Building a Framework for a More Inclusive Healthcare System

Objective: With the explosion in the use of telehealth technologies, it is essential to address the challenges in global telehealth inequity in order to create a path to healthcare equality. To this end, this research paper focuses on investigating telehealth as it relates to the COVID-19 pandemic and its impact on healthcare inequality, telehealth inequity, and the continued vulnerabilities with increased demand in implementation. Study Design: A set of voluntary questions were e-mailed to active members of the IEEE-SA (Institute of Electrical and Electronics Engineers Standards Association) Transforming the Telehealth Paradigm: Sustainable Connectivity, Accessibility, Privacy, and Security for all. The interview answers were analyzed via deductive thematic analysis organized into higher themes and theme-specific codes. Setting: The country of residence varied among individuals who are the IEEE-SA Telehealth program members. These continents included: North America, South America, Africa, Asia, and Europe. Participants: Global healthcare leaders who are active members of the IEEE-SA Transforming the Telehealth Paradigm: Sustainable Connectivity, Accessibility, Privacy, and Security for all participated. The occupations of these individuals ranged from a variety of areas within the healthcare domain, such as physicians, scientists, and public health experts. Main outcome measure: Qualitative data obtained voluntarily from global healthcare leaders participating in the IEEE-SA Transforming the Telehealth Paradigm: Sustainable Connectivity, Accessibility, Privacy, and Security for all. Results: The major themes that emerged from the participants' responses included: telehealth infrastructure and access, digital literacy and user interface, government regulations, and telehealth legislation. Conclusions: Telehealth has the power to decrease healthcare disparities, thus getting closer to achieving health equity. However, there are three significant common global barriers to the implementation of telehealth: infrastructure, digital literacy, and government regulations. Because the results were based on interviewer responses, the conclusions acknowledged how the background of respondents, including career and education, influenced their experiences and, thus, the responses. Suggestions for change in reducing barriers to telehealth accessibility are detailed in this research. These suggestions were derived from respondents and focused on the global barriers to implementation. To reduce these barriers, changes in political health policy, patient health education, health provider telemedicine support, and in regulation for telemedicine are suggested. Limitations in our research project included a small sample size and the ensuing lack of representation from more geographical regions.

After the Virus: Disaster Capitalism, Digital Inequity, and Transformative Education for the Future of Schooling

The 2020 COVID-19 disaster triggered an educational crisis in the United States, deeply exacerbating the inequities present in education as schools went online. This primary impact may not be the only one, however: literature describes a secondary impact of such disasters through "disaster capitalism," in which the private sector captures the public resources of disaster-struck communities for profit. In response to these warnings, we ask how schools, families, and communities can counteract disaster capitalism for educational equity. To address this question, we first synthesize a critical framework for analyzing digital inequity in education. We then dissect the strategies disaster capitalism uses to attack the school-family-community relationship and exacerbate digital inequity in "normal" times as well as during crises. Employing the notion of community funds of knowledge, we next examine the resources schools, families, and communities can mobilize against disaster capitalism and digital inequity. Finally, guided by the concepts of generative change and transformative learning, we consider actionable practices of countering disaster capitalism for a transformative education. [ FROM AUTHOR] Copyright of Education & Urban Society is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Revisiting Acker's gendered organizational theory: what women overcome to stay in the superintendency

