This study explores whether queer people wait longer than non-queer people to seek professional medical care in the wake of an illness or injury. Little scholarship has evaluated queer people's pursuit of palliative medical care. An online survey was distributed to Virginia Tech students aged 18-30 years old who have experienced an illness or injury in the last year that compromised their daily function. Using demographic data obtained about gender identity and sexuality, respondents were divided into "queer" (non-cisgender and/or non-heterosexuals) and "non-queer" (cisgender, heterosexuals) groups. The survey assessed the number of days between the onset of an illness or injury and the first attempt to schedule care. The statistical analysis revealed significant differences suggesting that, of the people who had received care in the last 12 months, queer people, on average, waited fewer days than non-queer people to attempt to schedule care. This does not include respondents who indicated that they did not receive care in the last 12 months. This may indicate that queer people forego seeking palliative care unless absolutely necessary. This study is informed by M. Reynolds's Health Power Resources theory, and demonstrates the importance of measuring not only the presence of behaviors but also the absence of relevant behaviors when applying this theory. Based on the results, this study calls for further research into both delays in care-seeking behavior and into healthcare avoidance among queer individuals. / Master of Science / If two different people catch an illness and one of them identifies as transgender or gay, but the other one identifies as straight and cisgender, which one of them will wait longer to see a doctor? Waiting longer to get healthcare can be dangerous and costly, and yet many people wait to get healthcare even when they get sick or injured. Queer people (those who do not identify as cisgender and heterosexual) have themselves reported experiencing a number of barriers to receiving healthcare in the United States. This study compares how long queer and non-queer people wait to seek healthcare after an illness or injury to see if these reported barriers to accessing healthcare contribute to a greater reluctance among queer people to pursue healthcare. This reluctance is measured as the number of days between the start of a person's medical ailment and their first attempt at scheduling or receiving professional care for said ailment. A survey was conducted of Virginia Tech students, all of whom experienced an illness or injury in the last 12 months that compromised their ability to perform daily tasks (such as attending classes or completing housework). The results indicated that, of the people who had received care in the last year, queer people, on average, waited fewer days than non-queer people to seek care. However; this dataset does not reflect the experiences of those who indicated that, despite getting sick or injured, they did not receive care in the last 12 months. This may suggest that queer people avoid getting professional help for an illness or injury unless absolutely necessary, instead waiting for injuries or illnesses to get better without professional care. Based on the results, more research is needed on both delays in care-seeking and on healthcare avoidance among queer individuals.

<p dir="ltr">Health equity remains a fundamental goal in public health, driven by the significant disparities in health outcomes experienced by marginalized populations. This study investigates the multifaceted factors contributing to health disparities and highlights the necessity of comprehensive approaches to mitigate these inequalities. </p><p dir="ltr">First, we examine the impact of legislative climates on health outcomes for transgender and cisgender populations. We implemented a marginal structural model with inverse probability weighting to understand the causal relationship between state-level policy environments and transgender health disparities. Our findings reveal that while cisgender individuals generally experience consistent healthcare utilization and better health outcomes, transgender people in less supportive states face significant barriers and worse health outcomes. </p><p dir="ltr">Second, we explore the role of gender-affirming medical care during adolescence in influencing adult psychological and general health outcomes. Using data from the 2015 US Transgender Survey, we compare the health outcomes of transgender and non-binary individuals who received gender affirming medical care (GAMC) during adolescence with those who did not. Our causal moderation analysis demonstrates that GAMC during adolescence is associated with reduced psychological distress in adulthood, with the effect significantly moderated by state-level policy stigma. </p><p dir="ltr">Lastly, we conduct a qualitative study on breast cancer disparities between Black and White patients, using semi-structured interviews and health services data to map patient journeys across the cancer control continuum. Our thematic analysis identifies significant barriers faced by Black women, including cultural discordance, communication challenges, and delays in diagnosis, underscoring the need for tailored interventions to enhance provider-patient communication and support.</p><p dir="ltr">This study emphasizes the importance of a holistic approach to achieving health equity, addressing individual, systemic, and legislative factors. By advocating for inclusive policies, improving provider-patient communication, and ensuring access to comprehensive care, we can work toward eliminating health disparities and promoting equitable health outcomes for all populations. The findings provide a foundation for future research and policy development aimed at achieving these critical goals.</p><p><br></p>

