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.

Structural Gender Inequality and Mental Health among Chinese Men and Women

Little is known about the association between structural gender inequality and health in patriarchal China.This study employed a sample from the Chinese Women’s Social Status,consisting of 26,139 participants aged 18 and 70 years(13,494 women and 12,645 men).Structural gender inequality was assessed at the macro-,meso-,and micro-levels.Mental health was measured by the summed scores of eight questions on depressive symptoms.Multilevel linear regression was applied for analysis.Results showed that total sex ratio at birth was associated with poorer mental health among women and men but sex ratio at birth of the second-born child predicted better mental health.Gender inequality at meso-level resulted in poorer mental health and gender inequality at micro-level was associated with poorer mental health both for men and women.Eliminating structural gender inequality promotes populations’mental health in China.

Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention(CDCs) System in China, 2008–2017

Objective Allocation of human resources to address inequalities in the public health system has increasingly attracted societal and political attention.Using the Centers for Disease Control and Prevention(CDCs)system of China as an example,we evaluated inequality in the public health workforce distribution across different regions in China between 2008 and 2017,with the aim of providing information for policymakers to support resource allocation and address growing health inequities.Methods We used three standard public health workforce inequality indices-Gini coefficient,Theil L,and Theil T-and spatial autocorrelation analysis to explore spatial clusters of the workforce in different provinces,visualized with geographical tools.Results The aggregate workforce-to-population ratio decreased from 1.47 to 1.42 per 10,000 population from 2008 to 2017,and was consistently lower than the National Health Commission’s(NHC)recommended critical shortage threshold of 1.75.The workforce distribution inequality indices varied by regional socioeconomic and health system development.Geographic clustering of CDCs workforce distribution was evident,with H–H and L–L clusters in western China and the Guangdong-Fujian region,respectively.Conclusions Our study addressed key issues for government and policymakers in allocation of public health human resources.There is an urgent need for careful identification of analytic questions that will help carry out public health functions in the new era,alongside policy implications for an equitable distribution of the public health workforce focusing on the western region and low–low cluster areas.

Health Care Expenditure Inequality Associated With Pollution in China

This research builds an index to describe the inequality in health care expenditure related to pollution,and the measurement with Chinese provincial data set suggests that health care expenditure inequality related to pollution is obvious negative,which confirms that residents located in high-polluted areas cannot get the better health care resources.Meanwhile,the absolute value of health care expenditure inequality related to pollution is even larger than that related to income,which suggests the inequality related to pollution cannot be ignored.

A systematic review of the inequality of health burdens related to climate change

Climate change significantly impacts human health,exacerbating existing health inequalities and creating new ones.This study addresses the lack of systematic review in this area by analyzing 2440 publications,focusing on four key terms:health,disparities,environmental factors,and climate change.Strict inclusion criteria limited the selection to English-language,peer-reviewed articles related to climate health hazards,ensuring the relevance and rigor of the synthesized studies.This process synthesized 65 relevant studies.Our investigation revealed that recent research,predominantly from developed countries,has broadened its scope beyond temperature-related impacts to encompass diverse climate hazards,including droughts,extreme weather,floods,mental health issues,and the intersecting effects of Coronavirus Disease 2019.Research has highlighted exposure as the most studied element in the causal chain of climate change-related health inequalities,followed by adaptive capability and inherent sensitivity.The most significant vulnerabilities were observed among populations with low socioeconomic status,ethnic minorities,and women.The study further reveals research biases and methodological limitations,such as the paucity of attention to underdeveloped regions,a narrow focus on non-temperature-related hazards,challenges in attributing climate change effects,and a deficit of large-scale empirical studies.The findings call for more innovative research approaches and a holistic integration of physical,socio-political,and economic dimensions to enrich climate-health discourse and inform equitable policy-making.

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.

