Dangerous liaisons? Applying the social harm perspective to the social inequality, housing and health trifecta during the Covid-19 pandemic

Global rates of excess mortality attributable to the Covid-19 pandemic provide a fresh impetus to make sense of the associations between income inequality, housing inequality and the social gradient in health, suggesting new questions about the ways in which housing and health are treated in the framing and development of public policy. The first half of the paper uses a social harm lens to examine the threefold associations of the social inequality, housing and health trifecta and offers new insights for policy analysis which foregrounds the production, transmission, and experience of various types of harm which occur within the home. The main body of the paper then draws upon the outcomes of an international systematic literature mapping review of 213 Covid-19 research papers to demonstrate three specific harms associated with stay-at-home lockdowns: (i) intimate partner and domestic violence, (ii) poor mental health and (iii) health harming behaviours. The reported findings are interpreted using a social harm perspective and some implications for policy analysis are illustrated. The paper concludes with a reflection on the efficacy of social harm as a lens for policy analysis and suggests directions for further research in housing studies and zemiology.

Socioeconomic inequities in specialized health services use following COVID-19 in individuals from Southern Brazil.

BACKGROUND: Evidence on inequalities in the health services use is important for public policy formulation, even more so in a pandemic context. The aim of this study was to evaluate socioeconomic inequities in the specialized health use services according to health insurance and income, following COVID-19 in individuals residing in Southern Brazil. METHODS: This was a cross-sectional telephone survey with individuals aged 18 years or older diagnosed with symptomatic COVID-19 using the RT-PCR test between December 2020 and March 2021. Questions were asked about attendance at a health care facility following COVID-19, the facilities used, health insurance and income. Inequalities were assessed by the following measures: Slope Index of Inequality (SII) and Concentration Index (CIX). Adjusted analyses were performed using Poisson regression with robust variance adjustment using the Stata 16.1 statistical package. RESULTS: 2,919 people (76.4% of those eligible) were interviewed. Of these, 24.7% (95%CI 23.2; 36.3) used at least one specialized health service and 20.3% (95%CI 18.9; 21.8) had at least one consultation with specialist doctors after diagnosis of COVID-19. Individuals with health insurance were more likely to use specialized services. The probability of using specialized services was up to three times higher among the richest compared to the poorest. CONCLUSIONS: There are socioeconomic inequalities in the specialized services use by individuals following COVID-19 in the far south of Brazil. It is necessary to reduce the difficulty in accessing and using specialized services and to extrapolate the logic that purchasing power transposes health needs. The strengthening of the public health system is essential to guarantee the population's right to health.

The Evolution of Primary Care Telehealth Disparities During COVID-19: Retrospective Cohort Study.

BACKGROUND: Telehealth has become widely used as a novel way to provide outpatient care during the COVID-19 pandemic, but data about telehealth use in primary care remain limited. Studies in other specialties raise concerns that telehealth may be widening existing health care disparities, requiring further scrutiny of trends in telehealth use. OBJECTIVE: Our study aims to further characterize sociodemographic differences in primary care via telehealth compared to in-person office visits before and during the COVID-19 pandemic and determine if these disparities changed throughout 2020. METHODS: We conducted a retrospective cohort study in a large US academic center with 46 primary care practices from April-December 2019 to April-December 2020. Data were subdivided into calendar quarters and compared to determine evolving disparities throughout the year. We queried and compared billed outpatient encounters in General Internal Medicine and Family Medicine via binary logic mixed effects regression model and estimated odds ratios (ORs) with 95% CIs. We used sex, race, and ethnicity of the patient attending each encounter as fixed effects. We analyzed socioeconomic status of patients in the institution's primary county based on the patient's residence zip code. RESULTS: A total of 81,822 encounters in the pre-COVID-19 time frame and 47,994 encounters in the intra-COVID-19 time frame were analyzed; in the intra-COVID-19 time frame, a total of 5322 (11.1%) of encounters were telehealth encounters. Patients living in zip code areas with high utilization rate of supplemental nutrition assistance were less likely to use primary care in the intra-COVID-19 time frame (OR 0.94, 95% CI 0.90-0.98; P=.006). Encounters with the following patients were less likely to be via telehealth compared to in-person office visits: patients who self-identified as Asian (OR 0.74, 95% CI 0.63-0.86) and Nepali (OR 0.37, 95% CI 0.19-0.72), patients insured by Medicare (OR 0.77, 95% CI 0.68-0.88), and patients living in zip code areas with high utilization rate of supplemental nutrition assistance (OR 0.84, 95% CI 0.71-0.99). Many of these disparities persisted throughout the year. Although there was no statistically significant difference in telehealth use for patients insured by Medicaid throughout the whole year, subanalysis of quarter 4 found encounters with patients insured by Medicaid were less likely to be via telehealth (OR 0.73, 95% CI 0.55-0.97; P=.03). CONCLUSIONS: Telehealth was not used equally by all patients within primary care throughout the first year of the COVID-19 pandemic, specifically by patients who self-identified as Asian and Nepali, insured by Medicare, and living in zip code areas with low socioeconomic status. As the COVID-19 pandemic and telehealth infrastructure change, it is critical we continue to reassess the use of telehealth. Institutions should continue to monitor disparities in telehealth access and advocate for policy changes that may improve equity.

