[What is social sciences' contribution in the context of health crises and emerging risks? An anthropologist's perspective]. / Quel apport des sciences sociales face aux crises et risques émergents. Le regard d'un anthropologue.

What can the social science contribute during a public health crisis? Reflecting on this question, we turn to the medical anthropologist David Napier, who has developed research tools for understanding the complex drivers of health vulnerability and resilience. Interviewed by Nolwenn Bühler, he shares his vision of the Covid-19 crisis, and the role social sciences should be playing in understanding why populations either trust or mistrust policymakers. In that a crisis, by definition, involves demands on limited resources, social trust is itself put to the test. Napier cautions us about what this means at the level of inclusive health, and why we must be especially aware not only of how response policies themselves can create new vulnerabilities, but of why we must actively combat the xenophobia and stigma that insecurity can generate.

Face aux crises, quels sont les apports et contributions possibles des sciences sociales ? Afin de réfléchir à cette question, cet article donne la parole à un anthropologue médical, le professeur David Napier (University College London). Interviewé par Nolwenn Bühler, il partage sa vision du rôle des sciences sociales dans la crise liée au Covid-19. Les points qu'il met en avant concernent l'importance des facteurs sociaux de la pandémie, l'aggravation des inégalités que produisent les crises, créant de nouveaux besoins sur des ressources limitées, et la perte de « confiance sociale ¼. Il insiste sur ce dernier point en montrant comment le lien social est mis à l'épreuve dans les crises et comment l'insécurité nourrit le repli identitaire, alors qu'il faudrait lutter contre la xénophobie, les différentes formes de stigmatisation, et défendre des politiques sanitaires favorisant l'inclusivité.

Drawing a pandemic vulnerabilities' map: The SoNAR-global Vulnerabilities Assessment digital and its output.

This paper describes the process, advantages and limitations of a qualitative methodology for defining and analyzing vulnerabilities during the COVID-19 pandemic. Implemented in Italy in two sites (Rome and outside Rome, in some small-medium sized municipalities in Latium) in 2021, this investigation employed a mixed digital research tool that was also used simultaneously in four other European countries. Its digital nature encompasses both processes of data collection. Among the most salient is that the pandemic catalyzed new vulnerabilities in addition to exacerbating old ones, particularly economic. Many of the vulnerabilities detected, in fact, are linked to previous situations, such as the uncertainties of labor markets, having in COVID-19 to the greatest negative effects on the most precarious workers (non-regular, part-time, and seasonal). The consequences of the pandemic are also reflected in other forms of vulnerability that appear less obvious, having exacerbated social isolation, not only out of fear of contagion, but because of the psychological challenges posed by containment measures themselves. These measures created not mere discomfort, but behavioral changes characterized by anxiety, fearfulness, and disorientation. More generally, this investigation reveals the strong influence of social determinants throughout the COVID-19 pandemic, creating new forms of vulnerability, as the effects of social, economic, and biological risk factors were compounded, in particular, among already marginalized populations.

Community engagement and vulnerability in infectious diseases: A systematic review and qualitative analysis of the literature.

The global response to infectious diseases has seen a renewed interest in the use of community engagement to support research and relief efforts. From a perspective rooted in the social sciences, the concept of vulnerability offers an especially useful analytical frame for pursuing community engagement in a variety of contexts. However, few have closely examined the concept of vulnerability in community engagement efforts, leading to a need to better understand the various theories that underline the connections between the two. This literature review searched four databases (covering a total of 537 papers), resulting in 15 studies that analyze community engagement using a framing of vulnerability, broadly defined, in the context of an infectious disease, prioritizing historical and structural context and the many ways of constituting communities. The review identified historical and structural factors such as trust in the health system, history of political marginalization, various forms of racism and discrimination, and other aspects of vulnerability that are part and parcel of the main challenges faced by communities. The review found that studies using vulnerability within community engagement share some important characteristics (e.g., focus on local history and structural factors) and identified a few theoretical avenues from the social sciences which integrate a vulnerability-informed approach in community engagement. Finally, the review proposes an approach that brings together the concepts of vulnerability and community engagement, prioritizing participation, empowerment, and intersectoral collaboration.

