Popular health surveillance in traditional fishing communities and the ecology of knowledges in the fight against COVID-19. / Vigilância popular da saúde nas comunidades pesqueiras tradicionais e ecologia dos saberes no enfrentamento à COVID-19.

Considering the public health emergency of international importance caused by COVID-19, artisanal fishing workers, engaging in a dialogue with Brazilian leaders and scholars, created an Observatory on the impacts of this pandemic on fishing communities in March 2020. The purpose of this article is to analyze the experience of popular surveillance of fishermen and fisherwomen's health through daily reports produced at the Observatory. It is a monitoring process that allowed broadening the recognition of the diversity of vulnerable populations' ways of life that intertwine health, environment and work. The study used a qualitative, horizontal and emancipatory methodology and sought approaches to the practice of the ecology of knowledges, with the following results: shared construction of information and knowledges based on heterogeneous social experiences; practice of collective ombudsman with the appreciation of knowledges built in social struggles); joint assessment of public health inequities, territorial conflicts, and environmental, structural, and institutional racism; guidance of social leaders and fundraising through public notices. Thus, the dynamics and horizontality of learning based on solidarity and social emancipation from inter-knowledge are revealed.

Diante da emergência em saúde pública de importância internacional provocada pela COVID-19, trabalhadores da pesca artesanal, em diálogo com lideranças e acadêmicos brasileiros criaram, em março de 2020, um Observatório sobre os impactos dessa pandemia em comunidades pesqueiras. O objetivo deste artigo é analisar a experiência de vigilância popular da saúde de pescadores e pescadoras através de boletins diários produzidos no Observatório. Trata-se de um processo de monitoramento que possibilitou ampliar o reconhecimento da diversidade de modos de vida das populações vulneráveis que entrelaça saúde, ambiente e trabalho. O estudo utilizou metodologia qualitativa, horizontal e emancipatória e buscou aproximações à prática da ecologia dos saberes, tendo como resultados: construção compartilhada de informações e conhecimentos com base em experiências sociais heterogêneas; prática da ouvidoria coletiva com a valorização de saberes construídos nas lutas sociais; avaliação conjunta de iniquidades em saúde pública, conflitos territoriais e racismo ambiental, estrutural e institucional; orientação das lideranças sociais e captação de recursos através de editais públicos. Revela-se, assim, dinamicidade e horizontalidade de aprendizados com base na solidariedade e emancipação social a partir do interconhecimento.

Assessing COVID-19 pandemic excess deaths in Brazil: Years 2020 and 2021.

We estimated the impact of the COVID-19 pandemic on mortality in Brazil for 2020 and 2021 years. We used mortality data (2015-2021) from the Brazilian Health Ministry for forecasting baseline deaths under non-pandemic conditions and to estimate all-cause excess deaths at the country level and stratified by sex, age, ethnicity and region of residence, from March 2020 to December 2021. We also considered the estimation of excess deaths due to specific causes. The estimated all-cause excess deaths were 187 842 (95% PI: 164 122; 211 562, P-Score = 16.1%) for weeks 10-53, 2020, and 441 048 (95% PI: 411 740; 470 356, P-Score = 31.9%) for weeks 1-52, 2021. P-Score values ranged from 1.4% (RS, South) to 38.1% (AM, North) in 2020 and from 21.2% (AL and BA, Northeast) to 66.1% (RO, North) in 2021. Differences among men (18.4%) and women (13.4%) appeared in 2020 only, and the P-Score values were about 30% for both sexes in 2021. Except for youngsters (< 20 years old), all adult age groups were badly hit, especially those from 40 to 79 years old. In 2020, the Indigenous, Black and East Asian descendants had the highest P-Score (26.2 to 28.6%). In 2021, Black (34.7%) and East Asian descendants (42.5%) suffered the greatest impact. The pandemic impact had enormous regional heterogeneity and substantial differences according to socio-demographic factors, mainly during the first wave, showing that some population strata benefited from the social distancing measures when they could adhere to them. In the second wave, the burden was very high for all but extremely high for some, highlighting that our society must tackle the health inequalities experienced by groups of different socio-demographic statuses.

