Background: The degree of health variation among social groups is an important indicator of population health and the efficiency of economic and social systems. Previous studies revealed existence of health inequalities across Europe, however recent studies on the contribution of income to such inequalities are scarce. Aim: To investigate differences in self-reported health between the lowest and the highest income groups across Europe. Method: Data from the European Social Survey for 29 countries were examined. The absolute inequalities were calculated as differences in age-adjusted prevalence of poor self-reported health between the lowest and the highest income quintiles. The relative inequalities were measured by odds ratios for reporting poor health in the lowest income group compared to the highest one. Results: Income-related health inequalities were found in all countries. Larger relative inequalities among men were observed in Greece, Kosovo, Ireland, Israel, Iceland, and Slovenia; among women – in Lithuania, Denmark, Norway, Portugal, Cyprus, and Czech Republic. Conslusions: In Europe, income-related health inequalities persist, however, their degree varies across countries. Gender differences in income-related inequalities were observed within certain countries. For a comprehensive description of health situation in a country assessing both the prevalence of poor health and the inequality level is crucial.

Thesis advisor: Rebekah Levine Coley / Theories of upward mobility argue that academic and employment success grant individuals improved health, yet emerging evidence suggests that striving for such mobility in the context of marginalization may actually dysregulate physiological stress responses and compromise health. It is still unclear whether these associations operate as a function of cumulative exposure to risk (including both socioeconomic and racial/ethnic marginalization), or whether they would emerge outside of such collective risk. Further, little is known about how the school context, one of the most central contexts in adolescent development, affects associations between mobility and health, despite evidence that opportunities for socioeconomic comparisons or for discrimination at school may further exacerbate these associations. Drawing on data from the National Longitudinal Study of Adolescent Health, a longitudinal survey of a nationally representative school-based sample of adolescents in the United States (N=14,797), the current study sought to clarify links between achievement and physiological health. Multilevel regression analyses considered prospective associations between achievement and health while attending to potential variation in links across the socioeconomic spectrum and across racial/ethnic groups. Additionally, school-level factors were taken into account and explored as potential augmenting mechanisms in these links. Findings suggested promotive links between achievement and physiological health, but also suggested that such links were not shared broadly by all youth. Although links did not vary across the socioeconomic spectrum, Asian American youth demonstrated some greater health payoffs of achievement compared to their non-Hispanic White peers, while non-Hispanic Black and Mexican American youth largely experienced reversed links. These results suggest additional evidence that striving for academic achievement while experiencing racial/ethnic marginality may engender dysregulation of the stress-response system. Thus, findings are discussed in relation to the social and historical contexts that may contribute to such divergent links. However, the school-level factors considered did not moderate links among achievement, individual characteristics, and physiological health, pointing to the importance of future research considering alternate social and contextual mechanisms in these relationships. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.

Black women are disproportionately burdened by type-2 diabetes (Bancks et al., 2017) and their experience of health inequities is negatively shaped by institutionalized racism in the US (Feagin & Bennefield, 2014). Previous research has demonstrated the impact of type-2 diabetes on the Black community, yet fails to adequately capture the complexity of Black women’s experiences navigating the disease (Hurt et al., 2017). This two-phase qualitative dissertation study addresses this gap in the literature. Drawing from critical race theory (Delgado & Stefancic, 2012), feminist theory (Collins, 2002) and popular education (Freire, 1970), photovoice and interview methods were employed to examine how one group of Black women residing in Boston experience type-2 diabetes. Phase I included a photovoice project with 11 Black women between the ages of 36 and 69 recruited from an area diabetes clinic and community agencies. Phase II included one focus group (N=4) with interdisciplinary diabetes providers from an area diabetes clinic and 13 individual interviews with interdisciplinary diabetes providers including: physicians, nurse practitioners, clinical pharmacists, dieticians and social workers from three Boston medical institutions. The researcher explored provider perceptions of the photovoice findings and their implications for provider education and training. The researcher used inductive thematic analysis (Braun & Clark, 2006) to further contextualize the photovoice findings in phase I and to analyze providers’ reactions to the photovoice analysis in phase II. Photovoice participants and providers interpreted the photovoice findings differently. The photovoice participants’ analysis reflected a hopeful, aspirational message despite the complexity of navigating type-2 diabetes and the competing messages about health and wellness many Black women internalize. In contrast, provider reflections were more deficit driven and focused on medical management. Further, providers shared some biased assumptions about Black women’s experiences with type-2 diabetes such as inferring substance use as a concern from one of the photos. This research highlights the transformative power of photovoice methods (Wang & Burris, 1997) to engage Black women to make meaning of their experiences with type-2 diabetes and communicate their health priorities. These findings have important implications for interdisciplinary teaching models and future social work research and practice with Black women and other marginalized groups coping with chronic disease. / 2023-05-07T00:00:00Z