The descriptive epidemiology of sitting in Chilean adults: Results from the National Health Survey 2009-2010

Background: Although evidence on the health effects of sedentary behavior(SB) has grown systematically in recent years, few developing countries have reported population levels of SB, especially in South America. Our objective was to describe time spent sitting in a representative sample from Chile categorized by age, gender, educational level, and body mass index(BMI).Methods: A national health survey was conducted in Chile in a nationally representative sample(n = 5411) in 2009-2010. Sitting time(ST) was measured with the Global Physical Activity Questionnaire Version 2.Results: Data were from 5031 participants(43.26±0.41 years, mean±SE; 40.3% male). Overall, there were no gender differences in mean ST(men: 158.10±5.80 min/day, women 143.45±4.77 min/day; p = 0.05). ST was lower in those who lived in rural areas compared with urban areas(99.4 min/day vs. 160.0 min/day; p = 0.001). ST increased significantly with increasing BMI, but only in men(p = 0.009), and was positively related to years of education in both men and women(p < 0.0001).Conclusion: The findings were different from those reported in other countries and contexts, reinforcing the need for international surveillance and monitoring over time to inform policy makers. Differences in ST across different groups emphasize the need to develop tailored messages and interventions for reducing ST in different population subgroups.

What Is the Role of Work-Related Factors in Self-Reported Health Inequalities among Employed Individuals? A Longitudinal Study in Luxembourg

Objectives: We measured health inequalities among employed Luxembourg residents over time and the socio-economic and work-related determinants. Design and Setting: Longitudinal data were obtained from the Socio-economic Liewen zu L&#235;tzebuerg/European Union Survey on Income and Living Conditions, which has been conducted each year since 2003 in Luxembourg. Participants: Participants comprised 727 Luxembourg residents (58% men), aged between 21 and 55 years in 2003, who were employed between 2003 and 2012. Primary and Secondary Outcomes Measured: The variable of interest was self-reported health. We used transition indicators on work-related factors to consider changes that individuals may have experienced in their job over this period. Results: People who moved from a part-time to a full-time contract (odds ratio (OR): 5.52, confidence interval (CI): 1.55 - 19.73), and those who moved from the 3rd or 4th quartile of earnings to the 1st or 2nd quartile (OR: 2.48, CI: 1.02 - 6.05) between 2003 and 2012, had a higher risk of being in poor health in 2012. The risk of deterioration in self-reported health in 2012 among people who were healthy in 2003 was associated with the type of contract, economic activity, and occupation. Conclusion: Health inequalities occur among employed people in Luxembourg. Their importance varies according to work-related characteristics and economic activity. Our findings showed that declined health status was associated with contract type, profession, and economic activity. This suggests that measures should be taken to maintain good health for people working in these specific occupations or economic sectors (e.g. preventive action, reduction of risk exposure, change of occupation in the same company, and so on).

Asian-American elders’ health and physician use: An examination of social determinants and lifespan influences

While the Asian American population is growing rapidly, relatively little research has focused on intergroup health comparisons. The application of the life course perspective sheds new light on the inter-section of the ageing process and social determinants of health. This study compares physician use and health equity among Asian ethnic groups and non-Hispanic Whites. Data on Asian American and non-Hispanic White immigrants over 65 were extracted from the California Health Interview Survey. Weighted logistic regression models were tested applying the Commission on Social Determinants of Health model. Intergroup differences in physician use and health equity were observed. Furthermore, physician use and health varied among the groups by age. The diverse background of older Asian Americans and the differential effects of the ageing process point to the need for novel interventions to promote health among this population.

Socio-Economic Inequalities in Oral Health: The Case of Greece

Background: The literature on the socioeconomic determinants of oral health inequalities is rather limited. Since oral health is an integral part of general health, the investigation of oral and general health inequalities becomes an important research topic. The recent economic crisis has aggravated the level of general and oral health in Greece and evidence on inequalities is interesting for policy guidelines. Objective: The purpose of the present study is to measure the magnitude of self reported oral health inequalities in relation to certain demographic and socio-economic indicators such as gender, age, education and income status. Methods: We launched a cross-sectional survey across urban and rural population in Greece and we selected a random sample of 1500 individuals consisting of three age groups: 15 - 18 years, 35 - 45 years, and 65 to 74 years old. Self-reported general and oral health were both recorded and analyzed by means of an ordinal scale ranging from 0 = worse health to 100 = perfect health. Likert-type of scale questions were further used to capture self assessments of oral health. Dental Inequalities were assessed with reference to the following socio-economic variables: age, education, and income levels. Results: Statistically significant oral health inequalities were identified among the socio-economic groups in Greece. Lower levels of oral health were associated with those confronting financial difficulties, the aged and the less educated. The Gini Coefficient for Oral Health Goral = 0.344 (s.d. = 0.0033) was higher in comparison to general health Ggeneral = 0.289 (s.d. = 0.0016) indicating the need for public health intervention in the area of oral health. Conclusions: The paper demonstrates the significance of socioeconomic inequalities in oral health in Greece.

