Which social determinants of health have the highest impact in community oncology to advance patient care equity and improve health outcomes? A scoping review.

INTRODUCTION: To better understand the SDOH-health equity landscape within a community oncology setting to answer the research question, "Which SDOH can have the highest impact in community oncology to advance patient care equity and improve health outcomes?" METHODS: Arksey and O'Malley's scoping review framework was used to identify evidence related to SDOH and health equity in community oncology. The study was guided by the "10-Step Framework for Continuous Patient Engagement" and a Community Advisory Board to assure relevance to patients and community providers. Literature was retrieved from literary databases and oncology organizations' websites. Eligible studies included discussion of SDOH and health equity as outlined by the World Health Organization and Centers for Disease Control and Prevention, respectively, and involved community oncology/cancer care in outpatient settings. Studies were excluded if the SDOH-health equity relationship was not discussed. RESULTS: The review resulted in 61 exploratory and 17 confirmatory "intervention" studies addressing the impact of SDOH on health equity in community oncology settings. The most frequently SDOH-health equity pairs identified were the SDOH categories, social inclusion and non-discrimination, income and social protection, and structural conflict, all paired with the health equity category, access to care/treatment. Confirmatory studies focused on income and social protection (SDOH) and access to care/treatment (health equity); the SDOH categories, social inclusion and non-discrimination and health/general literacy-patient, paired with the health equity category, and adherence/compliance. CONCLUSIONS: Literature highlights the SDOH and health equity relationship within the realm of oncology. Most studies on SDOH/health inequities in the community oncology setting are exploratory. There is the need to shift from documentation of cancer inequities to implementing solutions.

Roles of Randomized Controlled Trials in Establishing Evidence-Based Gender-Affirming Care and Advancing Health Equity.

This article reviews the design of a recently published randomized controlled trial (RCT) on immediate vs delayed access to gender-affirming hormones for transgender and gender-diverse (TGD) people and outlines key learning points that clinicians should know about how RCTs can and cannot contribute to advancing health equity for TGD people.

Social prescribing in Canada: linking the Ottawa Charter for Health Promotion with health care's Quintuple Aim for a collaborative approach to health. / La prescription sociale au Canada : lier la Charte d'Ottawa pour la promotion de la santé à l'Objectif quintuple pour l'amélioration des soins de santé en vue d'une approche collaborative en santé.

Social prescribing offers a practical mechanism by which public health and health care systems can work together toward a future in which well-being is prioritized, health equity is addressed and people and communities thrive. The articles in this second part of the Health Promotion and Chronic Disease Prevention in Canada special issue on social prescribing explore how social prescribing in Canada supports action on two frameworks important to public health and health care communities: the Ottawa Charter for Health Promotion, which emphasizes building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and reorienting health services, and the Quintuple Aim for health care improvement, which focusses on improved population health, health equity, patient experience, care team well-being and reduced costs.

Social prescribing supports collaboration between public health and health care services by providing a mechanism for action on both the Ottawa Charter for Health Promotion and the Quintuple Aim for health care improvement. At the individual level, people develop personal skills (Ottawa Charter), and care experiences improve for participants, patients and health care workers (Quintuple Aim). At the community level, health service reorientation strengthens community action, builds supportive environments and reduces acute care costs by moving care upstream. At the population level, precision data on health and social care support prioritization and decision making for healthy public policy and health equity.

La prescription sociale renforce la collaboration entre la santé publique et les services de soins de santé en leur fournissant un mécanisme par lequel agir en respectant la Charte d'Ottawa pour la promotion de la santé et l'Objectif quintuple pour l'amélioration des soins de santé. À l'échelle individuelle, les personnes développent des compétences personnelles (Charte d'Ottawa) et les expériences en matière de soins sont meilleures pour les participants, les patients et les travailleurs de la santé (Objectif quintuple). À l'échelle locale, la réorientation des services de santé renforce l'action des collectivités, crée des environnements favorables et réduit les coûts des soins aigus en déplaçant les soins en amont. À l'échelle de la population, la présence de données précises sur les soins de santé et les soins sociaux favorise l'établissement des priorités et la prise de décision, ce qui conduit à des politiques publiques favorisant davantage la santé et à une meilleure équité en matière de santé.