Despite key improvements to social, political, and economic status, women remain underrepresented in key leadership positions across the United States, including the superintendency. Feminist research underscores that androcentric systems maintain, valorize, and reproduce the experiences and knowledge claims of upper middle-class, heterosexual, white men. Documented in related fields, gender inequity within public school systems is thus in part, the result of bias, discrimination, and highly gendered organizational practices. Part of a larger qualitative descriptive study conducted in spring 2021 of the COVID-19 pandemic, the purpose of this research was to examine normative culture within the New York State (NYS) Boards of Cooperative Educational Services (BOCES) superintendency, and how professional and personal supports affect women superintendents and ultimately their decision "to stay" in their position. The guiding research question for this part of the study asked how and why the NYS BOCES superintendency was gendered? Guided by and building upon Joan Acker's gendered organizational theory, 32 semi-structured, in-depth interviews were completed with NYS BOCES women superintendents. The BOCES organization was purposefully selected, in contrast to one of the 731 NYS public school districts, because of the level of political and economic power that BOCES superintendents have at the state level - and to that end, the role of women leadership in a highly influential state educational organization. Overall, study results are consistent with Acker's research, finding that the NYS BOCES is a highly gendered organization, and also in specific ways tied to contemporary context. Chief among these included that women superintendents face countless gender inequities and barriers associated with staying in their leadership role, but professional legacy, the extent to which the work benefited families, and appropriate work-life balance were motivating factors. Concluding with implications for research and practice, study findings are significant because this study is the first to empirically examine the NYS BOCES and the career trajectories of its women superintendents - and to do so from a feminist epistemological perspective and gendered theoretical framework focused creating transformative change within research and practice.

Unintended consequences of communicating rapid COVID-19 vaccine policy changes- a qualitative study of health policy communication in Ontario, Canada.

BACKGROUND: The success of the COVID-19 vaccination roll-out depended on clear policy communication and guidance to promote and facilitate vaccine uptake. The rapidly evolving pandemic circumstances led to many vaccine policy amendments. The impact of changing policy on effective vaccine communication and its influence in terms of societal response to vaccine promotion are underexplored; this qualitative research addresses that gap within the extant literature. METHODS: Policy communicators and community leaders from urban and rural Ontario participated in semi-structured interviews (N = 29) to explore their experiences of COVID-19 vaccine policy communication. Thematic analysis was used to produce representative themes. RESULTS: Analysis showed rapidly changing policy was a barrier to smooth communication and COVID-19 vaccine roll-out. Continual amendments had unintended consequences, stimulating confusion, disrupting community outreach efforts and interrupting vaccine implementation. Policy changes were most disruptive to logistical planning and community engagement work, including community outreach, communicating eligibility criteria, and providing translated vaccine information to diverse communities. CONCLUSIONS: Vaccine policy changes that allow for prioritized access can have the unintended consequence of limiting communities' access to information that supports decision making. Rapidly evolving circumstances require a balance between adjusting policy and maintaining simple, consistent public health messages that can readily be translated into action. Information access is a factor in health inequality that needs addressing alongside access to vaccines.

Response to the multi-country monkeypox outbreak: a view from Africa.

Human monkeypox was first reported in Africa in 1970. However, the disease has only entered notoriety since the current PHEIC in Europe and the Americas in 2022. At present there is a significant inequality in access to diagnostics, vaccinations and therapeutics, for which African nations are being completely left behind.

Social determinants of health inequity in Iran: a narrative review.

Objective: COVID-19 burden the health system by influencing several aspects of social determinants of health (SDH). We review SDH inequity in Iran with notice on COVID-19 pandemic and sanctions. Method: The Databases such as MEDLINE, Scopus, and Google Scholar were searched. The SDH components were extracted regarding the effect of COVID-19 and sanctions. Global burden of disease was used to evaluate the impact of sanctions on mortality in Iran. Result: The literacy rate improved over the last decades but, there is still inequality between provinces. Age and regional inequity exists, regarding NCD mortality. Food insecurity varies in different regions between 20% and 60%.Providing care for a growing aging population, with a large burden of NCDs and disabilities will be the major issue in the next decade. The decrease slop of mortality rate due to NCDs, have become smoother since impose of sanctions, while, cancer mortality have changed upwards. COVID-19, and sanctions negatively impacts lower socioeconomically vulnerable groups due to preexisting conditions which wider the existing inequity in SDH are adding a heavy burden of inequity in Iran. Conclusion: Iran, similar to large numbers of countries, face inequity at regional level in different SDH related issues. The COVID-19 pandemic showed that economic status and health are aligned. Sanctions superimposed on the COVID-19 pandemic cause harm to millions of innocent people. One of the main goals of health authorities is to reduce SDH inequity in order to achieve the goal of "health for all". To tackle these inequities, prompt action is needed.

