The Magnification of Health Disparities During the COVID-19 Pandemic.

Coronavirus disease 2019 has created and amplified racial health disparities. This has been particularly noticeable in populations with asthma. There is no one simple reason for this occurrence, but rather a complex interaction of biological, structural, and socioeconomic factors. This article will highlight reasons why the coronavirus disease 2019 pandemic has been particularly impactful among minority populations throughout the world and will also offer potential solutions to help overcome health disparities.

How community sport programs may improve the health of vulnerable population groups: a program theory.

BACKGROUND: Groups at risk of exclusion from society appear to have a lower health status and more health-related problems. Prevention efforts in these groups are not always successful, and new ways have to be sought by which health messages can be delivered. Many agree on low-threshold sport activities, also called 'community sports', to be a powerful tool to target socially vulnerable groups. Until now, it has not been investigated how and when such sport initiatives may be able to impact health outcomes in socially vulnerable populations. This study aims at developing a program theory that clarifies the mechanisms and necessary conditions for sport programs to be effective in health promotion. Such a program theory may constitute a backbone for developing health promotion initiatives within a sport for development setting. METHODS: We developed a program theory using a realist research design. We build on an extensive data set consisting of the insights of key stakeholders and participants of various community sport organizations at the one hand, and on relevant theoretical frameworks at the other hand. Data were collected through participatory observations of soccer trainings and related group activities, interviews with key stakeholders and participants, document analysis and two focus groups with stakeholders from associated social partnership organizations. RESULTS: The health promoting effect of community sport on socially vulnerable groups seems not to result from an improved physical condition or sport-technical skills as such, but from processes of experiential learning among peers, incremental responsibility-taking and reflexivity. On the condition that participants feel safe, are stimulated to reflect and enabled to become actor of themselves and their situation, these processes are likely to lead to increased self-esteem, self-efficacy and motivation to set and pursue personal (health) goals. The key-influencing factor in these processes is the coach, who therefore needs to be adequately skilled in, for example, social vulnerability, motivational coaching and group dynamics. CONCLUSIONS: The program theory developed in this study offers insights in the mechanisms proper to, and necessary conditions for community sport to be a lever for health promotion in socially vulnerable groups. Motivational processes at individual level and group connectivity are at the basis of personal health goal-setting. One of the necessary conditions is that these processes are guided by community sport coaches skilled in the meaning and impact of social exclusion, and capable of connecting with the target group.

The role of socioeconomic status in the relationship between detention and self-rated health among prison detainees in Belgium.

Prisoners are known to report worse health than the general population. Research has also shown that the prison population counts disproportionally more people with a lower socioeconomic status (SES), making it difficult to determine whether the worse self-reported health of prisoners is an effect of their detention or of their lower SES. This study assesses the influence of being in prison on self-rated health and if (and how) this relationship is mediated by SES. Data from detainees were collected in 12 Flemish prisons. To compare with the general population, data from the Belgian national health survey 2013 were used. To estimate the direct and indirect effect of being in prison on self-reported health, mediation analysis was carried out by means of natural effect models using nested counterfactuals. Following previous literature we find that prisoners report worse health than the general population and that SES has a significant influence on subjective health. Our results showed that the direct effect (exp(B) = 3.43; [95% CI: 2.924-4.024]) of being in prison on self-reported health is larger than the indirect effect (through SES) (exp(B) = 1,236; [95% CI: 1.195-1.278]), thus contradicting the hypotheses in previous literature that the SES is the main explanation for variation in self-reported health among prisoners. Lastly, the effect of SES on health is more important for the general population compared to detainees, suggesting that for prisoners the effect of being in prison seems to surpass the effect of SES on health.

Perceived discrimination In Primary Healthcare in Europe: evidence from the cross-sectional QUALICOPC study.

Recent figures show that discrimination in healthcare is still persistent in the European Union. Research has confirmed these results but focused mainly on the outcomes of perceived discrimination. Studies that take into account socioeconomic determinants of discrimination limit themselves to either ethnicity, income or education. This article explores the influence of several socioeconomic indicators (e.g. gender, age, income, education and ethnicity) on perceived discrimination in 30 European countries. Data from the QUALICOPC study were used. These data were collected between October 2011 and December 2013 in the participating countries. In total, 7183 GPs (general practitioners) and 61932 patients participated in the study, which had an average response rate of 74.1%. Data collection was co-ordinated by NIVEL (Dutch Institute for Research of Health Care). Bivariate binomial logistic regressions were used to estimate the impact of each socioeconomic indicator on perceived discrimination. Multivariate logistic regressions were used to estimate the unique effect of each indicator. Results indicate that in Europe, overall 7% of the respondents felt discriminated, ranging between 1.4% and 12.8% at the country level. With regard to socioeconomic determinants in perceived discrimination, income and age are both important indicators, with lower income groups and younger people having a higher chance to feel discriminated. In addition, we find significant influences of education, gender, age and ethnicity in several countries. In most countries, higher educated people, older people, women and the indigenous population appeared to feel less discriminated. In conclusion, perceived discrimination in healthcare is reported in almost all European countries, but there is large variation between European countries. A high prevalence of perceived discrimination within a country also does not imply a correlation between socioeconomic indicators and perceived discrimination.

Access, treatment and outcomes of care: a study of ethnic minorities in Europe.

OBJECTIVES: Recent research has shown that ethnic minorities still have less access to medical care and are less satisfied with the treatment they receive and the outcomes of the health care process. This article assesses how migrants in Europe experience access, treatment and outcomes in the European health care systems. METHODS: Data were obtained from the QUALICOPC study (Quality and Costs of Primary Care in Europe). Regression analyses were used to estimate the access, treatment and outcomes of care for ethnic minorities. RESULTS: In several countries, migrants experience that the opening hours of their GP practice were too limited and indicate that the practice was too far away from their work or home (lower access). They are more likely to report negative patient-doctor communication and less continuity of care than native patients (worse treatment). In addition, they are less satisfied with the care they received and are more likely to postpone care (worse outcomes). CONCLUSIONS: In general, migrants are still disadvantaged during the health care process. However, our results also indicate that satisfaction with the health care process improves for second-generation migrants in comparison with first-generation migrants.

The GP's perception of poverty: a qualitative study.

BACKGROUND: Health differences between people from lower and higher social classes increase. The accessibility of the health care system is one of the multiple and complex causes. The Physician's perceptions, beliefs and attitudes towards the patient are in this context important determinants. OBJECTIVES: To explore the general practitioners' definition of poverty and their perception of the deprived patients' attitude towards health and health care, to get insight into the ways general practitioners deal with the problem of poverty and to present the proposals general practitioners make to improve health care for the deprived. METHOD: The study involved qualitative methodology using 21 semi-structured interviews. The interviews were recorded and transcribed verbatim. The transcripts were coded using Framework Analysis techniques. Interviews were undertaken with general practitioners in primary care, working in a deprived area in the city of Ghent. RESULTS: In the definition of poverty, three concepts can be identified: socioeconomic aspects, psychological and individual characteristics, and socio-cultural concepts. General practitioners adopt different types of approaches to deal with deprived patients in practice: adaptation of the doctor-patient communication, lowering of the financial threshold, referral to specialists and other health care professionals. CONCLUSION: Including the issue of poverty and poverty in the curriculum of the medical students and in the in-service training for practicing doctors could have a positive impact on their attitude towards this patient group. Further research is needed into the barriers in the accessibility of the health care system for the deprived, exploring qualitatively and quantitatively the experiences and the living conditions of deprived patients and the perceptions of health care providers.