Social differences in COVID-19 vaccination status - Results of the GEDA 2021 study.

Background: The COVID-19 vaccination is a key measure to contain the pandemic. It aims to restrict new infections and to reduce severe courses of the disease. This paper examines the influence of various social determinants on COVID-19 vaccination status. Methods: The analyses are based on data from the study German Health Update (GEDA 2021), a nationwide telephone-based survey of the adult population in Germany, which was conducted between July and December 2021. In addition to bivariate analyses, the association between the COVID-19 vaccination status and the social determinants was examined using Poisson regression. Results: A total of 86.7% of people aged 18 years and older who participated in GEDA 2021 have been received at least one dose of COVID-19 vaccine. Social differences are evident: The proportion of people vaccinated against COVID-19 increases with age, income and higher education group. Lower vaccination rates are found among people with a history of migration, people living in rural areas and people from East Germany. An age-differentiated analysis shows that the social differences in COVID-19 vaccination uptake are lower among those aged 60 years and older. Conclusions: The presented results should be considered when designing targeted interventions to overcome potential barriers to COVID-19 vaccination uptake. Further research is needed regarding the explanatory factors for the social differences in vaccination behaviour, such as structural and group-specific barriers or psychological determinants.

SARS-CoV-2 infections in migrant populations in Germany: results from the COVID-19 snapshot monitoring survey.

OBJECTIVES: Research shows that there is an increased risk of SARS-CoV-2 infection in migrants and ethnic minorities. However, increasing evidence indicates that socio-economic factors, such as employment, education and income, contribute to the association between migrant status and SARS-CoV-2 infection. This study aimed to examine the association between migrant status and the risk of SARS-CoV-2 infection in Germany and to discuss potential explanations for these associations. STUDY DESIGN: This was a cross-sectional study. METHODS: Data from the German COVID-19 Snapshot Monitoring online survey were analysed, and hierarchical multiple linear regression models were used to calculate the probabilities of self-reported SARS-CoV-2 infection. Predictor variables were integrated in a stepwise method as follows: (1) migrant status (defined by own or parental country of birth other than Germany); (2) gender, age and education; (3) household size; (4) household language; and (5) occupation in the health sector, including an interaction term of migrant status (yes) and occupation in the health sector (yes). RESULTS: Of 45,858 participants, 3.5% reported a SARS-CoV-2 infection, and 16% were migrants. Migrants, participants in large households, those speaking a language other than German in their household and those working in the health sector were more likely to report SARS-CoV-2 infection. The probability of reporting SARS-CoV-2 infection was 3.95 percentage points higher for migrants than non-migrants; this probability decreased when integrating further predictor variables. The strongest association of reporting a SARS-CoV-2 infection was observed for migrants working in the health sector. CONCLUSIONS: Migrants and health sector employees, and especially migrant health workers, are at an increased risk of SARS-CoV-2 infection. The results show that the risk of SARS-CoV-2 infection is determined by living and working conditions rather than migrant status.

COVID-19 vaccination status among people with selected citizenships: results of the study GEDA Fokus.

