Qualitative study of UK health and care professionals to determine resources and processes that can support actions to improve quality of data used to address and monitor health inequalities.

INTRODUCTION: Health inequalities in the UK are investigated and addressed by analysing data across socioeconomic factors, geography and specific characteristics, including those protected under law. It is acknowledged that the quality of data underpinning these analyses can be improved. The objective of this work was to gain insights from professionals working across the health and care sector in England into the type(s) of resource(s) that can be instrumental in implementing mechanisms to improve data quality into practice. DESIGN: Qualitative study based on semistructured interviews involving health and care professionals. SETTING: England. PARTICIPANTS: A total of 16 professionals, mainly from the East of England. RESULTS: Awareness of mechanisms that could be put in place to improve quality of data related to health inequalities was high among interviewees. However, logistical (eg, workforce time, capacity and funding) as well as data usage (eg, differences in data granularity, information governance structures) barriers impacted on implementation of many mechanisms. Participants also acknowledged that concepts and priorities around health inequalities can vary across the system. While there are resources already available that can aid in improving data quality, finding them and ensuring they are suited to needs was time-consuming. Our analysis indicates that resources to support the creation of a shared understanding of what health inequalities are and share knowledge of specific initiatives to improve data quality between systems, organisations and individuals are useful. CONCLUSIONS: Different resources are needed to support actions to improve quality of data used to investigate heath inequalities. These include those aimed at raising awareness about mechanisms to improve data quality as well as those addressing system-level issues that impact on implementation. The findings of this work provide insights into actionable steps local health and care services can take to improve the quality of data used to address health inequalities.

Project GIVE: using a virtual genetics service platform to reduce health inequities and improve access to genomic care in an underserved region of Texas.

BACKGROUND: The utilization of genomic information to improve health outcomes is progressively becoming more common in clinical practice. Nonetheless, disparities persist in accessing genetic services among ethnic minorities, individuals with low socioeconomic status, and other vulnerable populations. The Rio Grande Valley (RGV) at the Texas-Mexico border is predominantly Hispanic/Latino with a high poverty rate and very limited access to genetic services. Funded by the National Center for Advancing Translational Sciences, Project GIVE (Genetic Inclusion by Virtual Evaluation) was launched in 2022 to reduce the time to diagnosis and increase provider knowledge of genomics in this region, with the goal of improving pediatric health outcomes. We describe our experience of establishing a virtual pediatric genomic service in this region to expeditiously identify, recruit, and evaluate pediatric patients with undiagnosed diseases. METHODS: We have utilized an innovative electronic health record (EHR) agnostic virtual telehealth and educational platform called Consultagene to receive referrals from healthcare providers in the RGV. Using this portal, genetic services, including virtual evaluation and genome sequencing (GS), are being delivered to children with rare diseases. The study has also integrated effective methods to involve and educate community providers through in-person meetings and Continuing Professional Education (CPE) events. RESULTS: The recruitment efforts have proven highly successful with the utilization of Consultagene in this medically underserved region. The project's ongoing engagement efforts with local healthcare providers have resulted in progressively more referrals to the study over time, thus improving inclusion and access to genomic care in the RGV. Additionally, the curated CPE content has been well received by healthcare providers in the region. CONCLUSIONS: Project GIVE study has allowed advanced genetic evaluation and delivery of GS through the virtual Consultagene portal, effectively circumventing the recognized socioeconomic and logistical barriers to accessing genetic services within this border community.

Nurses' perception about their role in reducing health inequalities in community contexts.

OBJECTIVE: to understand nurses' perception about their role in reducing health inequalities in community contexts. METHOD: a qualitative study with a phenomenological approach addressed from Heidegger's Interpretive Theory and the health inequality settings. A total of 18 in-depth interviews were conducted with nurses working in health institutions devoted to community interventions. The following five-phase process was adopted for the qualitative data analysis: Accumulation; Disassembling; Reassembling; Interpretation; and Conclusion. RESULTS: four main topics that nurses mobilize to mitigate health inequalities in community settings were identified, namely: Competences to create, operationalize, monitor and assess health policies; Leadership and management for health and care processes at the individual and collective levels; Professionals that devise care strategies; and Care approach based on characteristics of the territory. CONCLUSION: nurses perceive that their role contributes significantly to reducing health inequalities in community settings based on the creation, operationalization, monitoring and assessment of health policies. From the sociocultural, economic and political characteristics of the territory, they prioritize actions in disadvantaged human groups in order to improve access, opportunities, continuity and quality in health.