acase@tulane.edu / The Sustainable Development agenda, which will be driving the development discourse of the world in next fifteen years, has 17 goals and 169 target. Goal 3 is related to health and it has 13 targets. Target 3.8 states “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. This target - related to universal health coverage (UHC) is considered the linchpin of all other health targets. Although more than 100 countries across the world are pursuing UHC reforms, there is no one-size-fits-all approach to achieving UHC. It has been recommended that governments should develop approaches that fit the social, economic, demographic, and political context of their countries. Pakistan, the sixth most populous country in the world, underwent its first democratic transition after elections 2013. The 18th constitutional amendment of devolution has made health a provincial subject in the country. As promised in election manifestoes, all the three major political parties ruling provincial governments have recently committed to health financing reforms for achieving UHC. Though the existing literature provides a few key health financing indicators at the national level, there is a paucity of evidence for planning and monitoring UHC reforms at the provincial level. This dissertation, comprised of three papers, addressed this gap by providing empirical evidence on: i) incidence and determinants of catastrophic health expenditure, ii), efficiency of division level health systems in producing UHC tracer indicators. and iii) provincial progress towards Universal health coverage and associated in-equities from 2001-14. / 1 / Faraz Khalid

Research Question: This research adapted, tested, and evaluated a methodology to set priorities for systematic reviews topics within the Cochrane Collaboration that is sustainable and incorporates the social determinants of health and health equity into the analysis. Background: In 2008 a study was conducted to review, evaluate and compare the methods for prioritization used across the Cochrane Collaboration. Two key findings from that study were: 1) the methods were not sustainable and 2) health equity represented a gap in the process. To address these key findings, the objective of this research was to produce and test a method that is sustainable and incorporates the social determinants of health and health equity into the decision making process. As part of this research, the methods were evaluated to determine the level of success. Methodology: With assistance from experts in the field, a comparative analysis of existing priority setting methods was conducted. The Global Evidence Mapping (GEM) method was selected to be adapted to meet our research objectives. The adapted method was tested with assistance of the Cochrane Musculoskeletal Group in identifying priorities for Osteoarthritis. The results of the process and the outcomes were evaluated by applying the “Framework for Successful Priority Setting”. Results: This research found that the priority setting method developed is sustainable. Also, the methods succeeded in incorporating the social determinants of health and health equity into the analysis. A key strength of the study was the ability to incorporate the patients’ perspective in setting priorities for review topics. The lack of involvement of disadvantaged groups of the population was identified as a key limitation. Recommendations were put forward to incorporate the strengths of the study into future priority setting exercises within Cochrane and to address the limitations.

Research Question: This research adapted, tested, and evaluated a methodology to set priorities for systematic reviews topics within the Cochrane Collaboration that is sustainable and incorporates the social determinants of health and health equity into the analysis. Background: In 2008 a study was conducted to review, evaluate and compare the methods for prioritization used across the Cochrane Collaboration. Two key findings from that study were: 1) the methods were not sustainable and 2) health equity represented a gap in the process. To address these key findings, the objective of this research was to produce and test a method that is sustainable and incorporates the social determinants of health and health equity into the decision making process. As part of this research, the methods were evaluated to determine the level of success. Methodology: With assistance from experts in the field, a comparative analysis of existing priority setting methods was conducted. The Global Evidence Mapping (GEM) method was selected to be adapted to meet our research objectives. The adapted method was tested with assistance of the Cochrane Musculoskeletal Group in identifying priorities for Osteoarthritis. The results of the process and the outcomes were evaluated by applying the “Framework for Successful Priority Setting”. Results: This research found that the priority setting method developed is sustainable. Also, the methods succeeded in incorporating the social determinants of health and health equity into the analysis. A key strength of the study was the ability to incorporate the patients’ perspective in setting priorities for review topics. The lack of involvement of disadvantaged groups of the population was identified as a key limitation. Recommendations were put forward to incorporate the strengths of the study into future priority setting exercises within Cochrane and to address the limitations.