Association of socio-economic deprivation with COVID-19 incidence and fatality during the first wave of the pandemic in Italy: lessons learned from a local register-based study.

BACKGROUND: COVID-19 has been characterised by its global and rapid spread, with high infection, hospitalisation, and mortality rates worldwide. However, the course of the pandemic showed differences in chronology and intensity in different geographical areas and countries, probably due to a multitude of factors. Among these, socio-economic deprivation has been supposed to play a substantial role, although available evidence is not fully in agreement. Our study aimed to assess incidence and fatality rates of COVID-19 across the levels of socio-economic deprivation during the first epidemic wave (March-May 2020) in the Italian Province of Foggia, Apulia Region. METHODS: Based on the data of the regional active surveillance platform, we performed a retrospective epidemiological study among all COVID-19 confirmed cases that occurred in the Apulian District of Foggia, Italy, from March 1st to May 5th, 2020. Geocoded addresses were linked to the individual Census Tract (CT) of residence. Effects of socio-economic condition were calculated by means of the Socio-Economic and Health-related Deprivation Index (SEHDI) on COVID-19 incidence and fatality. RESULTS: Of the 1054 confirmed COVID-19 cases, 537 (50.9%) were men, 682 (64.7%) were 0-64 years old, and 338 (32.1%) had pre-existing comorbidities. COVID-19 incidence was higher in the less deprived areas (p < 0.05), independently on age. The level of socio-economic deprivation did not show a significant impact on the vital status, while a higher fatality was observed in male cases (p < 0.001), cases > 65 years (p < 0.001), cases having a connection with a nursing home (p < 0.05) or having at least 1 comorbidity (p < 0.001). On the other hand, a significant protection for healthcare workers was apparent (p < 0.001). CONCLUSIONS: Our findings show that deprivation alone does not affect COVID-19 incidence and fatality burden, suggesting that the burden of disease is driven by a complexity of factors not yet fully understood. Better knowledge is needed to identify subgroups at higher risk and implement effective preventive strategies.

COVID-19 and Kidney Disease: Progress in Health Inequity From Low-Income Settings.

The acute coronavirus disease-2019 (COVID-19) pandemic has had a significant impact on the incidence and prevalence of acute kidney injury and chronic kidney disease globally and in low-income settings. Chronic kidney disease increases the risk of developing COVID-19 and COVID-19 causes acute kidney injury directly or indirectly and is associated with high mortality in severe cases. Outcomes of COVID-19-associated kidney disease were not equitable globally owing to a lack of health infrastructure, challenges in diagnostic testing, and management of COVID-19 in low-income settings. COVID-19 also significantly impacted kidney transplant rates and mortality among kidney transplant recipients. Vaccine availability and uptake remains a significant challenge in low- and lower-middle-income countries compared with high-income countries. In this review, we explore the inequities in low- and lower-middle-income countries and highlight the progress made in the prevention, diagnosis, and management of patients with COVID-19 and kidney disease. We recommend further studies into the challenges, lessons learned, and progress made in the diagnosis, management, and treatment of patients with COVID-19-related kidney diseases and suggest ways to improve the care and management of patients with COVID-19 and kidney disease.

The impact of health inequities on physicians' occupational well-being during COVID-19: A qualitative analysis from four US cities.

