The Role of Health Inequality in the Maternal Health Services Provided by Public Institutions in Mexico

This work aims to determine the role of inequality in the provision of maternal health services among five regions in Mexico (northwest, northeast, central, the Mexico City-State of Mexico region and the south). We consider the most important service providers corresponding to the main health institutions in Mexico (IMSS, ISSSTE, SESAS, IMSS-Oportunidades). Therefore, a cross-sectional prospective study was conducted to analyze eight intervention packages (Prenatal Care, Syphilis, Influenza, Obstetric Urgent Care, HIV in pregnancy, delivery care, neonatal care and accessibility) offered by the Maternal and Perinatal Health (MPH) program. A quantitative analysis demonstrates low to marginal performance of the MPH program in three regions (South, Mexico City-State of Mexico and the Northwest) and marginal in two other regions (Central and Northeast). Furthermore, four of the intervention packages presented the lowest performance in the South (Prenatal Care, Syphilis, Influenza and Obstetric Urgent Care), as did the average of the total of the MPH packages. The performance of HIV in Pregnancy package was marginal in the Southern and Mexico City-State of Mexico regions and Neonatal Care was low in the Northwest. The assessment of the MPH intervention packages allows us to identify their strengths and weaknesses. This information allows us to identify similarities and differences among the geographical regions in order to describe and analyze the strengths, weaknesses, opportunities and threats in the current system and hence to improve the decision making regarding the Maternal and Perinatal Health Programs in Mexico. The results suggest that a homogenization has taken place in terms of the low quality of the services.

The Health Inequality between the Rural and Urban Area in China

China＇s accomplishments in health sector over the past decades have been internationally recognized. However, these accomplishments have disguised the deep health inequality between the urban and rural areas. This paper aims to investigate the health inequality from the perspectives of health status, health care utilization and health insurance on the basis of statistic data. Finally, the authors propose some advices of addressing the inequality.

Community-Based Hepatitis B Campaign in Asian Americans

Chronic hepatitis B (CHB) disproportionately affects minority groups in the US, particularly Asian Americans, with numerous factors contributing to this disparity. Of the 2.4 million people living with chronic HBV in the US, 60% are Asian American. Many are unaware of their status and lack access to proper clinical care, with less than ten percent receiving necessary antiviral treatment. Barriers to screening and care include lack of disease awareness, language and cultural barriers, and financial constraints. Additionally, healthcare providers and systems in the US often overlook the importance of CHB, leading to inadequate care. In response, the Center for Viral Hepatitis (CVH) has implemented a community-based outreach program over the past sixteen years, employing a multifaceted approach involving all sectors of society and various organizations to combat health disparities in CHB. This grassroots campaign has proven highly effective, leveraging CVH’s leadership in spearheading numerous collaborative activities with community members, healthcare professionals, and policymakers. We have summarized the key points of CVH's efforts and their significance in combating CHB-related health disparities. The CHB Screening and Awareness Campaign, tailored to the Asian American community, serves as a successful model for increasing CHB screening, linkage-to-care, and addressing socio-cultural barriers and health literacy. Insights from these outreach programs have guided the development of culturally relevant resources and education initiatives. These findings suggest that such community-driven approaches are essential for addressing health disparities. The strategies and outcomes of CVH’s efforts can inform future health initiatives for other minority communities in the US and globally.

Health Inequalities during 20 Years of Rapid Economic Development in China (1980-2000):A Mortality Analysis

Objective To examine the influence of China＇s economic reforms on population health and regional mortality rates.Methods Longitudinal study measuring the mortality trends and their regional variations.Using data from the three most recent national censuses,we used the model life table to adjust the mortality levels within the population for each census,and to calculate life expectancy.We then examined the variation in patterns of mortality and population health by economic status,region and gender from 1980-2000.Results Life expectancy varied with economic status,province,and gender.Results showed that,although life expectancy in China had increased overall since the early 1980s,regional differences became more pronounced.Life expectancy for populations who live in the eastern coastal provinces are greater than those in the western regions.Conclusion Differences in life expectancy are primarily related to differences in regional economic development,which in turn exacerbate regional health inequalities.Therefore,it is necessary to improve economic development in less developed regions and to improve health policies and the public health system that address the needs of everyone.

Inequity in the global distribution of monkeypox vaccines

Monkeypox(mpox)has been a public health emergency of international concern that emerged in mid-2022 and has spread to 110 countries.The clinical findings of the disease vary according to the seriousness of the cases.Although its case fatality risk has not been high,a significant percentage of patients require hospitalization.In this context,local initiatives were taken to extend the limited supply of vaccines against the disease;however,such measures have not been sufficient to contain the spread of cases and ensure an equitable distribution of health resources.As a result,endemic regions of low-income countries continue to have insufficient access to mpox vaccination.Despite this and considering the global scope of the disease,there is still little discussion in the literature about the difficulties in achieving adequate vaccination coverage rates for the target population of interest.In this article,we briefly discussed general aspects of the disease,including its surveillance,the current global context of challenges for mpox vaccination,and issues on global allocation of health resources as well as proposed related recommendations.