Cubas provision of free health services to the entire population via neighborhood-based family doctors produced dramatic health gains and achieved a relative state of health equality. Since 1989, however, the termination of Soviet trade, a grave economic crisis, intensification of the US embargo, welfare reductions, and population aging have placed Cubas health successes and elder care services in jeopardy. Little independent research, though, has focused on the influence of post-Cold War circumstances on citizen attitudes about health programs and resources targeting Cubas older population. This research examined global and domestic factors since 1989 that have most influenced perceptions of the equitability and inequitability of health resources among older Cubans. Its multi-layered design drew on new International Political Economy, crystallization, and aspects of Grounded Theory. In-depth narrative interviews were conducted with Cubans age 60 years or older, their families and community support group members, family physicians and other medical personnel, and key health and government informants. Perceptions of health equity were found to correspond most with the geographic proximity and nearly unhindered physical access of older patients to their family doctors and the temporal availability of family physicians to their older patients. Conversely, perceptions of health inequity corresponded most with the older persons experience of medicine shortages and health resource rationing following global socio-political-economic change and domestic policy shifts after 1989. Furthermore, the life course influences of the pre- and post-revolutionary eras and pre-1989 and post-Cold War period were seminal in shaping the perceptions and expectations of the older participants regarding health care, the leadership, and Cuban socialism. The findings have added to the international health and cross-cultural gerontology literature. Decision-makers and health practitioners in Cuba and elsewhere have been informed about the importance of popular perceptions of the impact of health and elder policy change in an era of globalized social relations and capital. The research also has contributed a gerontological dimension and a narrative perspective to further the development of new International Political Economy.

Research Question: This research adapted, tested, and evaluated a methodology to set priorities for systematic reviews topics within the Cochrane Collaboration that is sustainable and incorporates the social determinants of health and health equity into the analysis. Background: In 2008 a study was conducted to review, evaluate and compare the methods for prioritization used across the Cochrane Collaboration. Two key findings from that study were: 1) the methods were not sustainable and 2) health equity represented a gap in the process. To address these key findings, the objective of this research was to produce and test a method that is sustainable and incorporates the social determinants of health and health equity into the decision making process. As part of this research, the methods were evaluated to determine the level of success. Methodology: With assistance from experts in the field, a comparative analysis of existing priority setting methods was conducted. The Global Evidence Mapping (GEM) method was selected to be adapted to meet our research objectives. The adapted method was tested with assistance of the Cochrane Musculoskeletal Group in identifying priorities for Osteoarthritis. The results of the process and the outcomes were evaluated by applying the “Framework for Successful Priority Setting”. Results: This research found that the priority setting method developed is sustainable. Also, the methods succeeded in incorporating the social determinants of health and health equity into the analysis. A key strength of the study was the ability to incorporate the patients’ perspective in setting priorities for review topics. The lack of involvement of disadvantaged groups of the population was identified as a key limitation. Recommendations were put forward to incorporate the strengths of the study into future priority setting exercises within Cochrane and to address the limitations.