Background: the COVID-19 vaccination offers protection against severe disease progression. Data show that people with a history of migration are less likely to be vaccinated against COVID-19 than people without a history of migration, but are at increased risk of infection. Methods: Data were used from the GEDA Fokus interview survey (November 2021 - May 2022), which included people living in Germany with Croatian, Italian, Polish, Syrian or Turkish citizenship (n=5,495). In addition to bivariate analyses, Poisson regressions were used to examine the association between uptake of at least one COVID-19 vaccination and sociodemographic, health- and migration-related factors. Results: 90.0% of participants reported having received at least one COVID-19 vaccination. Having visited a general practitioner or specialist in the past 12 months, living in Germany for 31 years or more, and having a greater sense of belonging to society in Germany were associated with vaccination uptake in bivariate analyses. Regression analysis showed that older people and those with higher education were more likely to be vaccinated. Conclusions: Sociodemographic factors are associated with uptake of the COVID-19 vaccine among individuals with selected citizenships. Low-threshold information and vaccination offers are important to ensure equal access to vaccination.

A Novel Ontological Approach to Estimate Inequalities and Underuse of Social Prescriptions for Mental Health in Primary Care in England

Mental health conditions are a significant contributor to morbidity and mortality and cost an estimated £1.6 trillion per year globally. The COVID-19 pandemic and its associated lockdowns have contributed to increases in common mental health problems (CMHP) like depression. Bodies in the UK recommend the use of non-medical interventions like social prescriptions to support individuals suffering from CMHP. In 2019, NHS-England committed to support the use of social prescribing across England. Despite this commitment, the proportion of eligible individuals with a CMHP that actually receive a social prescription remains unknown. To overcome this knowledge gap, a novel ontological approach was used to estimate the proportion of individuals with a CMHP that received a social prescription, disaggregated by different attributes (region, ethnicity, socio-economic status, sex, age) across a four-year period from 2017–2020. We discovered two general trends. First, there was a 1.4-fold increase in the presentation of individuals, across all attributes, to primary care with a CMHP across the four-year period analysed. There was also marked variation in the presentation to primary care with a CMHP based on different attributes (2020 variation figures - regions: 2.8-fold;ethnicity: 1.8-fold;socio-economic status: 1.4-fold;sex: 1.7-fold;age: 3.9-fold). Second, despite an increase in the use of social prescribing for mental health, there was still substantial underuse of it across all attributes in England (the highest percentage seen across all attributes in 2020 was 14%). The general trends revealed through our analyses provide valuable insights that can help to inform both policy and practice to address variation, health inequalities as well as to proactively design and implement appropriate services. © 2022, Springer Nature Switzerland AG.

Undocumented immigrants suffering from inequality of vaccination access in Japan: measuring the institutional barriers and exploring the associated factors.

OBJECTIVES: Undocumented immigrants (UIs) have been reported to suffer from the unequal distribution of COVID-19 vaccination, but this inequality has never been quantified, and the associated factors have not been measured. STUDY DESIGN AND METHODS: We interviewed 190 municipal offices throughout Japan about the access to COVID-19 vaccination for UIs and control group foreigners. Using logistic regression, we investigated the association between assured access and municipal characteristics. RESULTS: Out of the respondent municipalities, 57.5% answered that UIs can apply for a COVID-19 vaccination voucher. Additionally, 31.5% said they had received an inquiry about vaccines from UI individuals. Furthermore, only 23.2% of the municipalities responded that they had issued vouchers for UIs at least once. The control groups were reported to have been given more access to vouchers. Logistic regression showed that the foreign resident ratio, tertiary industry, and university graduation ratio were positively associated with vaccination access. CONCLUSIONS: This study revealed for the first time that UIs are disproportionately marginalized compared with other visitors, implying that "illegality" plays an important role in the context of vaccination eligibility. The street-level vaccination desks of local governments may refuse to supply vaccines. Vaccine equity will be more readily achievable when vaccination access to all populations including UIs is ensured. Such access will also improve overall public health by increasing the vaccination rate.

Inequalities in access to new medication delivery services among non-communicable disease patients during the COVID-19 pandemic: findings from nationally representative surveys in Thailand.