Medical Schools Are Updating Their Curricula as Climate Change Becomes Impossible to Ignore.

This Medical News article discusses the introduction of coursework on climate change in medical schools, residency programs, and beyond.

Structural Racism and Obesity-Related Cancer Inequities in the United States: Challenges and Research Priorities.

Structural racism has been identified as a fundamental cause of health disparities. For example, racial, ethnic, and economic neighborhood segregation; concentrated poverty; community disinvestment; and sociocultural context influence obesity and cancer disparities. Effects of structural racism are also evident through neighborhood obesogenic conditions such as limited access to affordable and healthy foods and physical activity opportunities within segregated communities that contribute to obesity and obesity-related cancer disparities. This article describes and expands on cross-cutting themes raised during a webinar held by the National Cancer Institute (NCI): (1) how structural factors, including neighborhood segregation and obesogenic conditions within racial and ethnic disadvantaged communities, influence disparities in the United States; (2) current research challenges and best ways to address them; and (3) selected priorities of the NCI aimed at addressing multilevel and intersecting factors that influence obesity-related cancer disparities. Further research is needed to understand how residential segregation and neighborhood obesogenic conditions influence cancer prevention and control across the continuum. Identifying the best approaches to address obesity and cancer disparities using social determinants of health framework and community-engaged approaches guided by a structural racism lens will allow researchers to move beyond individual-level approaches.

[Social inequalities in health]. / Les inégalités sociales de santé.

Social inequalities in health include all the impacts caused by the different social characteristics of individuals on their health. They strongly influence the health status of the French population. Socio-professional category, gender and ethnic origin are all determining factors in the health of people who, however, are not dependent on the healthcare system. Action in the healthcare field will therefore focus on the effects of these inequalities, to limit the number of people who forego healthcare, and to promote collective and individual health.

How can health systems approach reducing health inequalities? An in-depth qualitative case study in the UK.

BACKGROUND: Addressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system's level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions. METHODS: In-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach. RESULTS: Interviews (n = 14) with wide representation from local authority (n = 8), NHS (n = 5) and voluntary, community and social enterprise (VCSE) sector (n = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system's approach to reducing health inequalities was evident as was collective action and involving people, with links to a "strong third sector". Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system. CONCLUSION: We provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system's working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.

Indicators of social inequalities associated with cancer mortality in Brazilian adults: scoping review. / Indicadores de desigualdades sociais associados à mortalidade por neoplasias nos adultos brasileiros: revisão de escopo.

The objective of this study was to identify indicators of social inequalities associated with mortality from neoplasms in the Brazilian adult population. A scoping review method was used, establishing the guiding question: What is the effect of social inequalities on mortality from neoplasms in the Brazilian adult population? A total of 567 papers were identified, 22 of which were considered eligible. A variety of indicators were identified, such as the Human Development Index and the Gini Index, which primarily assessed differences in income, schooling, human development and vulnerability. A single pattern of association between the indicators and the different neoplasms was not established, nor was a single indicator capable of explaining the effect of social inequality at all levels of territorial area and by deaths from all types of neoplasms identified. It is known that mortality is influenced by social inequalities and that the study of indicators provides an opportunity to define which best explains deaths. This review highlights important gaps regarding the use of non-modifiable social indicators, analysis of small geographical areas, and limited use of multidimensional indicators.