Situational Analysis of Access to Essential Healthcare Services in Nigeria: Implication for Trans-Sectorial Policy Considerations in Addressing Health Inequities

Background: Socioeconomic factors influence health outcomes and the distribution of health resources within and between countries globally. In Nigeria, there are various socio-economic factors that have been reported to be responsible for health inequities across the different geopolitical zones. Objective: To assess health inequities in relation to socio-economic factors that affect access to essential health care services in Nigeria, using family planning, maternal care, and childcare as indicators. Method: The study involved a cross-sectional secondary analysis of data from the 2018 Nigeria Demographic and Health Survey (NDHS) and a literature review of transdisciplinary approaches to addressing health inequities. Result: The overall result from the findings suggests a strong influence of geographical and socioeconomic factors in the distribution of healthcare services. Specifically, family planning services were more readily available and accessible in the Southern zones of Nigeria than in the Northern zone of Nigeria, which could be attributed to socio-cultural, religious, and access-related barriers. Results also showed that access to most maternal and child health care services was often skewed towards the southern zones, which could be due to the presence of more healthcare workers who provide these services coupled with higher access to maternal care, hence a higher uptake and utilization of maternal care services. Also, children in the northern zones had lesser odds of receiving basic and age-appropriate vaccination than those in other regions, which could be attributed to the supply-side disparities that exist between the northern and southern regions. Conclusion: This study concludes that level of educational attainment, wealth quintiles, as well as financial barriers, are the major socio-economic factors that influence access to maternal and childcare services.

Social, Clinical and Psychometric Factors Affecting Self-Rated Oral Health, Self-Rated Health and Wellbeing in Adults: A Cross-Sectional Survey

Background: Many studies examined and reported oral and general health inequalities in clinical health, SROH and SRH. Objectives: The study aims to explore the social influences, gradients and predictors of self-rated oral health (SROH) and self-rated health (SRH) and wellbeing in Greek adults. Methods: Cross-sectional study, of men and women, aged 65 years and over (N = 743) in Greece. Descriptive and statistical analyses were performed for dentate and edentulous participants. For the association between socioeconomic exposures and binary outcomes, logistic regression was performed to estimate Odds Ratios and 95% Confidence Intervals (OR, 95% CI);levels of association and Cramer’s V were applied to calculate associations and p-values. Results: The objective socioeconomic measures, such as household income, education level and last main occupation were significant predictors and determinants of both SROH and self-rated health (SRH). For Satisfaction with life (SWL), there was a diversity in the results analogous to the dental status of the participants. Household income and SSS were predictors of SWL in dentate participants. In the total sample Household income, occupation and SSS, were predictors of SWL, while in edentulous participants only occupation and SSS were statistically significant (p < 0.05). Subjective social status was statistically significant for SROH, SRH and SWL (p < 0.01). More men than women reported their SROH and SRH as good. Household income and SSS were predictors of SWL, in dentate participants, thus the better the income and the higher the relative social status, the higher feeling of SWL was recorded. Place of residence had significant associations only with SWL. Household income, education, occupation and SSS had significant levels of association with SROH and SRH in dentate participants (p < 0.05). Conclusion: There are socioeconomic gradient inequalities in SROH and SRH in Greek adults living in Attica area. Subjective social status is a predictor of SROH, SRH and SWL. The need to prioritize interventions to eliminate disparities and inequalities in oral and general health and wellbeing of elders is evident.

Disparities in Oral Healthcare Access Due to the COVID-19 Pandemic

The U.S. has experienced very high numbers of positive COVID-19 cases, along with high unemployment rates during the COVID-19 pandemic. Similarly, on a global level, the pandemic has resulted in an increase in the unemployment rate, loss of insurance and an overall adverse social impact. In the social sector, there has been a huge gap in supply and demand;this has been especially apparent in the healthcare industry. The COVID-19 pandemic has had a significant negative impact on high-contact industries, including dentistry. Causative factors have included social distancing, shortage of healthcare professionals and loss of insurance due to unemployment. The result has been a void in preventative oral health services. Limited information on the disproportionate access to oral healthcare, due to the increase in unemployment and corresponding loss of insurance during the COVID-19 pandemic is available. This study was designed to investigate the disparities in access to oral healthcare amidst the global economic crisis and rise in unemployment.

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.