Introduction: In the new century, worldwide health professionals face new pressures for changes towards more cost-effective and sustainable health care for all populations. Globalization creates daunting challenges as well as new opportunities for institutions and health professionals being more connected and rethink their strategies toward an interprofessional practice. Although Health professionals are paying increased attention to issues of global health, there are no current competency assessment tools appropriate for evaluating their competency in global health. This study aims to assess global health competencies of family medicine residents, nursing, physiotherapy and occupational therapy students in five universities across Ontario, Canada Methods: A total of 429 students participated in the Global Health Competency Survey, drawn from family medicine residency, nursing, physiotherapy and occupational therapy programs of five universities in Ontario, Canada. The surveys were evaluated for face and content validity and reliability. Results: Factor analysis was used to identify the main factors to be included in the reliability analysis. Content validity was supported with one floor effect in the “racial/ethnic disparities” variable (36.1%), and few ceiling effects. Seven of the twenty-two variables performed the best (between 34% and 59.6%). For the overall rating score, no participants had floor or ceiling effects. Five factors were identified which accounted for 95% of the variance. Cronbach’s alpha was >0.8 indicating that the survey items had good internal consistency and represent a homogeneous construct. The results of the survey demonstrated that self-reported knowledge confidence in global health issues and global health skills were low for family medicine residents, nursing, physiotherapy and occupational therapy’ students. The percentage of residents and students who self-reported themselves confident was less than 60% for all global health issues. Conclusion: The Global Health Competency Survey demonstrated good internal consistency and face and content validity. The new century requires professionals competent in global health. Improvements in the core competencies in global health can be a bridge to a more equal world. Institutions must offer interprofessional approaches and a curriculum that exposes them to a varied learning methods and opportunities to improve their knowledge and skills in global health.

Research Question: This research adapted, tested, and evaluated a methodology to set priorities for systematic reviews topics within the Cochrane Collaboration that is sustainable and incorporates the social determinants of health and health equity into the analysis. Background: In 2008 a study was conducted to review, evaluate and compare the methods for prioritization used across the Cochrane Collaboration. Two key findings from that study were: 1) the methods were not sustainable and 2) health equity represented a gap in the process. To address these key findings, the objective of this research was to produce and test a method that is sustainable and incorporates the social determinants of health and health equity into the decision making process. As part of this research, the methods were evaluated to determine the level of success. Methodology: With assistance from experts in the field, a comparative analysis of existing priority setting methods was conducted. The Global Evidence Mapping (GEM) method was selected to be adapted to meet our research objectives. The adapted method was tested with assistance of the Cochrane Musculoskeletal Group in identifying priorities for Osteoarthritis. The results of the process and the outcomes were evaluated by applying the “Framework for Successful Priority Setting”. Results: This research found that the priority setting method developed is sustainable. Also, the methods succeeded in incorporating the social determinants of health and health equity into the analysis. A key strength of the study was the ability to incorporate the patients’ perspective in setting priorities for review topics. The lack of involvement of disadvantaged groups of the population was identified as a key limitation. Recommendations were put forward to incorporate the strengths of the study into future priority setting exercises within Cochrane and to address the limitations.

Introduction: In the new century, worldwide health professionals face new pressures for changes towards more cost-effective and sustainable health care for all populations. Globalization creates daunting challenges as well as new opportunities for institutions and health professionals being more connected and rethink their strategies toward an interprofessional practice. Although Health professionals are paying increased attention to issues of global health, there are no current competency assessment tools appropriate for evaluating their competency in global health. This study aims to assess global health competencies of family medicine residents, nursing, physiotherapy and occupational therapy students in five universities across Ontario, Canada Methods: A total of 429 students participated in the Global Health Competency Survey, drawn from family medicine residency, nursing, physiotherapy and occupational therapy programs of five universities in Ontario, Canada. The surveys were evaluated for face and content validity and reliability. Results: Factor analysis was used to identify the main factors to be included in the reliability analysis. Content validity was supported with one floor effect in the “racial/ethnic disparities” variable (36.1%), and few ceiling effects. Seven of the twenty-two variables performed the best (between 34% and 59.6%). For the overall rating score, no participants had floor or ceiling effects. Five factors were identified which accounted for 95% of the variance. Cronbach’s alpha was >0.8 indicating that the survey items had good internal consistency and represent a homogeneous construct. The results of the survey demonstrated that self-reported knowledge confidence in global health issues and global health skills were low for family medicine residents, nursing, physiotherapy and occupational therapy’ students. The percentage of residents and students who self-reported themselves confident was less than 60% for all global health issues. Conclusion: The Global Health Competency Survey demonstrated good internal consistency and face and content validity. The new century requires professionals competent in global health. Improvements in the core competencies in global health can be a bridge to a more equal world. Institutions must offer interprofessional approaches and a curriculum that exposes them to a varied learning methods and opportunities to improve their knowledge and skills in global health.