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Where you are born, the school you attend, your highest level of education, your race, age, and sex, these are all things that can directly, or indirectly impact your health. The social determinants of health is a phrase that can better be used to sum them all up. It refers to the social situation you exist in, and how that affects your ability to purchase healthy foods or obtain the medical care you need, and so much more. When it comes to certain measurements of health, people who fall within certain groups or populations, for example, minorities, or people of lower socio-economic statuses (SES), tend to have worse results than their white, or higher SES counterparts. These differences in health outcomes are referred to as disparities. As social scientists, healthcare professionals, and anyone with the means to address these disparities, we are ethically obligated to do so. There are already several initiatives aimed at addressing the social determinants of health. Through these initiatives, those in need are provided with things such as food vouchers, ride vouchers, and health education. What is missing, are organized studies with specific goals and appropriate sample sizes to address the efficacy of these initiatives. Once we have more such studies to provide us with data that supports the efficacy of these interventions, we can then advocate for policies that will make these resources widely available and encourage health equity. / Urban Bioethics

Background: There is a 3-fold risk of developing end stage kidney disease in Non-Hispanic African Americans compared to Non-Hispanic White Americans (Centers for Disease Control and Prevention, 2017). Estimated glomerular filtration rate (eGFR), one of the fundamental algorithms for coordinating treatment for kidney disease which factors in age, race, gender, and levels of creatinine, may pose an issue in this vulnerable population. Currently African Americans receive a correction factor between 1.21 and 1.16 to their eGFR to adjusting the value higher, potentially impacting appropriate kidney disease classification, and delaying beneficial interventions (National Kidney Foundation, 2020). Methods: A systematic literature search of four databases was completed. Eligibility criteria included 1) published in a peer reviewed journal, 2) English language, 3) the use of race correction in calculating eGFR, and 4) a quantitative study design. A total of 47 articles were screened with 17 selected for final review. The Johns-Hopkins Nursing Evidence - Based Practice evidence guide was then used to rate the strength and quality of the evidence. Results: Early evidence of the unreliability of race based eGFR equations emerged in 2008, and the body of evidence continues to grow. Recent studies have found eGFR calculated with no race corrections correlate best with directly measured iothalmate GFR in black patients (Zelnick et al., 2021), and that a potential 1,066,026 Black Americans may be reclassified to a more severe stage of CKD (Bragg-Gresham et al., 2021). Use of the race correction in GFR equations has been poorly supported in studies conducted in Africa and Brazil. For those with HIV, an accurate eGFR is doubly important yet all eGFR equations have marked variability. Some medical facilities have successfully updated to calculating eGFR without the racial coefficient (Shi et al., 2021). Conclusion: Nurses should be aware of the implications of using race correction in eGFR equations, educate their patients on its use, and advocate for those near threshold targets to ensure equitable and timely access to appropriate kidney disease interventions.

<p>Public health infrastructure (PHI) serves as the core foundation for essential public health and its services. However, the U.S. PHI has been weakened by understaffing, underfunding, limited resources and partnerships, and outdated data and information systems over the past few decades. The recent COVID-19 pandemic exacerbated its vulnerability and weakened nature, resulting in increased health disparities and worse health outcomes in general for the nation. The goal of this study was to identify elements of local PHI that are associated with the completion of 20 key public health activities while adjusting for state differences. Cross-sectional secondary data were acquired and linked from two national surveys of local health departments, the National Profile of Local Health Departments survey and the National Longitudinal Survey of Public Health Systems. In total, 20 multivariable logistic regression models were created to analyze the relationships between variables. State fixed effects were used in multivariable models to control for state differences. It was found that state differences affected the correlations of infrastructure variables. Several staffing elements, abilities to provide certain services, and participation in certain types of actions were strongly correlated with the completion of best practice activities. These findings will add to the discussion of what the minimum necessary elements of PHI may be.</p>