BACKGROUND: This study describes the inequalities in access to a medication delivery service (MDS) during the COVID-19 pandemic and identifies the social determinants of health-related inequalities among non-communicable disease (NCD) patients. METHODS: Data were obtained from a study on the impact of health behaviours and modifications in health behaviours during the COVID-19 pandemic in the Thai population in 2021. The participants were recruited from Bangkok and all four regions of Thailand. The concentration index was used to examine the inequality among income quintiles, which were standardised by age, sex, living area, job type, health insurance scheme, and education level. Logistic regression was used to examine the associations between socio-demographics and access to regular services and new NCD MDSs, adjusted for age, sex, and other covariates. RESULTS: Among 1,739 NCD patients, greater income inequalities in accessing regular NCD services and collecting medicines at registered pharmacies during the COVID-19 pandemic were observed, for which the concentration index indicated utilisation inequalities in favour of richer households. In contrast, receiving medicine at primary care centres, by postal delivery, and delivered by village health volunteers were the new NCD MDSs, which favoured less wealthy households. NCD patients living in rural areas were more likely to access new NCD MDSs, compared to those in urban areas (adjusted odds ratio = 2.30; 95% confidence interval [CI]: 1.22-4.34). Significant associations with receiving medicine at hospitals were also observed for the income quintiles. Individuals in the lowest and 2nd lowest income quintiles were more likely to access new MDSs than those in the richest quintiles. CONCLUSIONS: This study highlighted a disproportionate concentration of access to new NCD MDSs during the COVID-19 pandemic in Thailand, which was more concentrated in lower-income groups. The government should further study and integrate MDSs with the highest cost benefits into nationwide regular systems, while addressing systematic barriers to access to these services, such as the lack of shared health data across health facilities and tele pharmacy equipment. This will promote access to public services among patients in the less advantaged groups and reduce the health inequality gap.

Short and Long-term Impacts of COVID-19 Pandemic on Health Equity: A Comprehensive Review.

Background: The impact of the COVID-19 pandemic on human life has led to profound consequences in almost all societies worldwide, and this includes its significant impact on all aspects of health. Health equity has been among the main challenges in any healthcare system. However, with the COVID-19 crisis worsening health inequalities, the need to prioritize health equity in upstream national and international plans must receive scholarly attention. Therefore, this paper reports the findings of a review of the current synthesized evidence about the impact of the COVID-19 pandemic on health equity. Methods: This is a comprehensive review in which we retrieved relevant studies during the period starting from 12/01/2019 to 01/15/2021 are retrieved from various databases. The PRISMA flow diagram and a narrative approach are used for synthesizing the evidence. Results: We initially retrieved 1173 studies, and after a primary quality appraisal process, 40 studies entered the final phase of analysis. The included studies were categorized into five main outcome variables: Accessibility (95%), Utilization (65.8%), Financial protection: 15 (36.5%), Poverty (31.7%), and Racism (21.9%) Conclusion: COVID-19 pandemic has been the most devastating global challenge in recent history. While the COVID-19 crisis is still unfolding, its multidimensional adverse effects are yet to be revealed. Nevertheless, some people, e.g., the elderly, minorities, as well as marginalized and poor persons, have suffered the COVID-19 consequences more than others. In line with the whole government/whole society approach, we advocate that governments need to strengthen their special efforts to reduce the extra burden of the pandemic on the most vulnerable populations.

Hunger in French Guiana's Vulnerable Urban Neighborhoods: A Neglected Consequence of COVID-19.

BACKGROUND: In French Guiana, restrictions to control the spread of SARS-CoV-2 were put in place between March 2020 and March 2022. In vulnerable urban neighborhoods, during this period, requests for food assistance increased and fear of hunger overtook fear of being affected by COVID-19. OBJECTIVE: The objective of this survey was to describe food security during the COVID-19 pandemic in French Guiana and to study the relationship between the socioeconomic conditions of the study households and household hunger. METHODS: A multicenter survey was therefore conducted in mobile clinics and fixed structures providing care to at-risk urban populations. In a face-to-face interview, a community health worker asked participants questions about the sociodemographic and economic profile of the household, and about household food security (food consumption score, coping strategies in the face of food shortages, and household hunger index). Two hundred seventy-seven households were recruited in February 2021. RESULTS: According to the household hunger scale, 42.6% of households experienced moderate hunger and 23.8% of households experienced severe hunger in the month preceding the survey. Lack of residence permit, lack of social support, water insecurity, small housing, and lack of access to an urban garden were determinants related to the risk of household hunger. CONCLUSIONS: Food insecurity has affected a large majority of the households in this survey, and the immediate consequences for children's health were already apparent. These results draw attention to a neglected health problem in a socioeconomically vulnerable population during the COVID-19 pandemic.