O objetivo deste estudo foi identificar indicadores de desigualdades sociais associados à mortalidade por neoplasias na população adulta brasileira. Utilizou-se como método a revisão de escopo, estabelecendo-se a pergunta norteadora: qual o efeito das desigualdades sociais na mortalidade por neoplasias na população adulta brasileira? Foram identificados 567 trabalhos, sendo 22 considerados elegíveis. Identificou-se uma diversidade de indicadores, como o Índice de Desenvolvimento Humano e o Índice de Gini, entre outros, que avaliaram primordialmente diferenças de renda, escolarização, desenvolvimento humano e vulnerabilidade. Não foi estabelecido um único padrão de associação entre os indicadores e as diferentes neoplasias, assim como não se identificou um indicador único capaz de explicar o efeito da desigualdade social em todos os níveis de área e por óbitos por todos os tipos de neoplasias, mas identificou-se que a mortalidade é influenciada pelas desigualdades sociais e que o estudo dos indicadores proporciona definir qual melhor explica os óbitos. Essa revisão destaca importantes lacunas referentes ao uso de indicadores sociais não modificáveis, à análise de pequenas áreas e ao uso limitado de indicadores multidimensionais.

A Narrative Review of the Current Research in Cancer-Related Pain Inequities: The Necessity of Applying Intersectionality to Advance Cancer Pain Research.

Cancer-related pain has a significant impact on quality of life for patients with cancer. In populations without cancer, there are documented pain inequities associated with minoritized racial and/or ethnic groups, women, and low socioeconomic status. However, our understanding of pain inequities specifically among patients with cancer remains incomplete. We narratively synthesized published quantitative research on cancer-related pain inequities in the US in the past decade. A search identified 17 English-language articles examining pain for patients with various cancer types at different treatment stages. Our review revealed mixed findings comparing cancer-related pain by racial group (e.g., Black vs White) and sex (male vs female), but consistent findings indicating that people with lower (vs higher) socioeconomic status and younger (vs older) patients report more cancer-related pain. Research on cancer pain among sexual and gender minorities remains scant. Key research gaps include a need for more research that incorporates an intersectional perspective by exploring intersecting subgroups and measuring social and structural processes that drive pain inequities. These findings underscore an important need for researchers to use an intersectional approach to cancer pain to help elucidate key populations at-risk for exacerbated cancer-related pain and identify ways to mitigate social and structural processes that drive these inequities.

There are known differences in pain experiences among people from different racial or ethnic groups, sex (male or female) or gender (men or women), and socioeconomic groups such as low income people. However, we don't fully understand these differences among cancer patients yet. This review looks at the past 10 years of research on how cancer-related pain may differ for people from different sociodemographic groups. We collected information from 17 studies in the US that looked at how pain from different types of cancer and different stages of treatment may differ for people from these different groups. We found mixed results when comparing pain between racial groups and sex and/or gender groups, but consistently found that people with lower incomes and younger patients reported more pain. There's not much research on how cancer pain affects sexual and gender minorities (LGBTQ+ people). Our review suggests that we need an intersectional approach to best understand cancer-related pain in order to best address how structural discrimination influences pain. Researchers should use an intersectional perspective, which will help us find out who's most at risk of severe cancer pain and find ways to help them better.

Training an Anti-Ableist Physical Therapist Workforce: Critical Perspectives of Health Care Education That Contribute to Health Inequities for People With Disabilities.

Americans with disabilities represent the largest historically underserved and marginalized health disparity population in the United States. This perspective piece will raise the awareness of physical therapist faculty and clinicians on gaps in health care provider knowledge about disability and provide actionable strategies, frameworks, and resources available to improve disability competence to make changes in clinical education and practice. In this perspective piece, 3 contributions are made. First, health disparities experienced by Americans with disabilities as a result of health care providers' biased assumptions about disability and lack of disability competence are described through an in-depth illustration of lived experiences of people with disabilities. Second, a discussion of disability competence in physical therapist education is provided. Finally, critical and evidence-based insights and actionable frameworks and resources to address disability competence training gaps and to promote anti-ableist practice are provided.

United States Federal Policies Contributing to Health and Health Care Inequities in Puerto Rico.

