Master of Public Health - MPH / Substance abuse has become a significant public health concern in South Africa, more specifically in the Western Cape province. This has become a source of great alarm as South African Police Service (SAPS) statistics show that 80% of the crimes committed in the Western Cape are related to substance abuse. The Western Cape was the province that reported the highest number of persons treated during the 2008-2010 period. During the period January to June 2016, there were 2,976 admissions across all treatment centres in the Western Cape, which was a slight increase compared to the 2,674 admissions during the previous six-month review period. It has also been reported that substance abuse has increased the burden on an already challenged primary health care system in South Africa. The proportion of new treatment admissions amounted to 71% of all admissions during the period 2015-2019.

Endometriosis is a gynaecological disorder that affects an estimated 176 million women worldwide. Endometriosis causes serious societal impacts, such as loss of work productivity and effectiveness of non-work-related activities. Regardless that a significant number of women are impacted, many clinical questions remain unanswered, treatment failures are common, diagnosis takes an average of seven and a half years, and there is little investment in investigating disease mechanisms. At the same time, in the last few decades, endometriosis has been repeatedly mislabelled, which still presents indications on the current endometriosis care. Furthermore, there is still a tendency to exclude women's experiential knowledge, which presents one of the biggest burdens of endometriosis. The Degree Project demonstrates communication barriers to early diagnosis from 262 women using survey data and aims to understand women and medicine's power relations. Through this analysis, women's perspective is presented and discussed. The analytical discussion is divided into four chapters: medical knowledge, pain communication, desired communication support and experiential support. The study identifies how the relationship of knowledge and power impact pain communication and consequently the diagnosis of endometriosis. This study contributes to endometriosis, gender and communication for development studies by suggesting the incorporation of women’s experiential knowledge to address the challenges of pain communication and the diagnostic delay.

Objective: Using the Social Determinants of Health as the study's theoretical underpinning, the authors examined the impact of the North Carolina Community Transformation Grant Project farmers' market initiatives on changes in awareness and use of farmers' markets, and fruit and vegetable consumption. Methods: During the farmers' market season, the researchers conducted a random digit-dial telephone survey among residents in 3 rural North Carolina counties to examine changes in farmers' market awareness, shopping, and fruit and vegetable consumption. They examined change over 1 year using t tests, chi-square tests, and propensity score matching. Results: In 1 county there were increases in farmers' market shopping and fruit and vegetable consumption, and in 1 county there were decreases in farmers' market shopping and fruit and vegetable consumption. Conclusions and Implications: The impact of farmers' market initiatives may be affected by county-specific socioeconomic contexts.

Indiana University-Purdue University Indianapolis (IUPUI) / Depression is the most commonly occurring mental illness the world over. It poses a significant health and economic burden across the individual and community. Not all occurrences of depression require the same level of treatment. However, identifying patients in need of advanced care has been challenging and presents a significant bottleneck in providing care. We developed a knowledge-driven depression taxonomy comprised of features representing clinical, behavioral, and social determinants of health (SDH) that inform the onset, progression, and outcome of depression. We leveraged the depression taxonomy to build decision models that predicted need for referrals across: (a) the overall patient population and (b) various high-risk populations. Decision models were built using longitudinal, clinical, and behavioral data extracted from a population of 84,317 patients seeking care at Eskenazi Health of Indianapolis, Indiana. Each decision model yielded significantly high predictive performance. However, models predicting need of treatment across high-risk populations (ROC’s of 86.31% to 94.42%) outperformed models representing the overall patient population (ROC of 78.87%). Next, we assessed the value of adding SDH into each model. For each patient population under study, we built additional decision models that incorporated a wide range of patient and aggregate-level SDH and compared their performance against the original models. Models that incorporated SDH yielded high predictive performance. However, use of SDH did not yield statistically significant performance improvements. Our efforts present significant potential to identify patients in need of advanced care using a limited number of clinical and behavioral features. However, we found no benefit to incorporating additional SDH into these models. Our methods can also be applied across other datasets in response to a wide variety of healthcare challenges.

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Where someone lives, how much education they have, their income, all are recognized as social determinants of health, and as being of greater importance in their overall health status and outcomes than are their doctors and medicines. But all of these are affected by times in which they have lived. These encompass the physical world, the social forms, institutions, economic activities, material goods, the customs, beliefs, morals, laws, norms, and arts of the world in which we move, and all change over time. The experiences of a body moving through time alter that body in direct and indirect ways, to create change that is persistent through time. A patient might reasonably say "to understand me you need to understand the times in which I have lived." Similarly the health of a population can only be fully understood if the history of that population is considered. A case study of an individual within a specific population is used to illustrate these points. / Urban Bioethics

This thesis discloses findings from a scoping review of Social and Structural Determinant of Health (SSDOH)-related academic and grey literature from neurosurgery and fields with neurosurgical overlap. The purpose of this thesis is to identify which social determinants have been assessed, for which surgical procedures they were evaluated, and what disparities were found. To identify studies to include or consider for this systematic review, the review team worked with a medical librarian to develop detailed search strategies for each database. Studies were screened by title and abstract independently by two reviewers. Disagreements between reviewers were resolved by a third reviewer, blinded to the decisions of the primary reviewers. The scoping review of the SSDOH in neurosurgical outcomes identified 99 studies from the year 1990 to 2020. Identified studies were targeted predominantly toward spine surgery patients, evenly distributed in analyses of gender, race and economic stability. The relatively low volume of neurosurgical papers focused on the SSDOH and emphasis on one subspecialty demonstrates the need for an expanded interest in the SSDOH in neurosurgery. / Urban Bioethics

