Workforce Initiatives to Advance Health Equity and Diverse Representation.

The persistence of health inequity and the need for workforce diverse representation within child and adolescent psychiatry require systemic solutions. There are recommendations and strategies particularly for the training programs with "all of the above" approach to tackle these complex systemic issues. One of the ways is to think through existing and innovative training pipelines by making them less leaky, enhancing quality, expanding the type and size, and connecting them to reach children and adolescents in need.

Identifying Precise Targets to Improve Child Mental Health Care Equity: Leveraging Advances in Clinical Research Informatics and Lived Experience.

To reduce child mental health disparities, it is imperative to improve the precision of targets and to expand our vision of social determinants of health as modifiable. Advancements in clinical research informatics and please state accurate measurement of child mental health service use and quality. Participatory action research promotes representation of underserved groups in informatics research and practice and may improve the effectiveness of interventions by informing research across all stages, including the identification of key variables, risk and protective factors, and data interpretation.

Gender health equity: The case for including men's health.

United States' federal policy and infrastructure fail to explicitly consider the health of men, particularly the poor health of marginalized men. This inattention to men's health hinders the nation's ability to improve population health, to achieve gender health equity, and to achieve health equity more broadly. Expanding efforts to consider gender in federal policy and infrastructure to include men, naming men as a population whose poor health warrants policy attention, creating offices of men's health in federal agencies, and utilizing an intersectional lens to develop and analyze policies that affect health would likely yield critical improvements in population health and health equity in the United States. Using data from the Centers for Disease Control and Prevention, I illustrate the persistence of sex differences in mortality and leading causes of death, and how these patterns mask gender gaps in health that are driven largely by marginalized men. Given the common practice of presenting data by sex and race separately, it is difficult to recognize when the health of specific groups of men warrants attention. I utilize the case of Black men to illustrate the importance of an intersectional approach, and why men's health is critical to achieving gender and racial equity in health. While a gender mainstreaming approach has enhanced the nation's ability to consider and address the health of women and girls, it has not expanded to be inclusive of boys and men. Consequently, I argue that if our goal is to achieve health equity, it is critical to employ an intersectional approach that simultaneously considers the full range of factors that influence individual and population health and well-being. An intersectional approach would facilitate efforts to simultaneously explore strategies to achieve racial, ethnic, and gender health equity, which are driven by structural determinants beyond sex and gender related factors.

The Use of Health Equity Impact Assessments to Modify Evidence Based Strategies within Local Health Departments in North Carolina.

BACKGROUND: Health equity impact assessments (HEIAs) inform the reduction of health inequities by evaluating programs or policies that affect target populations. Local health departments (LHD) receiving funding through the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) Program conducted HEIAs for evidence-based strategies (EBSs). This paper describes the impact of HEIAs on the implementation of EBSs and highlights lessons learned during implementation of HEIA modifications. METHODS: We conducted a content analysis using data from the HEIA Modification Tracker and focus groups to identify themes and lessons learned. RESULTS: Fifteen HEIAs were conducted by five LHDs between 2016 and 2020. The most common modifications to EBS implementation were 1) increasing education and training for community members and 2) altering messaging mediums and language to reach intended audiences. DISCUSSION: Health equity impact assessments serve as a systematic and tangible way to center health equity, reflect on past processes, and inform improvements.

Reimagining Rural Health Equity: Understanding Disparities And Orienting Policy, Practice, And Research In Rural America.

A narrative has taken hold that public health has failed the US. We argue instead that the US has chronically failed public health, and nowhere have these failures been more apparent than in rural regions. Decades of underinvestment in rural communities, health care, and public health institutions left rural America uniquely vulnerable to the COVID-19 pandemic. Rural communities outpaced urban ones in deaths, and many rural institutions and communities sustained significant impacts. At the same time, the pandemic prompted creative actions to meet urgent health and social needs, and it illuminated opportunities to address long-standing rural challenges. This article draws on our cross-disciplinary expertise in public health and medical anthropology, as well as our research on COVID-19 and rural health equity in northern New England. In this Commentary, we articulate five principles to inform research, practice, and policy efforts in rural America. We contend that advancing rural health equity beyond the pandemic requires understanding the forces that generate rural disparities and designing policies and practices that account for rural disadvantage.

Engaging Antiracist And Decolonial Praxis To Advance Equity In Oregon Public Health Surveillance Practices.