What was a gap is now a chasm: Remote schooling, the digital divide, and educational inequities resulting from the COVID-19 pandemic.

COVID-19 resulted in the unexpected transition to remote learning for K-12 schools, exacerbating the existing digital divide and impacting the educational outcomes of marginalized youth. This article reviews the literature on the impacts of the pandemic on the educational outcomes of marginalized youth due to remote learning and the digital divide. Here, we provide an overview of the pandemic and remote schooling from an intersectional lens, discuss the impacts of the digital divide on learning for students during the pandemic, and then consider impacts on the delivery of special education supports. Additionally, we review the literature on the widening achievement gap in relation to the COVID-19 pandemic. Future directions for research and practice are discussed.

Global inequities in access to COVID-19 health products and technologies: A political economy analysis.

This paper presents a political economy analysis of global inequities in access to COVID-19 vaccines, treatments, and diagnostic tests. We adapt a conceptual model used for analysing the political economy of global extraction and health to examine the politico-economic factors affecting access to COVID-19 health products and technologies in four interconnected layers: the social, political, and historical context; politics, institutions, and policies; pathways to ill-health; and health consequences. Our analysis finds that battles over access to COVID-19 products occur in a profoundly unequal playing field, and that efforts to improve access that do not shift the fundamental power imbalances are bound to fail. Inequitable access has both direct effects on health (preventable illness and death) and indirect effects through exacerbation of poverty and inequality. We highlight how the case of COVID-19 products reflects broader patterns of structural violence, in which the political economy is structured to improve and lengthen the lives of those in the Global North while neglecting and shortening the lives of those in the Global South. We conclude that achieving equitable access to pandemic response products requires shifting longstanding power imbalances and the institutions and processes that entrench and enable them.

A global spatial analysis of factors associated with case and mortality rates for coronavirus disease 2019 during the first year of the pandemic.

BACKGROUND: A increasing number of studies have revealed associations between country-level determinants and coronavirus disease 2019 (COVID-19) outcomes. This ecological study was conducted to analyze country-level parameters related to COVID-19 infections and deaths during the first year of the pandemic. METHODS: The examined predictors comprised demographics, economic factors, disease prevalence and healthcare system status, and the relevant data were obtained from public databases. The index dates were set to 15 July 2020 (Time 1) and 15 December 2020 (Time 2). The adjusted spatial autoregression models used a first-order queen contiguity spatial weight for the main analysis and a second-order queen contiguity spatial weight for a sensitivity analysis to examine the predictors associated with COVID-19 case and mortality rates. RESULTS: Obesity was significantly and positively associated with COVID-19 case and mortality rates in both the main and sensitivity analyses. The sensitivity analysis revealed that a country's gross domestic product, population density, life expectancy and proportion of the population older than 65 y are positively associated with COVID-19 case and mortality rates. CONCLUSIONS: With the increasing global prevalence of obesity, the relationship between obesity and COVID-19 disease at the country level must be clarified and continually monitored.

Invited Commentary: To Make Long-Term Gains Against Infection Inequity, Infectious Disease Epidemiology Needs to Develop a More Sociological Imagination.

In a recent article in the Journal, Noppert et al. (Am J Epidemiol. 2023;192(3):475-482) articulated in detail the mechanisms connecting high-level "fundamental social causes" of health inequity to inequitable infectious disease outcomes, including infection, severe disease, and death. In this commentary, we argue that while intensive focus on intervening mechanisms is welcome and necessary, it cannot occur in isolation from examination of the way that fundamental social causes-including racism, socioeconomic inequity, and social stigma-sustain infection inequities even when intervening mechanisms are addressed. We build on the taxonomy of intervening mechanisms laid out by Noppert et al. to create a road map for strengthening the connection between fundamental cause theory and infectious disease epidemiology and discuss its implications for future research and intervention.