Housing and Health in Urban Areas

Living environment, and especially dwellings, affect health in several ways end represent a key social determinant of health. The current COVID-19 pandemic has further highlighted its relevance. Factors linked to housing and neighborhood conditions that influence health, can be grouped into broad categories: the health impacts of residential instability;those related to housing internal conditions;the health impacts of context in which dwelling is located;the housing affordability. Many answers to these requirements can be offered by co-housing and social housing and Authors describe same examples from international experiences. These problems nowadays need to be assessed with a multidisciplinary approach, because of the complexity and wideness of its components. To guarantee good health standards it is also necessary to direct political and administrative choices to improve the overall conditions of the neighborhood and of the buildings, and, to dispose of a clear and updated regulatory system, since key factor to ensure health and social justice. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Establishing an Academic-Community Partnership to Explore the Potential of Barbers and Barbershops in the Southern United States to Address Racial Disparities in HIV Care Outcomes for Black Men Living With HIV.

Black men comprise most new HIV infections in the Southern United States and have worse HIV outcomes than their non-Black counterparts. We developed an academic-community partnership in Nashville, Tennessee, to explore opportunities to improve HIV outcomes for Black men. We recruited barbers to an HIV training and focus group discussion about prevention and potential barber/barbershop-based strategies to address HIV-related needs for Black men. We assessed HIV knowledge and stigma with validated scales and conducted thematic analysis on discussion transcripts. HIV-related stigma was low (1.8 of 15 points [SD = 1.69]) among 13 participants of unknown HIV status (12 men and one woman). HIV knowledge increased among eight (67%) participants after receiving a brief HIV didactic. Participants described general health care barriers (e.g., the social norm that Black men do not go to the doctor until they are "damn near dead"), fears about unwanted HIV disclosure when seeking HIV testing or care, and community fears about negative stereotypes associated with HIV. Participants expressed enthusiasm about receiving more HIV-related training and utilizing communication skills and client/community relationships to serve as health educators and navigators. Barbers highlighted opportunities to disseminate HIV information in barbershops and combine HIV interventions with other health issues, such as COVID-19, and suggested that these interventions may help reduce HIV-related stigma. Our findings suggest that barbers and barbershops are an underutilized resource for disseminating HIV-related health information and engaging Black men in HIV and other important prevention and care activities such as COVID-19.

A mixed-studies systematic review of the experiences of body image, disordered eating, and eating disorders during the COVID-19 pandemic.

OBJECTIVES: This systematic review assessed the influence of the COVID-19 pandemic and associated restrictions on body image, disordered eating (DE), and eating disorder outcomes. METHODS: After registration on PROSPERO, a search was conducted for papers published between December 1, 2019 and August 1, 2021, using the databases PsycINFO, PsycARTICLES, CINAHL Plus, AMED, MEDLINE, ERIC, EMBASE, Wiley, and ProQuest (dissertations and theses). RESULTS: Data from 75 qualitative, quantitative, and mixed-methods studies were synthesized using a convergent integrated approach and presented narratively within four themes: (1) disruptions due to the COVID-19 pandemic; (2) variability in the improvement or exacerbation of symptoms; (3) factors associated with body image and DE outcomes; (4) unique challenges for marginalized and underrepresented groups. Disruptions due to the pandemic included social and functional restrictions. Although most studies reported a worsening of concerns, some participants also reported symptom improvement or no change as a result of the pandemic. Factors associated with worse outcomes included psychological, individual, social, and eating disorder-related variables. Individuals identifying as LGBTQ+ reported unique concerns during COVID-19. DISCUSSION: There is large variability in individuals' responses to COVID-19 and limited research exploring the effect of the pandemic on body image, DE, and eating disorder outcomes using longitudinal and experimental study designs. In addition, further research is required to investigate the effect of the COVID-19 pandemic on body image and eating concerns among minoritized, racialized, underrepresented, or otherwise marginalized participants. Based on the findings of this review, we make recommendations for individuals, researchers, clinicians, and public health messaging. PUBLIC SIGNIFICANCE: This review of 75 studies highlights the widespread negative impacts that the COVID-19 pandemic and associated restrictions have had on body image and disordered eating outcomes. It also identifies considerable variations in both the improvement and exacerbation of said outcomes that individuals, researchers, clinicians, and other public health professionals should be mindful of if we are to ensure that vulnerable people get the tailored support they require.