Public health surveillance and data systems in the US remain an unnamed facet of structural racism. What gets measured, which data get collected and analyzed, and how and by whom are not matters of happenstance. Rather, surveillance and data systems are productions and reproductions of political priority, epistemic privilege, and racialized state power. This has consequences for how communities of color are represented or misrepresented, viewed, and valued and for what is prioritized and viewed as legitimate cause for action. Surveillance and data systems accordingly must be understood as both an instrument of structural racism and an opportunity to dismantle it. Here, we outline a critique of standard surveillance systems and practice, drawing from the social epidemiology, critical theory, and decolonial theory literatures to illuminate matters of power germane to epistemic and procedural justice in the surveillance of communities of color. We then summarize how community partners, academics, and state health department data scientists collaborated to reimagine survey practices in Oregon, engaging public health critical race praxis and decolonial theory to reorient toward antiracist surveillance systems. We close with a brief discussion of implications for practice and areas for continued consideration and reflection.

Cancer in Sexual and Gender Minorities: Role of Oncology RNs in Health Equity.

Despite comprising almost 8% of the population of the United States, sexual and gender minority (SGM) patients with cancer experience health inequities with poorer outcomes than non-SGM patients. Although sex-based guidelines.

Equity in HIV/AIDS services requires optimization of mainstreaming sectors in Ethiopia.

BACKGROUND: Mainstreaming HIV and AIDS across sectors is crucial to close the disparities in service provision and coverage. However, evidence has shown that certain social groups are left behind in receiving HIV/AIDS services. The objective of this study was twofold: to understand the reasons behind the existing inequities and to explore challenges of equity in HIV/AIDS services in the Amhara region of Ethiopia. METHODS: Twenty-two adults (aged 26-57 years) from eighteen sectors that are mainstreaming HIV and AIDS were purposefully selected until the point of saturation and participated in a semi-structured in-depth interview conducted between January 20 and February 17, 2023. Interviewees were asked to describe their mainstreaming experiences in equitable HIV/AIDS services, reflect on the challenges and barriers that impede equitable service provision, or explain the reasons behind the existence of inequity in HIV/AIDS services. The interviews were audio recorded, transcribed, translated, and iteratively analysed, with early analysis informing subsequent interviews. An inductive-reflexive thematic analysis was conducted, whereby themes and subthemes were identified, and the relationships between subthemes and patterns were critically reviewed. RESULTS: The challenges to equitable HIV/AIDS service provision were grouped into eight thematic areas: (1) changing contexts that shifts public and government attention to emerging diseases, war and political instability, and poverty; (2) leadership-related, such as the lack of supervision and monitoring, not politicising HIV/AIDS (not providing political attention to HIV/AIDS) and weak intersectoral collaboration; (3) financial constraints due to a random budgeting and contract interruption with non-governmental organisations (NGOs); (4) lack of resources due to scarcity and unfair distribution; (5) inadequate skilled personnel due to inadequate numbers and lack of continuous professional and career development; (6) lack of equity-related evidence-based tools and guidelines; (7) inadequate understanding of equity due to lack of training and misunderstanding, and lack of access to equity-oriented tools and guidelines; and (8) cultural norms, values, and perceptions. CONCLUSIONS: This study identified critical challenges faced in the equitable HIV/AIDS services provision. To achieve equity in HIV/AIDS services, mainstreaming sectors need to invest in mechanisms to sustain services in emergency situations; identify effective leaders to maintain collaboration, monitoring, and evaluation; institutionalise responsive budgeting and establish alternative funds to maintain non-governmental organisations initiatives; provide continuous up-to-date training and create a common evidence-sharing platform; implement proper recruitment, education, and professional development of HIV/AIDS focal persons; and promote and practice culturally safe care. It is, therefore, essential to optimise sectors that are mainstreaming HIV/AIDS and incorporate equity considerations in their strategic plans and working guidelines.

Pragmatic strategies to address health disparities along the continuum of care in chronic liver disease.

Racial, ethnic, and socioeconomic disparities exist in the prevalence and natural history of chronic liver disease, access to care, and clinical outcomes. Solutions to improve health equity range widely, from digital health tools to policy changes. The current review outlines the disparities along the chronic liver disease health care continuum from screening and diagnosis to the management of cirrhosis and considerations of pre-liver and post-liver transplantation. Using a health equity research and implementation science framework, we offer pragmatic strategies to address barriers to implementing high-quality equitable care for patients with chronic liver disease.

Primary health care as a tool to promote equity and sustainability; a review of Latin American and Caribbean literature.