Puerto Rico, a territory of the United States since 1898, has recently experienced an increasing frequency and intensity of natural disasters and public health emergencies. In 2022, Hurricane Fiona became the latest storm to attract media attention and cast a light on Puerto Rico's deteriorating conditions, including infrastructural failings, health care provider shortages, and high levels of chronic illness. Although recent events have been uniquely devastating, decades of inequitable US federal policy practices have fueled the persistence of health inequities in the territory. Here we demonstrate how existing health and health care inequities in Puerto Rico have been exacerbated by compounding disasters but are rooted in the differential treatment of the territory under US federal policies. Specifically, we focus on the unequal US Federal Emergency Management Agency response to disasters in the territory, the lack of parity in federal Medicaid funding for Puerto Rico, and Puerto Rico's limited political power as a territory of the United States. We also provide empirically supported policy recommendations aimed at reducing health and health care inequities in the often-forgotten US territory of Puerto Rico. (Am J Public Health. 2024;114(S6):S478-S484. https://doi.org/10.2105/AJPH.2024.307585) [Formula: see text].

Racial and social inequities in medication use: A review of articles responding to the Journal of Managed Care + Specialty Pharmacy's Call to Action.

This article provides a summary of Viewpoint and Research articles responding to the 2020 Journal of Managed Care + Specialty Pharmacy Call to Action to address racial and social inequities in medication use. We find great heterogeneity in terms of topic, clinical condition examined, and health disparity addressed. Common recommendations across Viewpoint articles include the need to increase racial and ethnic diversity in clinical trial participants, the need to address drug affordability and health insurance literacy, and the need to incentivize providers and plans to participate in diversity initiatives, such as the better capture of information on social determinants of health (SDOH) in claims data to be able to address SDOH needs. Across research articles, we also find a large range of approaches and study designs, spanning from randomized controlled trials to surveys to observational studies. These articles identify disparities in which minoritized beneficiaries are shown to be less likely to receive medications and vaccines, as well as less likely to be adherent to medications, across a variety of conditions. Finally, we discuss Healthy People 2030 as a potential framework for future health disparity researchers.

Successes and challenges of partnership working to tackle health inequalities using collaborative approaches to community-based research: mixed methods analysis of focus group evidence.

BACKGROUND: The concept of collaborative approaches involves community residents in joint decision-making processes to maintain or enhance their material and social conditions. During COVID-19, public services saw the benefits of actively collaborating with communities and involving residents in decision-making processes. As communities have resources and assets, they are well-placed to contribute to developing local health and wellbeing initiatives. An interdisciplinary and nationally funded three-phase research programme, "Mobilising community assets to tackle health inequalities", was established with the objective of utilising local, cultural, and natural assets to support health and wellbeing. The current study aimed to synthesise evidence collected by research teams awarded funding in phase one of the programme, comprising academic and non-academic, health and social care, voluntary and community partners. METHODS: Ten online focus groups were conducted with research teams from across the UK exploring the successes and challenges of partnership working to tackle health inequalities using collaborative approaches to community-based research. Eight focus group questions were split between partnership working and health inequalities. RESULTS: Thematic and content analysis produced 185 subthemes from which 12 themes were identified. Major themes representing an above average number of coded responses were research evidence; funding; relationships with partners; health inequalities and deprivation; community involvement; and health service and integrated care systems. Minor themes were link workers and social prescribing; training and support; place-based factors; longevity of programmes; setting up and scaling up programmes; and mental health. CONCLUSIONS: Successes included employing practice-based and arts-based methods, being part of a research project for those not normally involved in research, sharing funding democratically, building on established relationships, and the vital role that local assets play in involving communities. Challenges involved a lack of sustainable financial support, the short-term nature of funding, inconsistencies in reaching the poorest people, obtaining the right sort of research evidence, making sufficient research progress, building relationships with already over-burdened health care staff, and redressing the balance of power in favour of communities. Despite the challenges, participants were mainly optimistic that collective approaches and meaningful co-production would create opportunities for future research partnerships with communities.