The European Association for the Study of Obesity (EASO) Endorses the Milan Charter on Urban Obesity.

The Milan Charter on Urban Obesity highlights the challenges of urban environments as a battleground for human health, as cities are often organized to subvert public health goals, and promote rather than prevent the development of obesity and consequent non-communicable diseases. The Charter articulates ten principles which detail actions and strategies through which general practitioners, diverse medical specialists, related healthcare professionals, administrators and healthcare practice managers, policy actors - within health systems and at a national level - along with experts across disciplines, and citizens, can work in cooperation to meet this challenge and improve public health. The Charter urges the adoption of decisions that deliver the following: (i) policies which enable our cities to become healthier and less obesogenic, more supportive of well-being and less health-disruptive in general, and (ii) policies that fully support primary prevention strategies, that address social stigma, and that ensure fair access to treatment for people living with obesity. The Milan Charter on Urban Obesity aims to raise awareness of our shared responsibility for the health of all citizens, and focuses on addressing the health of people living with obesity - not only as a challenge in its own right, but a gateway to other major non-communicable diseases, including cardiovascular diseases, type 2 diabetes, and some cancers.

New competences to manage urban health: Health City Manager core curriculum.

A core curriculum is an essential step in development knowledge, competences and abilities and it defines educational content for the specialized area of practice in such a way that it can be delivered to new professional job. The Health City Manager core curriculum defines the strategic aspects of action to improve health in cities through a holistic approach, with regard to the individual, and a multi-sectoral approach, with regard to health promotion policies within the urban context. The Health City Manager core curriculum recognizes that the concept of health is an essential element for the well-being of a society, and this concept does not merely refer to physical survival or to the absence of disease, but includes psychological aspects, natural, environmental, climatic and housing conditions, working, economic, social and cultural life - as defined by the World Health Organization (WHO). The Health City Manager core curriculum considers health not as an "individual good" but as a "common good" that calls all citizens to ethics and to the observance of the rules of civil coexistence, to virtuous behaviours based on mutual respect. The common good is therefore an objective to be pursued by both citizens and mayors and local administrators who must act as guarantors of equitable health ensuring, that the health of the community is considered as an investment and not just as a cost. The role of cities in health promotion in the coming decades will be magnified by the phenomenon of urbanization with a concentration of 70% of the global population on its territory.

Linking socioeconomic inequalities and type 2 diabetes through obesity and lifestyle factors among Mexican adults: a structural equations modeling approach.

OBJECTIVE: To assess the association between type 2 diabetes (DM2) and socioeconomic inequalities, mediated by the contribution of body mass index (BMI), physical activity (PA), and diet (diet-DII). MATERIALS AND METHODS: We conducted a cross-sectional analysis using data of adults participating in the Diabetes Mellitus Survey of Mexico City. Socioeconomic and demographic characteristics as well as height and weight, dietary intake, leisure time activity and the presence of DM2 were measured. We fitted a structural equation model (SEM) with DM2 as the main outcome, and BMI, diet-DII and PA served as mediator variables between socioeconomic inequalities index (SII) and DM2. RESULTS: The prevalence of DM2 was 13.6%. From the fitted SEM, each standard deviation increases in the SII was associated with increased scores of DM2 (ß=0.174, P<0.001). CONCLUSIONS: The results in the present study show how high scores in the index of SII may influence the presence of DM2.

OBJETIVO: Evaluar la asociación entre diabetes tipo 2 y las inequidades socioeconómicas (IS), mediada por la contribución del índice de masa corporal (IMC), actividad física (AF) y dieta (dieta-DII). MATERIAL Y MÉTODOS: Se realizó un análisis transversal utilizando datos de la Encuesta de Diabetes Mellitus de la Ciudad de México. Se midieron las características sociodemográficas, altura, peso, ingesta dietética, actividad de tiempo libre y presencia de diabetes. Se ajustó un modelo de ecuaciones estructurales (MEE) con diabetes como resultado principal, e IMC, dieta-DII y PA sirvieron como variables mediadoras entre el IS y la diabetes. RESULTADOS: La prevalencia de diabetes fue de 13.6%. A partir del MEE ajustado, cada aumento de la desviación estándar en el IS se asoció con un aumento en las puntuaciones de diabetes (ß=0.174, P<0.001). CONCLUSIONES: Los resultados en el presente estudio muestran cómo los puntajes altos en las IS pueden influir en la presencia de diabetes.