OBJETIVOS: Esta revisión sistemática evaluó la influencia de la pandemia de COVID-19 y las restricciones asociadas en los resultados en imagen corporal, la alimentación disfuncional y los trastornos alimentarios. MÉTODO: Después del registro en PROSPERO, se realizó una búsqueda de artículos publicados entre el 1 de diciembre de 2019 y el 1 de agosto de 2021, utilizando las bases de datos PsycINFO, PsycARTICLES, CINAHL Plus, AMED, MEDLINE, ERIC, EMBASE, Wiley y ProQuest (disertaciones y tesis). RESULTADOS: Los datos de 75 estudios cualitativos, cuantitativos y de métodos mixtos se sintetizaron utilizando un enfoque integrado convergente y se presentaron narrativamente dentro de cuatro temas: (1) interrupciones debidas a la pandemia de COVID-19; (2) variabilidad en la mejoría o exacerbación de los síntomas; (3) factores asociados con resultados de la imagen corporal y alimentarios disfuncional; (4) desafíos únicos para los grupos marginados y subrepresentados. Las interrupciones debidas a la pandemia incluyeron restricciones sociales y funcionales. Aunque la mayoría de los estudios informaron un empeoramiento de las preocupaciones, algunos participantes también informaron una mejoría de los síntomas o ningún cambio como resultado de la pandemia. Los factores asociados con peores resultados incluyeron variables psicológicas, individuales, sociales y relacionadas con el trastorno alimentario. Las personas que se identificaron como LGBTQ + informaron preocupaciones únicas durante COVID-19. DISCUSIÓN: Existe una gran variabilidad en las respuestas de los individuos a COVID-19 y una investigación limitada que explora el efecto de la pandemia en los resultados de la imagen corporal, la alimentación disfuncional y los trastornos de la conducta alimentaria utilizando diseños de estudios longitudinales y experimentales. Además, se requiere más investigación para investigar el efecto de la pandemia de COVID-19 en la imagen corporal y las preocupaciones alimentarias entre los participantes minoritarios, racializados, subrepresentados o marginados. Basados en los hallazgos de esta revisión, se hacen recomendaciones para individuos, investigadores, médicos y mensajes de salud pública.

Ethnic/Racial Disparity in Mortality from COVID-19: Data for the Year 2020 in Brazil.

The study aimed to investigate ethnic/racial disparities in COVID-19 mortality in Brazilian federative units and their respective capitals in 2020. Population data and number of COVID-19 deaths were extracted by skin color (white, black, brown and indigenous) from all Brazilian states and their respective capitals. The mortality rate of COVID-19 by ethnicity in Brazilian states was higher between people from brown skin color, followed by indigenous and black. Only in one state, in the Federal District and in the federal capital, age-standardized mortality rates were higher among white's people. There is a high percentage of deaths from COVID-19 higher than expected among non-white individuals, especially in south-central states and capitals of the country. Mortality from COVID-19 affect ethnic-racial groups unevenly in Brazil and the number of excess deaths among non-whites was over 9000. Urgent government measures are needed to reduce the racial disparity in health indicators in Brazil.

Long COVID and chronic pain: overlapping racial inequalities

The American Public Health Association (APHA) and prominent U.S. health organizations have acknowledged racism as a central cause of health inequality. In the midst of the COVID-19 pandemic, the U.S. confronts an additional public health crisis: mass impairment from Long COVID. Occupational segregation and institutionalized racism have made working-class Black, Indigenous, and people of color (BIPOC) more likely to experience Long COVID. Medical gatekeepers also prevent equal access to health: BIPOC face more obstacles in their search for disability accommodations and social support. To provide health equity to the Long COVID community, Disability Studies must confront racialize understandings of chronic pain and the consequences of these meanings by centering the lived experiences of BIPOC living with chronic pain.