Primary health care (PHC) has increased in global relevance as it has been demonstrated to be a useful strategy to promote community access to health services. Multilateral organizations and national governments have reached a consensus regarding the basic principles of PHC, but the application of these varies from country to country due to the particularities of local health systems.This article aims to review and summarize PHC strategies and the configuration of health networks in Latin American and Caribbean countries.The review was carried out using keywords in at least 9 databases. Papers in languages other than English, Portuguese, and Spanish were excluded, while non-refereed articles and regional gray literature were incorporated. As a result, 1,146 papers were identified. After three instances of analysis, 142 articles were selected for this investigation. Data were analyzed according to an analysis by theme.The evidence collected on health reforms in the region reflects the need to intensify care strategies supported by PHC and care networks. These must be resilient to changes in the population's needs and must be able to adapt to contexts of epidemiological accumulation.

Advancing Health Equity Through Artificial Intelligence: An Educational Framework for Preparing Nurses in Clinical Practice and Research.

The integration of artificial intelligence (AI) into health care offers the potential to enhance patient care, improve diagnostic precision, and broaden access to health-care services. Nurses, positioned at the forefront of patient care, play a pivotal role in utilizing AI to foster a more efficient and equitable health-care system. However, to fulfil this role, nurses will require education that prepares them with the necessary skills and knowledge for the effective and ethical application of AI. This article proposes a framework for nurses which includes AI principles, skills, competencies, and curriculum development focused on the practical use of AI, with an emphasis on care that aims to achieve health equity. By adopting this educational framework, nurses will be prepared to make substantial contributions to reducing health disparities and fostering a health-care system that is more efficient and equitable.

California's COVID-19 Vaccine Equity Policy: Cases, Hospitalizations, And Deaths Averted In Affected Communities.

In March 2021, California implemented a vaccine equity policy that prioritized COVID-19 vaccine allocation to communities identified as least advantaged by an area-based socioeconomic measure, the Healthy Places Index. We conducted quasi-experimental and counterfactual analyses to estimate the effect of this policy on COVID-19 vaccination, case, hospitalization, and death rates. Among prioritized communities, vaccination rates increased 28.4 percent after policy implementation. Furthermore, an estimated 160,892 COVID-19 cases, 10,248 hospitalizations, and 679 deaths in the least-advantaged communities were averted by the policy. Despite these improvements, the share of COVID-19 cases, hospitalizations, and deaths in prioritized communities remained elevated. These estimates were robust in sensitivity analyses that tested exchangeability between prioritized communities and those not prioritized by the policy; model specifications; and potential temporal confounders, including prior infections. Correcting for disparities by strategically allocating limited resources to the least-advantaged or most-affected communities can reduce the impacts of COVID-19 and other diseases but might not eliminate health disparities.

Protecting Patients And Society In An Era Of Private Equity Provider Ownership: Challenges And Opportunities For Policy.

Private equity (PE) acquisitions in health care delivery nearly tripled from 2010 to 2020. Despite concerns around clinical and economic implications, policy responses have remained limited. We discuss the US policy landscape around PE ownership, using policies in the European Union for comparison. We present four domains in which policy can be strengthened. First, to improve oversight of acquisitions, policy makers should lower reporting thresholds, review sequential acquisitions that together affect market power, automate reviews with potential denials based on market concentration effects, consider new regulatory mechanisms such as attorney general veto, and increase funding for this work. Second, policy makers should increase the longer-run transparency of PE ownership, including the health care prices garnered by acquired entities. Third, policy makers should protect patients and providers by establishing minimum staffing ratios, spending floors for direct patient care, and limits on layoffs and the sale of real estate after acquisition (forms of "asset stripping"). Finally, policy makers should mitigate risky financial behavior by limiting the amount or proportion of debt used to finance PE acquisitions in health care.

Pandemic Planning, Response, and Recovery for Pediatricians: A Focus on Health Equity and Social Determinants of Health.

This article summarizes how pediatricians may be uniquely positioned to mitigate the long-term trajectory of COVID-19 on the health and wellness of pediatric patients especially with regard to screening for social determinants of health that are recognized drivers of disparate health outcomes. Health inequities, that is, disproportionately deleterious health outcomes that affect marginalized populations, have been a major source of vulnerability in past public health emergencies and natural disasters. Recommendations are provided for pediatricians to collaborate with disaster planning networks and lead strategies for public health communication and community engagement in pediatric pandemic and disaster planning, response, and recovery efforts.