Linking socioeconomic inequalities and type 2 diabetes through obesity and lifestyle factors among Mexican adults: a structural equations modeling approach / Asociación entre las inequidades socioeconómicas y la diabetes tipo 2 mediada por la obesidad y factores del estilo de vida en adultos mexicanos: un enfoque de modelos de ecuaciones estructurales

Abstract: Objective: To assess the association between type 2 diabetes (DM2) and socioeconomic inequalities, mediated by the contribution of body mass index (BMI), physical activity (PA), and diet (diet-DII). Materials and methods: We conducted a cross-sectional analysis using data of adults participating in the Diabetes Mellitus Survey of Mexico City. Socioeconomic and demographic characteristics as well as height and weight, dietary intake, leisure time activity and the presence of DM2 were measured. We fitted a structural equation model (SEM) with DM2 as the main outcome, and BMI, diet-DII and PA served as mediator variables between socioeconomic inequalities index (SII) and DM2. Results: The prevalence of DM2 was 13.6%. From the fitted SEM, each standard deviation increases in the SII was associated with increased scores of DM2 (β=0.174,P<0.001). Conclusion: The results in the present study show how high scores in the index of SII may influence the presence of DM2.

Resumen: Objetivo: Evaluar la asociación entre diabetes tipo 2 y las inequidades socioeconómicas (IS), mediada por la contribución del índice de masa corporal (IMC), actividad física (AF) y dieta (dieta-DII). Material y métodos: Se realizó un análisis transversal utilizando datos de la Encuesta de Diabetes Mellitus de la Ciudad de México. Se midieron las características sociodemográficas, altura, peso, ingesta dietética, actividad de tiempo libre y presencia de diabetes. Se ajustó un modelo de ecuaciones estructurales (MEE) con diabetes como resultado principal, e IMC, dieta-DII y PA sirvieron como variables mediadoras entre el IS y la diabetes. Resultados: La prevalencia de diabetes fue de 13.6%. A partir del MEE ajustado, cada aumento de la desviación estándar en el IS se asoció con un aumento en las puntuaciones de diabetes (β=0.174,P<0.001). Conclusión: Los resultados en el presente estudio muestran cómo los puntajes altos en las IS pueden influir en la presencia de diabetes.

Assessment of factors affecting diabetes management in the City Changing Diabetes (CCD) study in Tianjin.

OBJECTIVE: This study aimed to identify the local levels of vulnerability among patients with Type-II diabetes (T2DM) in Tianjin. The study was aimed at curbing the rise of T2DM in cities. METHODS: 229 participants living with T2DM were purposively sampled from hospitals in Tianjin. Collected data were coded and analysed following well-established thematic analysis principles. RESULTS: Twelve themes involving 29 factors were associated with diabetes patients' vulnerability: 1. Financial constraints (Low Income, Unemployment, No Medical Insurance/Low ratio reimbursement); 2. Severity of disease (Appearance of symptoms, complications, co-morbidities, high BMI, poor disease control); 3. Health literacy (No/Low/Wrong knowledge of health literacy); 4. Health beliefs (Perceived diabetes indifferently, Passively Acquire Health Knowledge, Distrust of primary health services); 5. Medical environment (Needs not met by Medical Services); 6. Life restrictions (Daily Life, Occupational Restriction); 7. Lifestyle change (Adhering to traditional or unhealthy diet, Lack of exercise, Low-quality sleep); 8. Time poverty (Healthcare-seeking behaviours were limited by work, Healthcare-seeking behaviours were limited by family issues); 9. Mental Condition (Negative emotions towards diabetes, Negative emotions towards life); 10. Levels of Support (Lack of community support, Lack of support from Friends and Family, Lack of Social Support); 11. Social integration (Low Degree of Integration, Belief in Suffering Alone); 12. Experience of transitions (Diet, Dwelling Environment). CONCLUSION: Based on our findings, specific interventions targeting individual patients, family, community and society are needed to improve diabetes control, as well as patients' mental health care and general living conditions.