Immigrant women are at greater risk for postpartum depression (PPD) compared to non-immigrant women and experience multiple barriers to accessing health services to address their needs. This mixed method study explored the multi-level factors that contribute to the postpartum mental health of immigrant women in Canada and their ability to access requisite health services. In the quantitative phase, data from a longitudinal prospective cohort survey of women were used to examine predictors of PPD over the first postpartum year for a sample of women who delivered at two hospitals in Toronto, Ontario. In the qualitative phase, an interpretive descriptive design shaped by an integrated knowledge translation approach was used to understand the factors immigrant women living in Scarborough, Ontario (a region of Toronto) perceive as contributing to their postpartum emotional health and the factors immigrant women and care providers perceive as influencing access to health services. Across quantitative and qualitative findings, factors contributing to PPD among immigrant women included a lack of social support, individual and community-level challenges faced in terms of the social health determinants, physical health status, and client-provider relationships. Factors contributing to reduced access to health services included: lack of system knowledge, social health determinants, organizational and system barriers, limited access to treatment, and a need for service integration and system navigation support. Immigrant women in Canada experience numerous health inequities that increase their risk for PPD and v prevent them from accessing service supports to address PPD concerns. The Canadian health care system needs to be responsive to individual needs in order to facilitate equitable access and address the health needs of Canadian immigrant women and their families. The diversity and proportion of immigrants in Canada calls for a linguistically and culturally supportive health care system with a strategic approach to enhancing accessibility to address health inequities. / Dissertation / Doctor of Philosophy (PhD) / Immigrant women have a 2-3 times higher risk for postpartum depression (PPD) than native-born women. This study explored the factors that contribute to PPD among immigrant women in Canada and how health services can help them get the care they need, from the perspective of immigrant women and care providers. This study found increased PPD risk when women lacked social support, had physical health issues, and faced challenges such as low income and lack of English language skills. Working with care providers could help address these challenges or make it more difficult to get care. Immigrant women had more difficulty getting services when they lacked knowledge about the health care system, faced social, financial, and language-based barriers to care, and experienced barriers when using available services. The findings from this research can inform the design and delivery of health care to best meet the needs of immigrant women with PPD.

Although evidence of health inequities abound, why people in lower socio-economic classes have poorer health has not been sufficiently explored. The purpose of this study is to examine day labourers’ pathways to health inequities in a segregated, urban district in Japan. Critical ethnography was employed to investigate day labourers’ social environments and cultural behaviours in order to reveal the ways that social inequalities embedded in mainstream society and the day labourers’ sub-culture produce and sustain day labourers’ disadvantages, leading them into poorer health than the average population. Data were collected through observations of day labourer’s daily activities, events within the district and their interactions with social workers at a hospital. In addition, interviews were conducted with 16 day labourers and 11 professionals and advocates. The study found several components in the pathways to health inequities of day labourers. First, certain people in Japan are ostracized from the social, economic and political mainstream due to an inability to enact traditional Japanese labour practices. Commonly such exclusions make men become day labourers to survive. In a day labourer district, they are exposed to further social inequalities embedded in the work system and their living circumstance. Living and working as a member of the day labour community, they develop collective strategies in order to survive and preserve their social identities as day labourers. However, such strategies do not provide people with opportunities to lead healthy lives. The study also identified several social determinants of health for day labourers, including: 1) employment, 2) working conditions, 3) temporary living, 4) housing quality, 5) social networks and support, 6) marginalized neighbourhood, 7) access to health care, and 8) gender. The findings contribute to a better understanding of social construction of health inequities, which provides insight on the impact of precarious work in the Japanese society at large. Implications of these findings for public health policy and practice are also discussed.

Although evidence of health inequities abound, why people in lower socio-economic classes have poorer health has not been sufficiently explored. The purpose of this study is to examine day labourers’ pathways to health inequities in a segregated, urban district in Japan. Critical ethnography was employed to investigate day labourers’ social environments and cultural behaviours in order to reveal the ways that social inequalities embedded in mainstream society and the day labourers’ sub-culture produce and sustain day labourers’ disadvantages, leading them into poorer health than the average population. Data were collected through observations of day labourer’s daily activities, events within the district and their interactions with social workers at a hospital. In addition, interviews were conducted with 16 day labourers and 11 professionals and advocates. The study found several components in the pathways to health inequities of day labourers. First, certain people in Japan are ostracized from the social, economic and political mainstream due to an inability to enact traditional Japanese labour practices. Commonly such exclusions make men become day labourers to survive. In a day labourer district, they are exposed to further social inequalities embedded in the work system and their living circumstance. Living and working as a member of the day labour community, they develop collective strategies in order to survive and preserve their social identities as day labourers. However, such strategies do not provide people with opportunities to lead healthy lives. The study also identified several social determinants of health for day labourers, including: 1) employment, 2) working conditions, 3) temporary living, 4) housing quality, 5) social networks and support, 6) marginalized neighbourhood, 7) access to health care, and 8) gender. The findings contribute to a better understanding of social construction of health inequities, which provides insight on the impact of precarious work in the Japanese society at large. Implications of these findings for public health policy and practice are also discussed.