Taking on the "new normal”: emerging psychologists' reflections on the COVID-19 pandemic

PurposeCoronavirus (COVID-19) rapidly became the "new normal” with profound implications for everyone's daily life. In this paper, emerging psychologists from diverse cultural backgrounds discuss four main ways in which COVID-19 impacted diverse psychological populations.Design/methodology/approachThis paper was written as a reflection on how COVID-19 has impacted diverse psychological populations using authors' academic and personal experiences.FindingsFirst, the authors explore inaccessible populations with a focus on domestic violence victims living in rural areas. Second, the authors consider consequences of social isolation with a focus on remote workers. Third, the authors investigate the consequences of public (dis)trust in the pandemic with a focus on migrant worker communities. Finally, the authors discuss pandemic-relevant subcultures with a focus on "anti-vaxxers”.Social implicationsThe paper concludes with a discussion of negative implications of the COVID-19 pandemic on diverse psychological populations, both for the present and the future, and ends with an action plan of possible interventions to overcome these limitations.Originality/valueOverall, the current paper provides a broad overview of how the pandemic has shaped and will continue to shape diverse psychological populations.

Social and ideological determinants of COVID-19 vaccination status in Spain.

OBJECTIVES: This study analysed the association between social and ideological determinants with COVID-19 vaccine accessibility and hesitancy in the Spanish adult population. STUDY DESIGN: This was a repeated cross-sectional study. METHODS: The data analysed are based on monthly surveys conducted by the Centre for Sociological Research between May 2021 and February 2022. Individuals were classified according to their COVID-19 vaccination status into (1) vaccinated (reference group); (2) willing to vaccinate but not vaccinated, proxy of lack of vaccine accessibility; and (3) hesitant, proxy of vaccine hesitancy. Independent variables included social (educational attainment, gender) and ideological determinants (voting in the last elections, importance attached to the health vs the economic impact of the pandemic, and political self-placement). We estimated odds ratio (OR) and 95% confidence interval (CI) conducting one age-adjusted multinomial logistic regression model for each determinant and then stratified them by gender. RESULTS: Both social and ideological determinants had a weak association with the lack of vaccine accessibility. Individuals with medium educational attainment had higher odds of vaccine hesitancy (OR = 1.44, CI 1.08-1.93) compared with those with high educational attainment. People self-identified as conservative (OR = 2.90; CI 2.02-4.15) and those who prioritised the economic impact (OR = 3.80; CI 2.62-5.49) and voted for parties opposed to the Government (OR = 2.00; CI 1.54-2.60) showed higher vaccine hesitancy. The stratified analysis showed a similar pattern for both men and women. CONCLUSIONS: Considering the determinants of vaccine uptake and hesitancy could help to design strategies that increase immunisation at the population level and minimise health inequities.

COVID-19 vaccination decisions among Gypsy, Roma, and Traveller communities: A qualitative study moving beyond "vaccine hesitancy".

BACKGROUND: Many people refuse vaccination and it is important to understand why. Here we explore the experiences of individuals from Gypsy, Roma, and Traveller groups in England to understand how and why they decided to take up or to avoid COVID-19 vaccinations. METHODS: We used a participatory, qualitative design, including wide consultations, in-depth interviews with 45 individuals from Gypsy, Roma, and Traveller, communities (32 female, 13 male), dialogue sessions, and observations, in five locations across England between October 2021 and February 2022. FINDINGS: Vaccination decisions overall were affected by distrust of health services and government, which stemmed from prior discrimination and barriers to healthcare which persisted or worsened during the pandemic. We found the situation was not adequately characterised by the standard concept of "vaccine hesitancy". Most participants had received at least one COVID-19 vaccine dose, usually motivated by concerns for their own and others' health. However, many participants felt coerced into vaccination by medical professionals, employers, and government messaging. Some worried about vaccine safety, for example possible impacts on fertility. Their concerns were inadequately addressed or even dismissed by healthcare staff. INTERPRETATION: A standard "vaccine hesitancy" model is of limited use in understanding vaccine uptake in these populations, where authorities and health services have been experienced as untrustworthy in the past (with little improvement during the pandemic). Providing more information may improve vaccine uptake somewhat; however, improved trustworthiness of health services for GRT communities is essential to increase vaccine coverage. FUNDING: This paper reports on independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or its arm's length bodies, and other Government Departments.

Talking about inequities: A comparative analysis of COVID-19 narratives in the UK, US, and Brazil.

