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Concept: Health disparities

70

There has been growing policy interest in social justice issues related to both health and food. We sought to understand the state of knowledge on relationships between health equity-i.e. health inequalities that are socially produced-and food systems, where the concepts of ‘food security’ and ‘food sovereignty’ are prominent. We undertook exploratory scoping and mapping stages of a ‘meta-narrative synthesis’ on pathways from global food systems to health equity outcomes. The review was oriented by a conceptual framework delineating eight pathways to health (in)equity through the food system: 1-Multi-Scalar Environmental, Social Context; 2-Occupational Exposures; 3-Environmental Change; 4-Traditional Livelihoods, Cultural Continuity; 5-Intake of Contaminants; 6-Nutrition; 7-Social Determinants of Health and 8-Political, Economic and Regulatory context. The terms ‘food security’ and ‘food sovereignty’ were, respectively, paired with a series of health equity-related terms. Combinations of health equity and food security (1414 citations) greatly outnumbered pairings with food sovereignty (18 citations). Prominent crosscutting themes that were observed included climate change, biotechnology, gender, racialization, indigeneity, poverty, citizenship and HIV as well as institutional barriers to reducing health inequities in the food system. The literature indicates that food sovereignty-based approaches to health in specific contexts, such as advancing healthy school food systems, promoting soil fertility, gender equity and nutrition, and addressing structural racism, can complement the longer-term socio-political restructuring processes that health equity requires. Our conceptual model offers a useful starting point for identifying interventions with strong potential to promote health equity. A research agenda to explore project-based interventions in the food system along these pathways can support the identification of ways to strengthen both food sovereignty and health equity.

Concepts: Agriculture, Health disparities, Nutrition, Economics, Concept, Population health, Food security, Agroecology

64

Disability is an emerging field within public health; people with significant disabilities account for more than 12% of the US population. Disparity status for this group would allow federal and state governments to actively work to reduce inequities. We summarize the evidence and recommend that observed differences are sufficient to meet the criteria for health disparities: population-level differences in health outcomes that are related to a history of wide-ranging disadvantages, which are avoidable and not primarily caused by the underlying disability. We recommend future research and policy directions to address health inequities for individuals with disabilities; these include improved access to health care and human services, increased data to support decision-making, strengthened health and human services workforce capacity, explicit inclusion of disability in public health programs, and increased emergency preparedness. (Am J Public Health. Published online ahead of print February 17, 2015: e1-e9. doi:10.2105/AJPH.2014.302182).

Concepts: Health care, Health economics, Public health, Health, Health disparities, Disability, Population health, Social model of disability

54

Addressing the causes of low engagement in health care is a prerequisite for reducing health inequalities. People who miss multiple appointments are an under-researched group who might have substantial unmet health needs. Individual-level patterns of missed general practice appointments might thus provide a risk marker for vulnerability and poor health outcomes. We sought to ascertain the contributions of patient and practice factors to the likelihood of missing general practice appointments.

Concepts: Health care, Health care provider, Cohort study, Health economics, Longitudinal study, Clinical trial, Health disparities, Illness

43

The Affordable Care Act (ACA) has unleashed a merger frenzy, with hospitals scrambling to shore up their market positions, improve operational efficiency, and create organizations capable of managing population health. The figures are impressive: 105 deals were reported in 2012 alone, up from 50 to 60 annually in the pre-ACA, pre-recession years of 2005-2007.(1) This activity could have lasting repercussions for consumers; the last hospital-merger wave (in the 1990s) led to substantial price increases with little or no countervailing benefits.(2) Since the primary driver of growth in private spending in recent years has been price increases for health care services, . . .

Concepts: Health care, Health economics, Medicine, Public health, Health insurance, Health, Health disparities, Consumer debt

42

In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition.

Concepts: Health care, Health care provider, Psychology, Health disparities, Consciousness, Behavior, Motivation, Human behavior

35

Social, economic and health disparities between northern and southern England have persisted despite Government policies to reduce them. We examine long-term trends in premature mortality in northern and southern England across age groups, and whether mortality patterns changed after the 2008-2009 Great Recession.

Concepts: Health disparities, Demography, Population, Sociology, Economics, Policy, England, Government

35

Sexual identity and sex of sexual contacts can both be used to identify sexual minority youth. Significant health disparities exist between sexual minority and nonsexual minority youth. However, not enough is known about health-related behaviors that contribute to negative health outcomes among sexual minority youth and how the prevalence of these health-related behaviors compare with the prevalence of health-related behaviors among nonsexual minorities.

Concepts: Health care, Health disparities, United States, United Kingdom, Sexual orientation, Minority group, Minority, Minority language

35

Racial disparities in use of analgesia in emergency departments have been previously documented. Further work to understand the causes of these disparities must be undertaken, which can then help inform the development of interventions to reduce and eradicate racial disparities in health care provision.

Concepts: Health care, Health, Human, Health disparities, Pain, Pain management

34

After nearly a decade of genome-wide association studies, no assessment has yet been made of their contribution toward an explanation of the most prominent racial health disparities observed at the population level. We examined populations of African and European ancestry and focused on cardiovascular diseases, which are collectively the largest contributor to the racial mortality gap. We conducted a systematic search for review articles and meta-analyses published in 2007-2013 in which genetic data from both populations were available. We identified 68 articles relevant to this question; however, few reported significant associations in both racial groups, with just 3 variants meeting study-specific significance criteria. For most outcomes, there were too few estimates for quantitative summarization, but when summarization was possible, racial group did not contribute to heterogeneity. Most associations reported from genome-wide searches were small, difficult to replicate, and in no consistent direction that favored one racial group or another. Although the substantial investment in this technology might have produced clinical advances, it has thus far made little or no contribution to our understanding of population-level racial health disparities in cardiovascular disease.

Concepts: Medicine, Genetics, Health disparities, Demography, Cardiovascular disease, Race, Racism, European American

33

We explored health care differences across the lifespan comparing people with developmental disabilities to people without developmental disabilities. Health care disparities are inequities occurring during the provision of and in access to health care that are experienced by socially disadvantaged populations. We discovered significant disparities between persons with and without developmental disabilities in health status, quality, utilization, access, and unmet health care needs. Our results highlight the need to educate health care clinicians on the care of patients with developmental disabilities of all ages.

Concepts: Health care, Health care provider, Health disparities, Sociology, Illness, Need