Since 2021, some state legislators have passed laws that limit what public institutions can teach about discrimination. The number of these laws, also called gag orders, is increasing despite a national outcry against racism, homophobia and transphobia, and other forms of discrimination. Many nursing and other professional healthcare organizations have recognized and published statements decrying racism in healthcare and calling for an increased focus on health disparities and advancing health equity. Similarly, national research institutions and private grant funders are funding health disparities research. Nursing and other faculty in higher education, however, are being gagged by laws and executive orders which prevent them from teaching and conducting research about historic and contemporary health disparities. This commentary seeks to highlight the immediate and long-term impact of academic gag orders and to encourage action in opposition of such legislation. Supported by professional codes of ethics and discipline-specific education, we present concrete activities readers can use to address gag order legislation and in doing so, protect patient and community health outcomes.

Neurodivergent occupations are ways of living and embodying life that speaks true for their neurotype. Examples include autistic play, ADHDer concepts of attention, and sensory processing differences. Though the neurodiversity movement is beginning to infiltrate health care services, neurodiversity-affirming practices within occupational therapy remains lacking. Neurodivergent occupations continue to be pathologized within occupational therapy, evident within the profession’s education, and all aspects of the occupational therapy process, such as assessment, treatment, and outcomes. Neurotypicality remains to be the benchmark for functioning within occupational therapy, much of which is secondary to the dominating medical model of disability and ableism proliferating the profession. These factors lead to OTPs creating occupational marginalization when attempting to support neurodivergent individuals, with neurodivergent OTPs pleading for the profession to reflect and modify current conceptualizations of occupational therapy. The proposed program, Embracing Neurodivergent Occupations, aims to answer this call. Embracing Neurodivergent Occupations is a knowledge translation tool incorporating tenets of disability justice, community-defined evidence practice, and lived-experience informed practice. The program intends to be an example of community-based participatory research (CBPR), with the program’s creation incorporating neurodivergent OTPs, scholars, and advocates from around the world for a holistic view on neurodivergent ways of living. Components of the Embracing Neurodivergent Occupations will include: (a) the first neurodiversity-affirming occupational therapy model (EMPOWER Model), (b) conversations on models of disablement and rehabilitation, (c) health and well-being priorities designated by autistic individuals, (d) steps for completing neurodiversity-affirming evaluations, (e) neurodiversity-affirming service and practitioner characteristics, and (f) a grading of commonly utilized occupational therapy programs and resources and their level of being neurodiversity-affirming. Embracing Neurodivergent Occupations has three phases: (1) an introductory workshop with OTPs within this author’s current work setting, (2) a website translating the program into a multimedia resource hub, and (3) morphing the introductory workshop into online modules. Embracing Neurodivergent Occupations aspires to support the profession’s ability to be anti-ableist, provide neurodiversity-affirming services through all aspects of the occupational therapy process, and ultimately empower neurodivergent occupational participation and well-being.

<p>  </p> <p>Maternal and infant health continues to be a compelling and urgent topic in the United States with prenatal care at its forefront for prevention of adverse outcomes. This study explored differences in adverse infant birth outcomes (i.e., preterm birth, low birthweight, and NICU stays) and postpartum maternal wellbeing outcomes (i.e., social support, depression, and confidence) related to the sociodemographic and baseline factors of mothers and their prenatal care experiences. </p> <p>Data was analyzed from the publicly available <em>Listening to Mothers III </em>dataset. Comprised of 2400 online-survey participants who gave birth to singleton infants in U.S. hospitals between 2011 and 2012. Structural equation modeling was employed with FIML to account for missing data. The model examined mediators of prenatal care (i.e., responsive provider behavior, week of first visit, duration of visits, group prenatal care; GPC) between maternal predictors and outcomes.</p> <p>Of infants in the sample, 8% were born preterm, 8% were born low birthweight, and 18% were admitted into the NICU. Depression and smoking during pregnancy, as well as participating in GPC, resulted in 15%, 20% and 18% greater proportions of infant NICU stays, respectively. For postpartum maternal wellbeing, participating in GPC increased the proportion of maternal confidence by 18%. Mothers who received responsive provider behavior had higher rates of social support (<em>b </em>= 0.28, <em>p </em>< .001), reported less depression (<em>b </em>= -0.19, <em>p </em>< .001), and felt more confident (<em>b </em>= 0.07, <em>p </em>= .02). </p> <p>Findings from this study suggest that the most impactful actions for prenatal care providers to take would be to provide increased support to mothers who identify as needing treatment for depression or smoking during pregnancy to best improve infant health through fewer admissions into the NICU, and to continue to bolster the responsiveness in which providers interact with patients to improve overall postpartum maternal wellbeing. </p>