Disproportionate mortality and morbidity burdens of the COVID-19 pandemic and coinciding media coverage of public acts of violence perpetrated against people of color in 2020 precipitated reckonings with structural inequities in global, national, and local contexts. This cross-country comparative analysis aims to describe how people voice and make sense race, racism, and privilege in their experiences with COVID-19 infection in the United States, United Kingdom, and Brazil. Anchored by continuous reflection on our individual and collective positionality, we conducted an inductive comparative analysis conceptually situated in intersectionality and critical race theory. Countries used a shared qualitative methodology to collect and analyze 166 narratives of people with experience of COVID-19 infection from 2020 to 2023. We selected 19 cases that illustrate cross-national differences in peoples' acknowledgment and narration of structural privilege and disadvantage in their observations of COVID-19 in their countries and in their personal experiences. People in the US had the most fluency with voicing race directly. In Brazil, while some respondents (especially younger people) demonstrated high racial consciousness, others struggled to identify and talk about racial relationships. In the UK, people voiced racial identifications, though often within white norms of politeness and an accompanying sense of discomfort. The findings overall illustrate moments the interview becomes or does not become a space for voicing social categories and systemic underpinnings of difference in COVID-19 infections and healthcare experiences. We reflect on cross-country differences in historical and contemporary racialized discourse and elaborate on implications of focusing on voicing in qualitative research.

Impact of COVID-19 on access to laboratories and human participants: exercise science faculty perspectives.

Restrictions due to the coronavirus (COVID-19) pandemic impacted the ability of faculty and students in exercise science to work in lab settings with human participants. The purpose of this study was to determine how exercise science faculty were impacted by COVID-19 restrictions with respect to access and use of exercise science lab and research facilities. Of the 100 surveyed participants categorized as requiring access to people and lab spaces (lab-based faculty), 61% (n = 61) reported decreased research productivity with 87% (n = 53) of those faculty in one or more of the following subdisciplines: exercise physiology, clinical exercise physiology, or biomechanics. Of all lab-based faculty, 40% (n = 40) participants reported having access to students and lab spaces and 55% (n = 55) indicated they were allowed to conduct in-person research. Of tenure-track lab-based faculty, 80% (n = 20) reported a decrease in research productivity, of which 60.0% (n = 12) identified as female. Among faculty with 5 or less years of teaching experience (n = 23), 69.6% (n = 16) reported a decrease in productivity, with 68.8% (n = 11) of those being female. All exercise science faculty surveyed reported issues with safety and social distancing, modified lab and research procedures, faculty workload, and research productivity. This information can be leveraged to create better infrastructure to support faculty and develop and implement strategies to reduce workload inequities.

Rebalancing gender inequity and the digital divide: Unintended consequences of working from home

Working-from-home (WFH) models represent one of several types of flexible work practices gaining ground in the context of the COVID-19 pandemic. Of particular interest is the increase in the use of digital technology platforms for work collaboration and communication. These have been largely well received in terms of their potential to mitigate disruptions to business activity and employee work life in the absence of in-person work contexts. Research indicates that the sales and adoption of many digital platforms have witnessed sharp increase since the advent of the COVID-19 pandemic. These have contributed to creating seamless organisational collaborations, shared access to electronic data and new organisational processes to mirror previous in-person work arrangements. Many organisational members have had to upskill at rapid rates to catch up with these developments. Despite the benefits to employees, managers and organisations in terms of facilitating continued remote work, we illuminate the hidden inequities within this work model and highlight the unintended consequences from the standpoint of gender, race and the digital divide. We identify key aspects of WFH that represent underlying factors which create conditions for inequities and illustrate these with a case study. Additionally, we analyse the role of technology as a platform for WFH, noting impacts on employee well-being, team dynamics, as well as manager-employee relations. We conclude by raising implications for managers, offering recommendations to rebalance the inequities identified, such as developing an inclusive organisational culture, creating systems to access and evaluate employee feedback as well as developing appropriate response mechanisms that support particularly vulnerable groups. © 2022 Kemi Ogunyemi and Adaora I. Onaga. All rights reserved.