OBJECTIVE: The aim of this study is to describe frontline physicians' perceptions of the impact of racial-ethnic and socioeconomic disparities in COVID-19 infection and mortality on their occupational well-being. METHODS: One hundred and forty-five qualitative, semistructured interviews were conducted between February 2021 and June 2022 with hospital medicine, emergency medicine, pulmonary/critical care, and palliative care physicians caring for hospitalized COVID-19 patients in four US cities. RESULTS: Physicians reported encountering COVID-related health disparities and inequities at the societal, organizational, and individual levels. Encountering these inequities, in turn, contributed to stress among frontline physicians, whose concerns revealed how structural conditions both shaped COVID disparities and constrained their ability to protect populations at risk from poor outcomes. Physicians reported feeling complicit in the perpetuation of inequities or helpless to mitigate observed inequities and experienced feelings of grief, guilt, moral distress, and burnout. CONCLUSIONS: Health inequities are an under-acknowledged source of physicians' occupational stress that requires solutions beyond the clinical context.

Locating Disability Within a Health Justice Framework.

This Article explores the connections between disability and health justice in service of further tethering the two theories and practices. The author contends that disability should shift from marker of health inequity alone to critical demographic in the analytical and practical application of health justice. This theoretical move creates a more robust understanding of the harms of health injustice, its complexities, and, remedially, reveals underexplored legal and policy pathways to promote health justice.

Improving social justice in observational studies: protocol for the development of a global and Indigenous STROBE-equity reporting guideline.

BACKGROUND: Addressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension. METHODS: We assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated knowledge translation approach, we will implement a five-phase plan which will include: (1) assessing the reporting of health equity in published observational studies, (2) seeking wide international feedback on items to improve reporting of health equity, (3) establishing consensus amongst knowledge users and researchers, (4) evaluating in partnership with Indigenous contributors the relevance to Indigenous peoples who have globally experienced the oppressive legacy of colonization, and (5) widely disseminating and seeking endorsement from relevant knowledge users. We will seek input from external collaborators using social media, mailing lists and other communication channels. DISCUSSION: Achieving global imperatives such as the Sustainable Development Goals (e.g., SDG 10 Reduced inequalities, SDG 3 Good health and wellbeing) requires advancing health equity in research. The implementation of the STROBE-Equity guidelines will enable a better awareness and understanding of health inequities through better reporting. We will broadly disseminate the reporting guideline with tools to enable adoption and use by journal editors, authors, and funding agencies, using diverse strategies tailored to specific audiences.

Decreasing Survey Response Rates in the Time of COVID-19: Implications for Analyses of Population Health and Health Inequities.

Objectives. To examine whether, and if so how, US national and state survey response rates changed after the onset of the COVID-19 pandemic. Methods. We compared the change in response rates between 2020 and 2019 of 6 (3 social and economic, 3 health focused) major US national surveys (2 with state response rates). Results. All the ongoing surveys except 1 reported relative decreases (∼29%) in response rates. For example, the household response rate to the US Census American Community Survey decreased from 86.0% in 2019 to 71.2% in 2020, and the response rate of the US National Health Interview Survey decreased from 60.0% to 42.7% from the first to the second quarter of 2020. For all surveys, the greatest decreases in response rates occurred among persons with lower income and lower education. Conclusions. Socially patterned decreases in response rates pose serious challenges and must be addressed explicitly in all studies relying on data obtained since the onset of the pandemic. Public Health Implications. Artifactual reduction of estimates of the magnitude of health inequities attributable to differential response rates could adversely affect efforts to reduce these inequities. (Am J Public Health. 2023;113(6):667-670. https://doi.org/10.2105/AJPH.2023.307267).

Health inequities and social determinants of health in refugee and immigrant communities.