Inequality in historical transboundary anthropogenic PM_(2.5) health impacts

Atmospheric transport of fine particulate matter(PM_(2.5)),the leading environmental risk factor for public health,is estimated to exert substantial transboundary effects at present.During the past several decades,human-produced pollutant emissions have undergone drastic and regionally distinctive changes,yet it remains unclear about the resulting global transboundary health impacts.Here we show that between 1950 and 2014,global anthropogenic PM_(2.5)has led to 185.7 million premature deaths cumulatively,including about 14%from transboundary pollution.Among four country groups at different affluence levels,on a basis of per capita contribution to transboundary mortality,a richer region tends to exert severer cumulative health externality,with the poorest bearing the worst net externality after contrasting import and export of pollution mortality.The temporal changes in transboundary mortality and cross-regional inequality are substantial.Effort to reduce PM_(2.5)-related transboundary mortality should seek international collaborative strategies that account for historical responsibility and inequality.

Diabetes and COVID-19:Diseases of racial,social and glucose intolerance

Diabetes and coronavirus disease 2019(COVID-19)are worldwide pandemics that have had a major impact on public health throughout the globe.Risk factors for developing diabetes and having adverse outcomes of COVID-19 appear to be similar;metabolic factors(such as obesity),non-White ethnicity and poorer socioeconomic status appear to be risk factors for both.Diabetes and COVID-19 have a significant effect on populations adversely affected by health inequality.Whilst we hope that COVID-19 will be mitigated by widespread use of vaccines,no such prospect exists for mitigating the pandemic of diabetes.In this brief opinion review,I compare risk factors for diabetes and adverse outcomes of COVID-19 and argue that tackling health and social inequality is likely to play a major role in solving the global diabetes pandemic and improve outcomes of COVID-19.

A cross-sectional study of the relationships between ethnicity and occupational classes with mental wellbeing in the UK

Various aspects of a job (e.g. contract clauses, promotion, wages, job security and workplacehierarchy) are becoming increasingly complex and have some effect on an employee’s wellbeing. Simultaneously,research about an increase in mental health issues due to workplace obstacles for ethnic minorities is amassing butthere is a lack of policymaking to tackle this via accessible mental health support at the workplace. My study aimsto assess the effect of occupational class and ethnicity on wellbeing in the UK working population. Methods: Thestudy assessed 3,374 adult employees who participated in the Health Survey for England from 2014–2016 and werecategorised in 1/3 National Statistics Socio-economic Classification groups. The Warwick-Edinburgh MentalWellbeing Scale was used as a measure of mental wellbeing. I explored the relationship between occupational classand wellbeing score using linear regression, accounting for demographic and socioeconomic covariates: age, sex,income and education. My sample’s ethnicity breakdown was White: 3,051;Black: 83;Asian: 180;Mixed: 39;Other:21 adults. Results: Of the sample, 46.8% of adults belonged to managerial and professional occupations and 90.4%were of White ethnicity. Managerial and professional occupations had a higher mean wellbeing score (48.54;P <0.001) than routine and manual occupations (47.69;P < 0.05). Multiple ethnic background showed the highest meanwellbeing score (52.82;P < 0.05), compared to White adults with the lowest wellbeing score (48.57;P << 0.001).Unlike occupational class which had a small effect size (partial eta-squared = 0.02), when holding education, income,age and sex constant, ethnicity had a statistically significant association with wellbeing. Conclusion: White ethnicityand routine and manual occupations are high-risk groups for poor mental wellbeing. The impact of ethnicity andoccupational class on wellbeing scores remained after accounting for socioeconomic and demographic factors.

The Strategy to Encourage the Bed Ridden Paraplegic Patient to Keep Fit at Home with the Development of Exercise Machine

Major drawbacks in caring for patients with physical limitations is that the conventional machines being used in most hospitals look like cages and the features and functions are not convenient for the user at home. As a result, the bed ridden paraplegic patients are unable to use the machines contenfly. The aim of this research is to show a solution to earing for bed ridden paraplegic patients, in order for them to keep fit at home, and to develop the exercise machine based on the disabled patients＇ needs--focusing on, full function, strength, safety and its practical usage. The method of study consists of five steps as follows： （1） home visiting for collecting general data, （2） checking the patient＇s ability and surveying patient＇s requirement, （3） setting ultimate goals from multi-professionals including family physician, rehabilitation doctor, physiotherapist, nurses and engineers, （4） designing the machine using software and building the prototype, and （5） testing a machine at the patient＇s home. The result of satisfaction after re-strengthening for a month was compared, at different times, between two disabled male patients of different ages and level of spine injury using two different types of exercise machines： MODEL1 and 2. One solution in dealing with health problems of the bed ridden paraplegic patients is a well-developed exercise programme from the multidisciplinary team. This helps the patients to exercise as suggested by diet, mental health support, as well as, exercise equipment which can provide many other benefits to bed ridden paraplegic patients. Moreover, with the development of the exercise machine, corrects inequality in health for handicap patients, specifically to tantamount with normal patients.