Background: Access to safe and nutritious food is a universal right, which is essential for well-being. Food security exists when “all people at all times have physical and economic access to sufficient, safe, and nutritious foods to meet their dietary needs and food preferences for an active and healthy life”. Despite a call by global leaders to ensure food security and eradicate food insecurity, food insecurity remains a serious public health concern in Canada. While public health nurses are ideally situated to advance this public health priority, they have been conspicuously absent from important research and decision-making tables where work to address these inequities take place. This is the impetus for this study. Purpose: To explore how public health nurses engage in work to address food insecurity. The study uncovers the dynamic interplay of structures, processes, and agency that enable and constrain public health nurses work. An understanding of the sociopolitical contexts of public health helps to strengthen public health nurses’ engagement in food insecurity thereby contributing to health equity in Canada. Methodology: A holistic qualitative case study approach informed by the tenets of critical realism was used to guide this study in Nova Scotia. Primary data sources were 19 individual interviews and a review of 33 documents. Data were transcribed verbatim. Data analysis was guided by Framework Analysis and matrix construction. The trustworthiness of data was ensured through Lincoln and Guba’s criteria for qualitative studies. Findings: Four major themes include: 1) Framing Food (In)Security, 2) The Role of Public Health Nurses; 3) Navigating the Terrain of Food Insecurity; and 4) Resources to Advance Food Insecurity Work in Public Health Nursing Practice. Discussion and Implications: The dynamic interplay among leaders with differing ideologies and organizational culture has an impact on health equity agendas and subsequently on public health nursing engagement in work to address food insecurity. Capitalizing on a “clash of cultures” is associated with effective community food security outcomes. We must continue to illuminate the tensions among public health nurses and other stakeholders as well as address issues of power relations both within and external to the public health system. Conclusion: Public health may benefit greatly from building capacity of public health nurses’ to engage in both upstream and downstream food insecurity work.

Thesis advisor: Karen S. Lyons / Background: Health equity is a complex phenomenon that embodies both the social determinants of health (structural and intermediary) and external factors, such as the health system. As a well-researched phenomenon, it is known that certain populations are more vulnerable than others to experiencing health inequities; specifically, those of low socioeconomic status, racial/ethnic minorities, older adults, and rural residents. However, gaps in knowledge exist in understanding why certain populations remain at higher risk of experiencing health inequities during a time of improved health insurance coverage and technological advances in health care. The purpose of this manuscript dissertation was to identify and address influential factors that serve as road blocks in achieving health equity, guided by the World Health Organization’s Conceptual Framework on the Social Determinants of Health. Methods: First, an integrative review was performed in order to determine current scope of practice restrictions and patient outcomes across the continuum of licensure for advanced practice registered nurses (APRNs), especially certified registered nurse anesthetists (CRNAs). Next, a secondary analysis of large national data set was done to identify the social determinants and risk factors for poor health effect among a national sample at high risk for poor health. And finally, a survey methodology study was completed to determine the roles that satisfaction with health care and physical function have on the perceived health status for rural, older adults in Massachusetts, and to explore the willingness of rural, older adults to use non-physicians for their health care needs. Results: The integrative review revealed the inconsistent use of APRNs at their full licensure. Nationally, APRNs had better geographic distribution in rural areas compared to physicians; yet many states continue to restrict APRN SOP. Second, across the U.S., older adults at the highest risk for poor health live in rural areas, are of lower socioeconomic status, and identify as racial/ethnic minorities. Third, both satisfaction with health care and the physical function of a small sample of older rural adults were significantly associated with physical health. And finally this body of work found that among a small sample of older rural adults, most were willing to use APRNs to meet their health care needs. Conclusions: With the ultimate goal of health equity it is necessary to empower those experiencing health inequities to be both aware of the problems as well as informed enough to push for change. Understanding why the experience of health differs among some individuals more than others helps to target change. The fusion of findings from this body of research has revealed a gap in health care that can be easily filled with simple policy change. APRNs at full SOP can generate means for high quality preventative, cost-saving care, and can better access the most vulnerable populations at a lower cost than physician counterparts. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Ongoing research indicates that the burden of infection and mortality from the coronavirus disease 2019 (COVID-19) has been disproportionately borne by Latinx populations in the United States (U.S.). While Latinx people account for 18.4% of the U.S. population, they make up 23.1% of total COVID-19 cases and almost 38% of all COVID-19-related-deaths in the U.S. Latinx people face systemic socioeconomic and political challenges that adversely impact their risk of exposure to and recovery from COVID-19. This investigation will discuss the health disparities experienced by the U.S. Latinx population that have been exacerbated by the COVID-19 pandemic, with a particular focus on the social determinants of health (SDOH) and the unmet social needs for this population.

No description available.