This article evaluates and elucidates the intersections across social and economic determinants of health and social structures that maintain current inequities and structural violence with a focus on the impact on imMigrants (immigrants and migrants), refugees, and those who remain invisible (e.g., people without immigration status who reside in the United States) from Black, Indigenous, and People of Color communities. Psychology has a history of treating individuals and families without adequately considering how trauma is cyclically and generationally maintained by structural violence, inequitable resources, and access to services. The field has not fully developed collaboration within an interdisciplinary framework or learning from best practices through international/global partnerships. Psychology has also been inattentive to the impact of structural violence prominent in impoverished communities. This structural harm has taken the form of the criminalization of imMigrants and refugees through detention, incarceration, and asylum citizenship processes. Most recently, the simultaneous occurrence of multiple catastrophic events, such as COVID-19, political polarization and unrest, police violence, and acceleration of climate change, has created a hypercomplex emergency for marginalized and vulnerable groups. We advance a framework that psychologists can use to inform, guide, and integrate their work. The foundation of this framework is select United Nations Sustainable Development Goals to address health inequities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Lessons Learned from Health Disparities in Coronavirus Disease-2019 in the United States.

In the United States, the coronavirus disease-2019 (COVID-19) pandemic has disproportionally affected Black, Latinx, and Indigenous populations, immigrants, and economically disadvantaged individuals. Such historically marginalized groups are more often employed in low-wage jobs without health insurance and have higher rates of infection, hospitalization, and death from COVID-19 than non-Latinx White individuals. Mistrust in the health care system, language barriers, and limited health literacy have hindered vaccination rates in minorities, further exacerbating health disparities rooted in structural, institutional, and socioeconomic inequities. In this article, we discuss the lessons learned over the last 2 years and how to mitigate health disparities moving forward.

A City Surveillance System for Social Health Inequalities: The Case of Barcelona.

INTRODUCTION: In the past, health inequalities were not prioritised in the political agenda of Barcelona. The change of city government (2015) was an opportunity to develop a Surveillance System for Social Health Inequalities in the city, which is described in this article. METHODS: The design of the Surveillance System formed part of the Joint Action for Health Equity in Europe (JAHEE), funded by the European Union. Various steps were considered by the experts to set up the System: define its objectives, target population, domains and indicators, and sources of information; perform data analysis; implement and disseminate the system; define the evaluation; and perform regular data updates. RESULTS: The System considers the following domains: social determinants of health, health-related with behaviours, use of healthcare, and health outcomes, and includes eight indicators. As axes of inequality, the experts chose sex, age, social class, country of origin, and geographical area. The Surveillance System for Social Health Inequalities is presented on a website including different types of figures. CONCLUSION: The methodology used to implement the Surveillance System can be used to implement similar systems in other urban areas around the world.

Addressing health inequities for children in immigrant families: Psychologists as leaders and links across systems.

What can psychologists do to address social determinants of health and promote health equity among America's approximately 20 million children in immigrant families (CIF)? This article identifies gaps in current research and argues for a stronger role for psychologists. Psychologists can advocate for and enact changes in institutional systems that contribute to inequities in social determinants of health and promote resources and services necessary for CIF to flourish. We consider systemic exclusionary and discriminatory barriers faced by CIF, including a heightened anti-immigrant political climate, continued threat of immigration enforcement, restricted access to the social safety net, and the disproportionate health, economic, and educational burden of the COVID-19 pandemic. We highlight the potential role of psychologists in (a) leading prevention that addresses stressors such as poverty and trauma; (b) changing systems to mitigate risk factors for CIF; (c) expanding workforce development across multiple disciplines to better serve their needs; (d) identifying mechanisms, such as racial profiling, that contribute to health inequity, and viewing them as public health harms; and (e) guiding advocacy for resources at local, state, and federal levels, including by linking discriminatory policies or practices with health inequity. A key recommendation to increase psychologists' impact is for academic and professional institutions to strengthen relationships with policymakers to effectively convey these findings in spaces where decisions about policies and practices are made. We conclude that psychologists are well positioned to promote systemic change across multiple societal levels and disciplines to improve the well-being of CIF and offer them a better future. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Impact of the COVID-19 Pandemic on Black Communities in Canada.