A realist impact evaluation of a tool to strengthen equity in local government policy-making.

BACKGROUND: Local governments have a critical role to play in addressing health inequities. Health equity impact assessments are recommended to help governments apply an equity lens to the development and implementation of policies and programs. Despite evidence of equity-positive benefits of such tools, adoption remains limited, prompting calls for evaluations to assess their impact and identify factors that will promote uptake across various contexts. METHODS: We conducted a mixed method study to evaluate the impact of an equity impact assessment (EIA) tool and process on policies and organisational capacity in a local government in Victoria, Australia, and identify factors that influenced this impact. We analysed 33 documents related to 18 EIAs, and conducted surveys (n = 40) and in-depth interviews (n = 17) with staff involved in EIAs. RESULTS: Almost all (17 of 18) EIAs resulted in equity-positive changes to policies and programs, most frequently addressing individual-level factors, such as making community communications and consultations more accessible to under-represented or under-served groups. Structural-level recommendations from one EIA, such as increasing diversity in decision-making panels, were found to impact both the current policy and a broad range of future, related projects and services. Improvements in equity-centric organisational culture and capacity (including staff awareness, skills and confidence) and increased engagement with under-represented communities were also reported. Factors perceived to influence the impact of EIA's related to organisational commitment and capacity to prioritise equity, process-level factors related to the type and timing of EIAs, and extent of implementation support. CONCLUSION: Our study supports wider uptake of health equity impact assessments in local government policies and programs. Legislation, leadership and resources from upper-tiers of government can help increase the adoption of equity tools to reduce disparities in population health.

Trends and inequalities in antenatal care coverage in Benin (2006-2017): an application of World Health Organization's Health Equity Assessment Toolkit.

INTRODUCTION: Between 2006 and 2017, antenatal care (ANC) coverage in Benin declined, potentially exacerbating inequalities and substantiating the need for health inequality monitoring. This study examines inequalities in ANC attendance in Benin, disaggregated by women's age, educational level, economic status, place of residence, region of residence, and the extent to which they have changed over time. METHODS: Three rounds of the Benin Demographic and Health Surveys (2006, 2011-12, and 2017-18) were analyzed to examine inequalities in ANC coverage. An exploratory descriptive approach was adopted for the analysis. Simple [difference (D) and ratio (R)] and complex [population attributable risk (PAR) and population attributable fraction (PAF)] measures of inequalities were computed using the World Health Organization's Health Equity Assessment Toolkit (WHO's HEAT) online platform. The measures were computed separately for each of the three surveys, and their estimates were compared. RESULTS: The findings revealed an 8.4% decline in at least four ANC visits between 2006 and 2017-18. The decline occurred irrespective of age, educational status, economic status, place of residence, and region. Region-related inequalities were the largest and increased slightly between 2006 (D = 54.6; R = 2.6; PAF = 47.8, PAR = 29.0) and 2017-18 (D = 55.8; R = 3.1; PAF = 57.2, PAR = 29.8). Education (2006: D = 31.3, R = 1.6, PAF = 40.5, PAR = 24.5; 2017-18: D = 25.2, R = 1.6, PAF = 34.9, PAR = 18.1) and rural-urban (2006: D = 16.8, R = 1.3, PAF = 17.8, PAR = 10.8; 2017-18: D = 11.2, R = 1.2, PAF = 13.1, PAR = 6.8) inequalities reduced while economic status inequalities did not improve (2006: D = 48, R = 2.2, PAF = 44.5, PAR = 26.9; 2017-18: D = 43.9, R = 2.4, PAF = 45.0, PAR = 23.4). Age inequalities were very minimal. CONCLUSION: ANC inequalities remain deeply ingrained in Benin. Addressing their varying levels requires comprehensive strategies that encompass both supply-and demand-side interventions, focusing on reaching uneducated women in the poorest households and those residing in rural areas and Atacora.