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There is substantial evidence that suicidal behaviour is disproportionately observed among those with lower socioeconomic positions. Prior literature suggests that policy measures tackling severe socioeconomic deprivation may have impacts on decreasing the health gaps. Yet, little research has been conducted to examine the effects of social and welfare policies on suicidal behaviour and its inequality. This is in part because the understanding of the socioeconomic inequity in suicidal behaviour has been limited by the strong biological individualism, thereby overlooking the potential importance of social and welfare policies to tackle the population-level determinants of suicide. Using jurisdictional and temporal variations in social policies and patterns of suicide, this dissertation contributes to the literature by providing a summary of the current knowledge base of socioeconomic inequality in suicide and suicidal behaviour, identifying the knowledge gaps and future research questions, and adding novel evidence on the impacts of individual social policy and aggregate welfare generosity on suicide mortality and its inequality. In Chapter Two, consists of a scoping review of studies addressing socioeconomic inequalities in suicide and suicidal behaviour or the relationship between socioeconomic positions and different outcomes of suicidal behaviour in high-income countries with quality data. The literature is summarized to map the findings on the socioeconomic inequity in suicidal behaviour. The chapter concludes with an assessment of gaps in the current knowledge base and suggests a future research agenda. In Chapter Three, I examined whether relative welfare generosity in Canadian provinces is associated with overall suicide mortality and employment-based inequalities in suicide mortality by exploiting the provincial differences within Canada. In Chapter Four, I investigated the effects of two recent social pension reforms targeting older adults—Basic Old Age Pension (BOAP) and Basic Pension (BP)—implemented in South Korea on suicide mortality. Taken together, the findings of the dissertation contribute to the existing literature by mapping the relevant literature, identifying research gaps about socioeconomic inequalities in suicide, and suicidal behaviour, and examining the roles of social policy as a moderator of socioeconomic inequalities in suicide. / Dissertation / Doctor of Philosophy (PhD) / There is substantial evidence that suicide and suicidal behaviour are disproportionately observed among those with lower socioeconomic positions. Prior literature suggests that policy measures tackling severe socioeconomic deprivation may have impacts on reducing health gaps. However, little research is conducted to examine what effects can be brought by social and welfare policies on suicidal behaviour. This dissertation contains three studies on socioeconomic inequality in suicide and suicidal behaviour and examines the impacts of socioeconomic policies and welfare generosity that may tackle inequality. The overarching aim of the dissertation is to advance our understandings of socioeconomic inequality in suicide and suicidal behaviour by providing a systematic analysis of socioeconomic inequality in suicide and suicidal behaviour and roles of social policy and welfare generosity on suicide and suicide inequality. The dissertation contributes to the literature by mapping the relevant literature, identifying research gaps about socioeconomic inequalities in suicide, and suicidal behaviour and demonstrate novel findings about the roles of social policy.

BACKGROUND: Pancreatic ductal adenocarcinoma maintains a formidable mortality rate with rising incidence despite extensive research efforts. As of 2021 pancreatic cancer is the third leading cause of cancer-related deaths in the United States despite its incidence representing only 3% of all cancer diagnoses. Given the high mortality rate, research efforts push to improve prognosis by expanding knowledge and tools in the realms of diagnostics, genetics, development of screening modalities, and targeted treatments. Modifications in treatment algorithms have led to only modest improvements in outcome. Current research efforts focus on primary and secondary prevention aimed at modifications of known environmental and hereditary risk factors. Available studies highlight the relationship between relative geography and cancers; however, there is a paucity of research available on the Social Determinants of Health on access to pancreatic cancer care and outcomes. PROPOSED PROJECT: Data will be extracted from the Surveillance, Epidemiology, and End Results (SEER) database and combined with US Census data along with medical record information as relevant over a seven-year period from January 1, 2010, through December 31, 2017. Social Vulnerability Index scores will be derived from the available data as a surrogate for Social Determinant of Health and be assigned to each case of pancreatic cancer from 2010-2017. These scores will be grouped by zip code. Analysis will then be performed to identify the mean stage at time of diagnosis for each zip code. Further analysis will be performed to calculate survival curves for each zip code and cox proportional-hazards will be performed on results to determine statistical significance of SVI with respect to geography. CONCLUSIONS: The proposed study will investigate the impact of geography as a Social Determinant of Health (SDoH) within the United States on the stage at time of diagnosis for pancreatic ductal adenocarcinoma. As a secondary measure, overall survival following diagnosis of pancreatic ductal adenocarcinoma will be examined. SIGNIFICANCE: This study will identify the impact of social determinants of health on geography and correlate the impact on outcomes in pancreatic ductal adenocarcinoma in the United States of America. This study may also identify geographic regions in which the incidence of PDAC is higher than expected which would present a population to investigate for additional screening studies and development of risk prediction models.