Covid-19 vaccination uptake by Hapu Mama - How are we progressing?

The Covid-19 vaccine has been recommended for pregnant people (hapu mama) in Aotearoa New Zealand since June 2021. We surveyed people birthing in a tertiary hospital regarding their vaccination status and reasons for this. There were 74% (142/191) of pregnant people who were fully vaccinated. Motivators for vaccination included protection against Covid-19 and antibody transfer to the baby (pepe). Unvaccinated participants worried about vaccine safety. Concerns were raised about the change in official advice without well-communicated reasons for the change. Future vaccine and booster rollouts must be delivered equitably and hapu mama must be a priority group.Copyright © 2022 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists. © 2022 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Classroom Assessment and Instructional Modes: An Exploration of School-Level Contextualized Psychometric Challenges

The global COVID-19 health pandemic caused major interruptions to educational assessment systems, partially due to shifts to remote learning environments, entering the post-COVID educational world into one that is more open to heterogeneity in instructional and assessment modes for secondary students. In addition, in 2020, educational inequities were brought to the forefront of social conscience. The purpose of this study is to empirically explore how contextual (i.e., school-level) race and economic factors may relate to and explain measurement challenges that can arise during shifts to remote learning. We fit a series of multilevel models to explore school-level factors in assessment data alongside psychometric problems of differential item functioning and person fit in classroom assessment measurement models. Our results demonstrate ways in which our project's classroom assessments were impacted by shifts to remote learning, emphasizing the importance of researchers and practitioners evaluating such concerns when seeking validity evidence for interpretation of classroom assessment data. © 2023 Taylor & Francis Group, LLC.

Lessons from the stigma of COVID-19 survivors: A Marxist criticism appraisal.

Stigma refers to devalued stereotypes that create barriers for stigmatized individuals. During the COVID-19 pandemic, the stigmatization of survivors worsened existing inequalities and triggered mass hysteria. The paper delves into the stigmatization experienced by COVID-19 survivors and the role of Marxist criticism in analyzing this issue. The main findings from the empiricist tradition approach suggest that the perception of COVID-19 stigma is higher among those who are older, belong to ethnic minorities, lack social support, have manual occupations, and possess lower levels of education. The proposed destigmatization pathways include psychological counseling services, social support, and health education. Employing a Marxist perspective can aid in illuminating how economic practices and material conditions influence prevalent ideologies related to stigma. The stigmatization of COVID-19 survivors may be perceived as a consequence of social power inequality, although the current emphasis on individual characteristics as triggers for stigma may neglect the wider systemic forces in operation. Thus, it's crucial to establish improved social care policies to combat exploitation and oppression due to power imbalances. The ultimate objective of such an examination is to identify effective approaches to tackle and eradicate stigma regarding health-related concerns. An interdisciplinary approach integrating a pluralistic perspective would benefit investigating how social systems and individual attributes contribute to the exacerbation of social inequality and stigmatization.

Telehealth for Chronic Disease Management Among Vulnerable Populations.

Chronic diseases disproportionately affect patients in low-income minority groups who traditionally use in-person healthcare services. COVID-19 disrupted their routines and limited options for people to receive care; this could exacerbate health inequities. The study examined telehealth chronic disease management among low-income minority groups. We used Florida Medicaid claims data from March to December 2020 and the American Consumer Survey to examine the study objectives. Data were analyzed using Linear and Logistic Regression. We retrieved claim records of 52,904 unique patients; 31,999 were female and 49% of the sample had at least one telehealth visit. Medicaid patients were 8% less likely to use telehealth and 21% more likely to have audio visits when compared to Medicare patients. The analyses suggest that Non-Hispanic Black patients and individuals with a lack of education experience significant health inequities. People with chronic obstructive pulmonary disease (5%) and heart failure (14%) were less likely to use telehealth than patients with diabetes. Telehealth will continue to be a health delivery option; thus we recommend that strategies are enacted to educate, and resources are provided to promote equity among Non-Hispanic Black patients. Without priority attention to people among low-income minority populations, health inequities will continue to plague this community.