中国健康的代际流动性

使用2010—2020年中国家庭追踪调查数据,构建具有质量调整生命年形式的自评健康连续变量,估计中国健康的代际流动性。研究发现:健康的代际传递程度相对较低,代际流动性较高,健康的代际秩回归系数为0.208。同性别的父代与子代间表现出更强的健康继承性,其中母女的健康关联最为紧密。健康的代际流动性在时间维度上表现出递增的变动趋势,但衰减偏误和生命周期偏误在一定程度上会扭曲对代际健康流动的估计。基于Gelbach方法的分解发现,母亲健康对代际健康传递具有更高的贡献率。中国代际福利流动性处于较高水平,福利的代际秩回归系数为0.172。研究结果为持续有效地实施健康中国战略提供了定量政策参考。

中国居民健康不平等的变迁趋势研究

利用中国家庭追踪调查2010年至2020年六期数据,采用增长曲线模型分析社会经济地位与生活方式对我国居民健康不平等的影响。研究发现,社会经济地位对居民健康水平的影响呈缩小趋势,而生活方式对居民健康水平的影响不断增大,社会经济地位与生活方式对健康水平的影响具有队列效应。教育与收入水平对较早出生队列的影响更为显著,而对于较晚出生队列,体育锻炼和生活方式的作用更为突出。研究结果有助于理解中国居民健康不平等的发展趋势,为减轻健康不平等提供一定参考。

社区特征、个人社会经济地位与老年人健康及其不平等

以往对老年人健康水平及其不平等现象的研究多从个体社会地位、关系网络的角度展开,较少关注外在于个体的宏观社会结构、社会资源因素可能引发的健康风险与潜在的健康不平等问题。本文利用clds2014年的数据拟合多层次模型,考察个人社会经济地位、社区社会结构和社会资本对老年人健康水平与不平等现象的影响机制。研究发现:不同社会经济特征的老年人在健康水平上存在明显的差异;社区特征对老年人健康水平存在着独立于个人因素的整体性影响,并对老年人健康不平等现象产生弱化与强化两种调节机制。(1)社区阶层异质性的分化程度会影响健康水平。其中,社区社会经济地位会弱化健康不平等,而社区内部阶层异质性则会强化健康不平等。(2)社区社会资本的培育能够显著提升老年人的健康水平并弱化健康不平等。因此,健康中国战略的实施要着眼于中国的健康分层现象,采取社区层面的健康干预,尽可能地增加弱势群体的健康资本。

三代间健康劣势传递以及教育的阻断作用——中国的经验证据

利用CHARLS数据,本文在祖辈—父母—孩子(G1-G2-G3)框架下研究三代间健康劣势传递。结果表明,我国家庭内存在显著的三代间健康劣势代际传递和跨代传递现象。代际传递表现为,祖辈健康劣势会显著增加父母健康劣势概率,父母健康劣势会显著增加孩子健康劣势概率;跨代传递表现为,祖辈健康劣势会显著增加孩子健康劣势概率。这些传递关系在多种检验中表现出稳健性。本文还发现:父母完成义务教育对健康劣势传递具有统计显著的阻断作用,但其作用程度较为有限。这提示我们,要阻断健康劣势传递,仅仅依赖改善教育是不够的,还需要寻求教育之外的手段和途径。机制分析表明,教育有助于个体改善健康行为,获得更好职业、更高收入以及更多社会关系支持,从而降低个体及其后代的健康劣势概率。

中国农村老龄健康:特征、成因与应对方略

文章基于多期中国健康与养老追踪数据分析我国农村老年人口的健康状况及其变化趋势,并从性别、地区、城乡、家庭四个维度剖析健康不平等的主要特征。研究发现,农村老年人自评健康较差但略有改善;患慢性病率达七成且共病特征明显;ADL失能率稳定在13%左右,但IADL失能率提高;男性、城镇、有配偶老年人的健康状况更好;健康性别差异随年龄增长而扩大,地区差异呈东高西低、南高北低的分布格局。当前,农村医疗和养老保障水平低、村居基础设施落后、医疗资源城乡配置非均衡、家庭照料功能弱化以及预防性保健不足是制约老龄健康发展的重点因素。下一步需要坚持全生命周期和积极老龄观理念,加强健康中国和乡村振兴战略协同,夯实设施、制度和资源基础,深化康养服务内核,促进农村老龄健康高质量、可持续、公平发展。