The COVID-19 pandemic has resulted in differential impacts on the Black communities in Canada and has unmasked existing race-related health inequities. The purpose of this study was to illuminate the impacts of the COVID-19 pandemic on Black people in Canada. Historically, social inequalities have determined the impacts of pandemics on the population, and in the case of the COVID-19 pandemic, disproportionate infections and mortalities have become evident among racialized communities in Canada. This qualitative descriptive study utilized an intersectionality framework. We invited Black stakeholders across Canada to participate in semi-structured interviews to deepen our knowledge of the impacts of the COVID-19 pandemic on Black communities in Canada. A total of 30 interviews were recorded, transcribed verbatim, and analyzed using content analysis. Our findings fell into three categories: (1) increased vulnerability to COVID-19 disease, (2) mental impacts, and (3) addressing impacts of the COVID-19 pandemic. The findings show the underlying systemic inequities in Canada and systemic racism exacerbated health inequities among the Black communities and undermined interventions by public health agencies to curb the spread of COVID-19 and associated impacts on Black and other racialized communities. The paper concludes by identifying critical areas for future intervention in policy and practice.

The role of health protection teams in reducing health inequities: findings from a qualitative study.

INTRODUCTION: The UK Health Security Agency's (UKHSA) Health Protection Teams (HPTs) provide specialist public health advice and operational support to NHS, local authorities and other agencies in England. The development of a three-year UKHSA Health Equity strategy creates a unique opportunity for HPTs to reduce health inequities within their work. AIMS: This study aimed to understand current health equity activities and structures within HPTs, and to propose future HPT-led health equity activities. METHODS: Between November 2021 - March 2022, HPT staff from the nine UKHSA regions were invited to participate in a semi-structured interview or focus group. RESULTS: Twenty-seven participants covering all nine UKHSA regions took part in a total of 18 interviews and two focus groups. There was enthusiasm to address health inequity, and many reported this as their motivation for working in public health. All HPTs routinely engaged in health equity work including, variously: liaising with other organisations; advocacy in case and outbreak management meetings; developing regional HPT health equity action plans; and targeting under-served populations in day-to-day work. HPT staff discussed the challenge of splitting their time between reacting to health protection incidents (e.g., COVID as the main priority at the time) and pro-active work (e.g., programmes to reduce risk from external hazards for vulnerable populations). Although COVID had raised awareness of health inequities, knowledge of health equity among the professionally diverse workforce appeared variable. Limited evidence about effective interventions, and lack of clarity about future ways of working with other organisations were also shared as barriers to tackling health inequities. CONCLUSION: HPTs welcomed the development of UKHSA's health equity strategy, and through this study identified opportunities where HPTs can influence, support and lead on tackling health inequities. This includes embedding health equity into HPTs' acute response activities, stakeholder working, and staff management. This study also identified a need for health equity training for HPTs to improve knowledge and skills, utilising evidence-based approaches to health equity. Finally, we have identified areas where HPTs can lead, for example using brief advice interventions and through developing resources, such as standard operating procedures that focus on vulnerable populations. These findings will support a more integrated approach to addressing health equity through health protection work.

Social and structural determinants of COVID-19 vaccine uptake among racial and ethnic groups.

Latino, Black, American Indian/Alaska Native (AI/AN), and Native Hawaiian or Other Pacific Islander people have the highest hospitalizations and death rates from COVID-19. Social inequalities have exacerbated COVID-19 related health disparities. This study examines social and structural determinants of COVID-19 vaccine uptake. Results from logistic regressions suggest Latino and Black people were less likely to be vaccinated. People that did not have health insurance, a primary care doctor and were unemployed were more than 30% less likely to be vaccinated for COVID-19. Greater perceived health inequalities in one's neighborhood and perceived racial/ethnic discrimination were associated with a decreased odds in being vaccinated. People that suffered the loss of a household member from COVID-19 were three times more likely to have been vaccinated. Establishing policies that will increase access to health insurance and create jobs with living wages may have lasting impacts. Furthermore, collaboration with local and national community organizations can enhance the development of sustainable solutions.