A Tale of Two Cities During the COVID-19 Pandemic: Evaluating Food Insecurity in Chicago and New York City.

BACKGROUND: COVID-19 revealed and broadened existing disparities in large cities. This article interprets the early impacts of COVID-19 on food insecurity (FI) in the Chicago and New York City (NYC) metropolitan areas for Black, Indigenous, and People of Color (BIPOC) and provides a study using a Social Determinants of Health (SDOH) framework. METHODS: A cross-sectional survey adapted from the National Food Access and COVID Research Team (NFACT) was deployed in Chicago (N = 680) and in NYC (N = 525) during summer 2020 and oversampled for race, ethnicity, and socioeconomic status. Multivariate binary logistic regression generated adjusted odds ratios (aOR) and 95% CIs for FI and select SDOH variables, which was conducted on each dataset. RESULTS: The prevalence of FI in NYC increased to 66.8% (from 57.8%) and in Chicago to 44.8% (from 41.0%). While higher income protected against FI before, protection was diminished or eliminated since COVID-19. FI declined for households with children in NYC while odds increased and became significant in Chicago. Respondents with chronic health conditions experienced increased odds of FI since COVID. In Chicago, this variable had the highest odds of FI. Respondents with depression or anxiety had increased odds of FI. In NYC, depression had the highest odds of FI. Females in NYC were protected against FI. Hispanics in NYC lost protection against FI from before to since COVID-19. CONCLUSIONS: Results support the observed rise of FI for BIPOC and its association with health status. The analysis has multifaceted, structural policy implications for reducing FI in urban centers.

Social determinants of health: a view on theory and measurement.

The theory and measurement of the social determinants of health featured in a three-part seminar series on Social Determinants of Health, Law and Policy held at the Taubman Center for Public Policy, Brown University in February 2012. The seminar series represents a broader commitment to engage the public, health providers, researchers, and policy makers in dialogue for the purposes of identifying and addressing social determinants of health at community and state levels. This article summarizes and expands upon the first part of the series by defining social determinants of health and exploring methodological debates over their measurement, with a focus on income inequality, racism and discrimination, housing security, and food security. The authors of this article and the members of the seminar series represent the kind of interdisciplinary and applied work necessary for addressing the five key areas of social determinants of health identified in Healthy People 2020: economic stability, education, social and community context, health and health care, and neighborhood and environment.

Experiences of collaboration, coordination and efficiency in the delivery of HIV/AIDS home-based care in Zimbabwe.

The difficulties of achieving successful collaboration between stakeholders can lead to uncoordinated and fragmented outcomes for HIV/AIDS programming, which has consequences for the immediate health and livelihood security of the intended beneficiaries. This article examines the collaboration between local, national and international partner organisations in the delivery of and coordination of HIV/AIDS home-based care in Zimbabwe. The purpose of the research was to provide an external assessment of home-based care and to identify the problems that impede the delivery of health resources. Fieldwork was conducted between 2005 and 2008 at rural and peri-urban locations in Zimbabwe, using a combination of informal interviews, focus groups and participant observation. The findings suggest that the delivery of healthcare is impeded by problematic relationships between programme stakeholders-government, non-governmental and community-based. The outcome of poor service delivery is demonstrated to have a direct negative impact on the access to services, quality of care, and health outcomes for programme participants. The methods and findings of this research highlight the use of rapid ethnographic appraisal by social scientists to represent the interests of HIV/AIDS-affected populations in programme and policy design. This approach is crucial in situations such as in Zimbabwe where beneficiaries are less willing to voice their opinions for fear of being cut off from what little assistance is available in case what they say is viewed as uncooperative or noncompliant with a programme's objectives. The findings question the widely held assumption that multisectoral relationships are the most efficient way to deliver services.