State extractive capacity,policy orientation,and inequity in the financing and delivery of health care in urban China

This paper explores how the Chinese government＇s reluctance/inability to invest in health has influenced the performance of its health system in the context of urban China. It focuses on two related issues. To what extent is the financing of the health care system progressive？ To what extent is the utilization of health care services equitable？ Section I explains why the Chinese government has become less willing and able to bear the burden of health care during the era of economic reform and inspects the impacts of these changes on the structure of overall health expenditure. The following two sections empirically examine the extent to which the shift toward out-of-pocket spending has made health care less accessible and less affordable for the poor and vulnerable. Section IV explores how inequity in health care and health services has put groups of people who are already socially disadvantaged at more disadvantaged positions. The study finds that the market-oriented health reform in urban China has exacerbated the cost problem that it intended to solve, reduced access to health services for the most vulnerable, and increased the instances of illness-induced poverty.

Primary care clinicians’ strategies to overcome financial barriers to specialty health care for uninsured patients

Objective:This study describes strategies used by federally qualified health centers(FQHCs)to assist medically uninsured patients in obtaining specialty health care services.Methods:Qualitative methods were used to study strategies for obtaining specialty health care for uninsured patients.Data were gathered from 10 primary care clinicians at three FQHC clinics by means of 10 semistructured interviews,23 brief interviews,and 45 h of direct observations.We captured additional data by studying cases of referred uninsured patients.Results:The following six strategies were identified:(1)quid pro quo-a specialist accept-ing the clinic’s medically uninsured patients was rewarded with referrals of the clinic’s insured patients;(2)over referral-clinicians referred insured patients whose needs could have been met at the FQHC;(3)brief hospitalization-when a specialist could not be obtained,high-risk patients were briefly hospitalized;(4)case building-diagnostic tests were conducted at the FQHC to justify a referral;(5)direct communication-communication between clinicians and specialists was neces-sary when requesting a referral;(6)specialty clinics-in return for conducting a specialty clinic at the FQHC,the specialist received all referrals of insured patients.Conclusion:Uninsured FQHC patients encountered difficulties accessing specialty health care,and in response,clinicians developed a range of innovative strategies.

Disparities in chiropractic utilization by race,ethnicity and socioeconomic status:A scoping review of the literature

Background Chiropractic is the largest complementary and alternative medicine profession in the United States,with increasing global growth.A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles.Objective There have been no prior studies to comprehensively integrate the literature on chiropractic utilization rates by race,ethnicity,and socioeconomic status.The purpose of this scoping review is to identify and describe the current state of knowledge of chiropractic utilization by race,ethnicity,education level,employment status,and income and poverty level.Search strategy Systematic searches were conducted in PubMed,Ovid MEDLINE,Cumulative Index of Nursing and Allied Health Literature(CINAHL),Cochrane Database of Systematic Reviews,and Index to Chiropractic Literature from inception to May 2021.Inclusion criteria Articles that reported race or ethnicity,education level,employment status,income or poverty level variables and chiropractic utilization rates for adults(≥18 years of age)were eligible for this review.Data extraction and analysis Data extracted from articles were citation information,patient characteristics,race and ethnicity,education level,employment status,income and poverty level,and chiropractic utilization rate.A descriptive numerical summary of included studies is provided.This study provides a qualitative thematic narrative of chiropractic utilization with attention to race and ethnicity,education level,income and poverty level,and employment status.Results A total of 69 articles were eligible for review.Most articles were published since 2003 and reported data from study populations in the United States.Of the race,ethnicity and socioeconomic categories that were most commonly reported,chiropractic utilization was the highest for individuals identifying as European American/White/non-Hispanic White/Caucasian(median 20.00%;interquartile range 2.70%-64.60%),those with employment as a main income source(median utilization 78.50%;interquartile range 77.90%-79.10%),individuals with an individual or household/family annual income between$40,001 and$60,000(median utilization 29.40%;interquartile range 25.15%-33.65%),and individuals with less than or equal to(12 years)high school diploma/general educational development certificate completion(median utilization 30.70%;interquartile range 15.10%-37.00%).Conclusion This comprehensive review of the literature on chiropractic utilization by race,ethnicity and socioeconomic status indicates differences in chiropractic utilization across diverse racial and ethnic and socioeconomic populations.Heterogeneity existed among definitions of key variables,including race,ethnicity,education level,employment status,and income and poverty level in the included studies,reducing clarity in rates of chiropractic utilization for these populations.