants of informal unit, compared with the formal unit despite the informal unit’s younger age profile. The self-reported hypertension varied significantly among urban units (p < 0.001), with 19.3% in the formal unit, 11.4% in the transition unit and 22.5% in the informal unit. Women of the urban units present significant differences (5% level) for body mass index calculated from self-reported measures (p < 0.001), fat mass (p = 0.005), waist circumference (p = 0.046) and waist-to-height ratio (p = 0.017). For women, overall physical activity was 67.4% (95%CI [64.8,70.0]), with differences among urban units (p = 0.025). For men it was of 85.2% (95%CI [82.3,87.6]), without significant differences among urban units (p = 0.266). The percentage of women and men who reported physical activity in leisure time was discrepant, with 95%CI [22.6, 27.4] and [53.2, 60.2], respectively. The results of pedometers also indicated that men walk significantly more than women (p < 0.001), with a difference of approximately 2000 steps/day.ConclusionsThe data collection process itself also gave us some clues on the involvement of local communities, exploring the potential of social capital of these settings and the role of the woman in famil...

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“…Social and physical environments have been recognized as important determinants of health [ 1 , 2 ]. In Africa, rapid urbanization has changed disease patterns.…”

Section: Introductionmentioning

confidence: 99%

Urban Planning and Health Inequities: Looking in a Small-Scale in a City of Cape Verde

et al. 2015

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“…Context-specific, complex, and process-oriented approaches such as intersectoral action require similarly appropriate mechanisms for assessing impact [ 6 , 50 ]. The complexity of evaluating the impact of intersectoral action on the SDH to improve health equity calls for more rigorous approaches to evaluate intersectoral action along a continuum, taking into account intersectoral processes, and the implementation and health equity impacts of interventions.…”

Section: Discussionmentioning

confidence: 99%

Intersectoral action for health equity: a rapid systematic review

Ndumbe-Eyoh¹,

Moffatt²

2013

BMC Public Health

102

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BackgroundAction on the social determinants of health is considered a necessary approach to improving health equity. Most of the social determinants of health lie outside the sphere of the health sector and thus collaboration with governmental and non-governmental sectors outside of health are required to develop policies and programs to improve health equity. Case studies of intersectoral action are available, however there is limited information about the impact of intersectoral action on the social determinants of health and health equity.MethodsSearch and retrieval of literature published between 2001 and 2011 was conducted in 6 databases. A staged screening of titles and abstracts, and later full-text, was conducted by two independent reviewers. Reviewers independently assessed the quality of the articles deemed relevant for inclusion. Data were extracted and synthesized in narrative format for all included studies, conducted by one reviewer and checked by another.Results17 articles of varied methodological quality met the inclusion criteria. One systematic review investigating partnership interventions found mixed and limited impacts on health outcomes. Primary studies evaluating the impact of upstream and midstream interventions showed mixed effects. Downstream interventions were generally moderately effective in increasing the availability and use of services by marginalized communities.ConclusionsThe literature evaluating the impact of intersectoral action on health equity is limited. The included studies identified reveal a moderate to no effect on the social determinants of health. The evidence on the impact of intersectoral action on health equity is even more limited. The lack of evidence should not be interpreted as a lack of effect. Rigorous evaluations of intersectoral action are needed to strengthen the evidence base of this public health practice.

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“…Smaller income differences, more trusts of one another, and greater participation in communal activities would lead to lower overall mortality rates [ 44 ], better self-rated health [ 45 ], and less psychological distress [ 18 ]. Barten et al argued for long term multi-sectorial approaches to address the social determinants of health in urban settings and adopted a multiple levels approach tackling issues of governance, the politics of power, decision making, and empowerment [ 46 ]. Tackling health inequities is a political imperative which requires leadership, political courage, social action, and a sound evidence-based and progressive public policy [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

Health Disparity Still Exists in an Economically Well-Developed Society in Asia

et al. 2015

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BackgroundThe socioeconomic inequalities in child health continue to widen despite improved economy.ObjectiveTo investigate the correlation between socio-economic factors and health risk behaviors and psychosocial well-being of children in Hong Kong.HypothesisThe null hypothesis is that for this particular developed region, there exists little or no correlation between social-economic factors and health risk behaviors and psychosocial well-being of children.DesignCross sectional territory wide survey.ParticipantsCaregivers of 7,000 children in kindergartens in Hong Kong.Measuring toolsYouth Risk Behavior Surveillance questionnaire, health-related knowledge and hygienic practice questionnaire, and Children Behavior Checklist (CBCL).ResultsChildren were less likely to have somatic complaints and anxiety/depression as reflected by CBCL scores coming from families of higher income, not being recipients of social assistance, with fathers in employment, and with higher parental education. Children with only mother or father as caretakers had lower odds ratios (ORs) 0.71 (95% CI 0.58-0.89) and 0.53 (95% CI 0.33-0.84) respectively to have the habit of eating breakfast, whilst parental education at post-secondary level and higher family income had higher ORs 1.91 (95% CI 1.31-2.78), and 1.63 (95% CI 1.11-2.39). Fathers unemployed, relatives as main caretakers and living in districts with low median household inome incurred higher ORs, as 1.46 (95% CI 1.10-1.94),1.52 (95% CI 1.27-1.83) and 1.17 (95% CI 1.02-1.34) respectively, of watching television over two hours daily, whilst children with parental education at secondary level or above incurred lower OR 0.33 (95% CI 0.24-0.45). Children with parental education at post-secondary level and higher family income had lower ORs of 0.32 (95% CI 0.48-0.97) and 0.52 (95% CI 0.34-0.79) respectively, with regard to exposing to passive smoking, and reversed for those living in districts with lower median household income, lower family income and recipient of CSSA with ORs 1.24 (95% CI 1.06-1.44) and 1.6 (95% CI 1.09-2.37) respectively.ConclusionNull hypothesis was not supported. A strong gradient was still found to exist among different socio-economic groups for various health-related behaviors in developed society like Hong Kong.

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Integrated Approaches to Address the Social Determinants of Health for Reducing Health Inequity

Cited by 46 publications

References 21 publications

Urban Planning and Health Inequities: Looking in a Small-Scale in a City of Cape Verde

Urban Planning and Health Inequities: Looking in a Small-Scale in a City of Cape Verde

Intersectoral action for health equity: a rapid systematic review

Health Disparity Still Exists in an Economically Well-Developed Society in Asia

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