Equity considerations for the implementation of health insurance benefit package in Ethiopia: result of expert Delphi exercise.

BACKGROUND: Efficiency, equity and financial risk protection are key health systems objectives. Equitable distribution of health care is among the priority strategic initiative of the government of Ethiopia. However, data on the distribution of interventions benefits or on disease burden disaggregated by subpopulations to guide health care priority setting is not available in Ethiopia. METHODS: Aligned with policy documents, we identified the following groups to be the worse off in the Ethiopian context: under-five children, women of reproductive age, the poor, and rural residents. We used the Delphi technique by a panel of 28 experts to assign a score for 253 diseases/conditions over a period of two days, in phases. The expert panel represented different institutes and professional mix. Experts assigned a score 1 to 4; where 4 indicates disease/condition predominantly affecting the poor and rural residents and 1 indicates a condition more prevalent among the wealthy and urban residents. Subsequently, the average equity score was computed for each disease/condition. RESULTS: The average scores ranged from 1.11 (for vitiligo) to 3.79 (for obstetric fistula). We standardized the scores to be bounded between 1 and 2; 1 the lowest equity score and 2 the highest equity score. The scores for each disease/condition were then assigned to their corresponding interventions. We used these equity scores to adjust the CEA values for each of the interventions. To adjust the CEA values for equity, we multiplied the health benefits (the denominator of the cost-effectiveness value) of each intervention by the corresponding equity scores, resulting in equity adjusted CEA values. The equity adjusted CEA was then used to rank the interventions using a league table. CONCLUSIONS: The Delphi method can be useful in generating equity scores for prioritizing health interventions where disaggregated data on the distribution of diseases or access to interventions by subpopulation groups are not available.

Human resource allocation status and equity research of Centers for Disease Control and Prevention in China from 2016 to 2020.

Background: In recent years, the development of global public health has become a matter of great concern and importance for governments worldwide. China, as the largest developing country, plays a crucial role in shaping the development of the public health and its ability to respond to sudden public health emergencies through the fairness of its human resource allocation in center for disease control and prevention (CDC). Objective: This study aims to analyze the situation of health human resource allocation in the China Centers for Disease Control and Prevention (China CDCs), assess the fairness of the allocation, and provide reference for the rational allocation of human resources. Methods: We selected data from the China Health Statistics Yearbook on healthcare technical personnel, other technical personnel, managerial personnel, and workforce technical personnel of China CDCs for the period of 2016-2020. We utilized the Health Resource Density Index to evaluate the level of human resource allocation in China CDCs. Additionally, we used the Gini coefficient and Theil index to assess the fairness of human resource allocation in China CDCs from both a population and geographical perspective. Results: Firstly, the educational qualifications and professional titles of CDC staff have improved, but the workforce is aging. Secondly, HRDI development trends vary among different personnel types and regions with varying levels of economic development. Finally, the results of the Gini coefficient and Theil index indicate that population distribution fairness is better than geographical distribution fairness. Overall, the unfair population distribution is primarily due to regional disparities. Conclusion: The China CDCs should tailor different standards for the allocation of health human resources based on regional characteristics, aiming to enhance the accessibility of health human resources in various regions and achieve equitable allocation.

The Impact of Racism on Health: A Health Equity Training on Structural Racism for Military Residents and Fellows.