Counselors are called to address barriers to human growth and development through advocacy (ACA, 2014), such as those posed by inequitable health care access for socially disadvantaged groups (CDC, 2013; IOM, 2011). Health care contributes to positive health outcomes (Healthy People 2020) and is therefore an important component of advancing health equity among marginalized populations, such as older sexual minority women (SMW) with disabilities. Despite evidence of disparate health care access and health outcomes, no research to date has explored the health needs or health care experiences of disabled older SMW. This study therefore sought to address this gap in the literature by: identifying current levels of health care access and barriers among older SMW with disabilities; exploring predictors of health care access among older SMW with disabilities; and identifying protective factors, such as social support and resilience, that moderate the relationship between health care access barriers and health outcomes. Results obtained from a sample of 208 respondents provided baseline data about health care access and barriers among older SMW with disabilities. Generally, respondents had a place to receive health care, but few had access LGBTQIA+-specific health services despite indicating that this type of health care was important to them. Only about half had accessed mental health services in the last six months, and people who had accessed mental health care perceived it to be easier to access than people who had not. Respondents most highly endorsed external barriers related to cost of health care, and they reported higher health care stereotype threat related to age and disability compared to gender and sexuality. External barriers to health care were predictive of most health care access indicators (e.g., utilization of general and specific health services, as well as health outcomes). Among internal barriers, sexuality- and disability-related health care stereotype threat emerged as predictors of health care access and health outcomes respectively. Similarly, acceptability of health services, accessibility of health services, and affordability of health services were specific external barrier categories that appeared to influence health care access and outcomes among older SMW with disabilities. Neither resilience nor social support moderated the relationship of external access barriers to physical or mental health outcomes. However, resilience had a significant independent relationship with physical health outcomes, and both resilience and social support had significant independent relationships with mental health outcomes. These findings illustrate the structural factors related to health care access and outcomes for older SMW with disabilities, as posited by health equity frameworks (Braveman, 2014). The most influential internal barriers related to health care stereotype threat, which may develop in response to minority stressors specific to health care settings. The findings of this study support lifespan perspectives on LGBTQIA+ health (Fredriksen-Goldsen, Simoni et al., 2014), as well as minority stress processes (Meyer, 2003), as frameworks for understanding LGBTQIA+ health in later life. Implications for counselors, counselor educators, community organizations, and policies are discussed. / Doctor of Philosophy / LGBTQIA+ older adults are at increased risk of negative health outcomes, but helping professions have limited resources for understanding their health care needs at present. Because nearly half of older sexual minority women (SMW) have disabilities, this study examined health care access and outcomes among older SMW with disabilities. This is relevant to counseling given the field's focus on social justice, advocacy, and equity, as well as the interconnected nature of physical and mental health. Across different ways of measuring health care access, external barriers related to health care systems and societal injustice were related to whether older SMW with disabilities could access health care. Health care stereotype threat, or internalized stigma related to experiences in health care, predicted health care access and health among disabled older SMW as well. These findings suggest that poor health care utilization and poorer health outcomes among older SMW with disabilities are the result of structural oppression rather than individual choices, which requires systemic interventions to correct. More research is needed to determine how counselors and other helping professionals can enhance strengths to support health among older SMW with disabilities.