Housing and Health in Urban Areas

Living environment, and especially dwellings, affect health in several ways end represent a key social determinant of health. The current COVID-19 pandemic has further highlighted its relevance. Factors linked to housing and neighborhood conditions that influence health, can be grouped into broad categories: the health impacts of residential instability;those related to housing internal conditions;the health impacts of context in which dwelling is located;the housing affordability. Many answers to these requirements can be offered by co-housing and social housing and Authors describe same examples from international experiences. These problems nowadays need to be assessed with a multidisciplinary approach, because of the complexity and wideness of its components. To guarantee good health standards it is also necessary to direct political and administrative choices to improve the overall conditions of the neighborhood and of the buildings, and, to dispose of a clear and updated regulatory system, since key factor to ensure health and social justice. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

COVID-19: Salt in the Wound of Health Care Inequality and the Cause of a New Health Care Disparity.

The year 2020 will forever be associated with a new chapter in the history of global health, COVID-19. However, this new chapter would have a similar message because many other chapters were written before it. The COVID-19 pandemic would disproportionately affect minorities, those of low socioeconomic class, and those with limited access to health care. However, COVID-19 would also bring about a new health care disparity, limiting access to medical care for those with non COVID-19 related medical needs.

Understanding health inequalities in Wales using the Blinder-Oaxaca decomposition method.

Background: Throughout Wales and the world, health inequality remains a problem that is interconnected with a wider and complex social, economic and environmental dynamic. Subsequently, action to tackle inequality in health needs to take place at a structural level, acknowledging the constraints affecting an individual's (or community's) capability and opportunity to enable change. While the 'social determinants of health' is an established concept, fully understanding the composition of the health gap is dependent on capturing the relative contributions of a myriad of social, economic and environmental factors within a quantitative analysis. Method: The decomposition analysis sought to explain the differences in the prevalence of these outcomes in groups stratified by their ability to save at least £10 a month, whether they were in material deprivation, and the presence of a limiting long-standing illness, disability of infirmity. Responses to over 4,200 questions within the National Survey for Wales (n = 46,189; 2016-17 to 2019-20) were considered for analysis. Variables were included based on (1) their alignment to a World Health Organization (WHO) health equity framework ("Health Equity Status Report initiative") and (2) their ability to allow for stratification of the survey sample into distinct groups where considerable gaps in health outcomes existed. A pooled Blinder-Oaxaca model was used to analyse inequalities in self-reported health (fair/poor health, low mental well-being and low life satisfaction) and were stratified by the variables relating to financial security, material deprivation and disability status. Results: The prevalence of fair/poor health was 75% higher in those who were financially insecure and 95% higher in those who are materially deprived. Decomposition of the outcome revealed that just under half of the health gap was "explained" i.e., 45.5% when stratifying by the respondent's ability to save and 46% when stratifying by material deprivation status. Further analysis of the explained component showed that "Social/Human Capital" and "Income Security/Social Protection" determinants accounted the most for disparities observed; it also showed that "Health Services" determinants accounted the least. These findings were consistent across the majority of scenarios modeled. Conclusion: The analysis not only quantified the significant health gaps that existed in the years leading up to the COVID-19 pandemic but it has also shown what determinants of health were most influential. Understanding the factors most closely associated with disparities in health is key in identifying policy levers to reduce health inequalities and improve the health and well-being across populations.

Health Equity Assessment Toolkit (HEAT and HEAT Plus): exploring inequalities in the COVID-19 pandemic era.

BACKGROUND: The Sustainable Development Goals have helped to focus attention on the importance of reducing inequality and 'leaving no one behind'. Monitoring health inequalities is essential for providing evidence to inform policies, programmes and practices that can close existing gaps and achieve health equity. The Health Equity Assessment Toolkit (HEAT and HEAT Plus) software was developed by the World Health Organization to facilitate the assessment of within-country health inequalities. RESULTS: HEAT contains a built-in database of disaggregated health data, while HEAT Plus allows users to upload and analyze inequalities using their own datasets. Version 4.0 of the software incorporated enhancements to the toolkit's capacity for equity assessments. This includes a multilingual interface, interactive and downloadable visualizations, flexibility to analyze inequalities using any dataset of disaggregated data, and the built-in calculation of 19 summary measures of inequality. This paper outlines the improved features and functionalities of the HEAT and HEAT Plus software since their original release, highlighted through an example of how the toolkit can be used to assess inequalities in the COVID-19 pandemic era. CONCLUSIONS: The features of the HEAT and HEAT Plus software make it a valuable tool for analyzing and reporting inequalities related to the COVID-19 pandemic, as well as its indirect impacts on inequalities in other health and non-health areas, providing evidence to inform equity-oriented interventions and strategies.