This dissertation includes an introductory chapter (Chapter 1), a collection of four manuscripts (Chapters 2-5), and a concluding chapter (Chapter 6). Chapter 2 has been published in the Canadian Journal of Nursing Research and Chapter 3 has been published in the International Journal of Qualitative Research. Chapter 4 and Chapter 5 will be submitted for journal publication. / In Canada as well as other countries with shared colonial histories, the healthcare system is complex and as a result, fragmentation of services is experienced. Indigenous populations experience increasingly disproportionate health disparities compared to non-Indigenous populations within Canada and around the world which increases the complexity of navigating the healthcare system. Patient navigation is known as a patient-centered approach to enable and empower individuals and families to overcome barriers experienced while accessing health and social services. The literature surrounding the Indigenous patient navigator (IPN) role remains sparse. Understanding the IPN role and how health and social service barriers are addressed and how enablers are promoted is necessary. A qualitative interpretive description methodology guided by a Two-Eyed Seeing framework and Social Determinants of Indigenous Peoples’ Health Tree Metaphor developed by Charlotte Loppie (2022) were employed. Interviews were conducted via telephone and virtual platform with 20 IPNs and 16 patients or family members who had received IPN services. Additionally, 10 IPN documents were reviewed. The results related to the barriers and enablers Indigenous Peoples experience when accessing biomedical health care services in Canada as well as the roles and activities the IPN enact to address these barriers and promote enablers to access health and social services. Findings suggest that the IPN role is an integral part of improving access to health and social services for Indigenous Peoples in Canada. Eight major IPN roles are outlined which assist to address health and social service barriers and promote enablers experienced by Indigenous Peoples in Canada across health care settings. Finally, findings will assist decision and policy makers to make informed choices surrounding the IPN role and how this role can bridge the gap in health inequity to improve access to health and social services for Indigenous communities across Canada and abroad. / Dissertation / Doctor of Philosophy (PhD) / Indigenous populations experience increasingly disproportionate health disparities compared to non-Indigenous populations within Canada increasing the complexity of navigating the healthcare system. Patient navigation is known as a patient-centered approach to enable and empower individuals and families to overcome barriers experienced while accessing health and social services. The literature surrounding the Indigenous patient navigator (IPN) role remains sparse; specifically, how the role addresses health and social service barriers as well as how the role supports Indigenous community members who access biomedical health care services. This dissertation explores the role of the IPN across health care settings in Ontario, Canada to understand the health and social service barriers and enablers that Indigenous Peoples experience as well as the roles and activities that the IPN addresses to bridge the gap in health inequity. The results will benefit Indigenous communities and healthcare providers providing care to Indigenous populations in Canada and abroad.

Yes / Laying claim to highest attainable standard of health is a human right. Support for this right is provided by the United Nations Declaration of Human Rights (United Nations [UN], 1948) and a small number of legally binding international treaties. Among the most important of these for health are the International Covenant on Economic, Social, and Cultural Rights (ICESCR) (UN, 1966a) and the Convention on the Rights of the Child (CRC) (UN, 1989). Both these human rights treaties are legally binding for those countries that have ratified them. The ICESCR, in particular, articulates a comprehensive view of the obligations of state members of the United Nations (UN) to respect, protect and fulfil the right to the enjoyment of the highest attainable standard of physical and mental health – known as ‘the right to health’. It provides for both freedoms, such as the right to be free from non-consensual and uninformed medical treatment, medical experimentation, or forced HIV testing, as well as entitlements. These entitlements include the right to a system of protection on an equal basis for all, a system of prevention, treatments and control of disease, access to essential medicines, and services for sexual and reproductive health; and access to information and education about health for everyone. The Committee on Economic, Social, and Cultural Rights (ECSCR) monitors compliance with these provisions. Most states have ratified the ICESCR, and all but two (Somalia and the US) have ratified the CRC.