Introduction: Recognizing the need for more opportunities to learn about health equity within military graduate medical education (GME), we developed a resident-led curriculum to introduce these concepts from a military cultural competency lens. The Impact of Racism on Health module focuses on structural racism and health disparities. Methods: This 60-minute module was presented to ear, nose, and throat (ENT) and pediatrics residents and fellows. It includes a case presentation of an adolescent with an asthma exacerbation, a large-group discussion about social determinants of health and structural racism, and a small-group discussion/debrief conceptualizing the case. Results: Thirty pediatrics residents and 15 ENT residents participated in this activity with a 46% and 60% pretest response rate, respectively. A two-sample Mann-Whitney U test showed statistically significant improvement (p = .005) in knowledge related to structural racism between the pretest (M = 0.5, SD = 0.3) and posttest (M = 0.7, SD = 0.1) knowledge assessments with a small effect size (r = 0.4; Z = 2.8). Discussion: We demonstrated that interactive teaching methods can be used to educate military GME trainees on the impact of structural racism on health outcomes for military health care beneficiaries. Understanding the role of structural racism in the context of military health care using curricula that highlight military-specific health disparities is essential to understanding the role of the military physician in systemically addressing health disparities.

Using a Culturally Responsive, Antiracist, and Equitable Approach to School Mental Health.

Amidst a national youth mental health crisis, comprehensive school mental health systems offer an opportunity to promote positive mental health for all students. To advance health equity, schools benefit from a culturally responsive, antiracist, and equitable (CARE) framework to address the youth mental health crisis. This article describes how to integrate CARE practices within a multi-tiered system of support for mental health in schools. The strategies align with a trauma-informed approach and aim to enhance the capacity of comprehensive school mental health systems to promote positive mental health and well-being for all students.

When is a network adequate? consumer perspectives on network adequacy definitions.

OBJECTIVES: Most Americans have insurance that uses managed care arrangements. Regulators have long sought to ensure access to care through network adequacy regulations. However, consumers have largely been excluded from conversations about network adequacy. To our knowledge, our study is the first to assess consumer preferences for various definitions of network adequacy including those aimed at supporting health equity and reducing disparities. STUDY DESIGN: We fielded a large and demographically diverse survey of US adults (N = 4008) from June 30 to July 2, 2023. The survey queried respondents about their perceptions of what adequate provider networks look like in the abstract. METHODS: Analyses were conducted using ordinary least squares regression with survey weights as well as t tests. RESULTS: Consumers were overwhelmingly supportive of standard definitions of adequacy focused on the number of providers and travel distance. Majorities also favored more expansive, health equity-focused definitions such as public transportation access, cultural competency, and lesbian, gay, bisexual, and transgender (LGBT+)-inclusive care. Being a woman; having higher levels of education, worse health, and recent experiences with the medical system; and ease of completing administrative tasks were relatively consistent positive predictors of supporting more expansive definitions. More controversial definitions saw effects of partisanship and LGBT+ identification. Rurality, insurance status, education, and recent experiences with the medical system affected perceptions of reasonable appointment wait times and travel distances. CONCLUSIONS: Our findings indicate that consumers have broad conceptions of network adequacy. Future work should assess consumer trade-offs in resource-constrained settings as well as perceptions of providers and carriers.

Aboriginal families living with MJD in remote Australia: questions of access and equity.

Managing genetic disease using medically assisted reproductive technology is increasingly promoted as a feasible option, given revolutionary advances in genomics. Far less attention has been directed to the issue of whether there is equitable access to this option. Context and circumstance determine equitable access; however, reporting has drawn overwhelmingly from affluent Anglo-western populations in developed countries. The experiences of poorer, less educated subpopulations within affluent countries and populations in less developed countries are underreported. The ability of consumers to understand the opportunities and risks of medically assisted reproductive technology is likewise not well described in the literature despite significant technological complexity and evidence that genetic disease may be overrepresented within some disadvantaged population groups.Equity is achieved by identifying barriers and allocating appropriate resources to enable understanding and access. In the case of utilising medically assisted technology, social and power relationships, regulations, and the presumptions of authority figures and policymakers reduce equitable access. Physical or cultural marginalisation from mainstream health services may result in reduced access to genetic and prenatal testing, in-vitro fertilisation and genetic screening of embryos necessary for medically assisted reproduction. Cost and regulatory frameworks can likewise limit opportunities to engage with services. Moreover, the quality of the information provided to prospective users of the technology and how it is received governs understanding of prevention and inhibits adequately informed choice.Best practice care and adequately informed choice can only be achieved by conscientiously attending to these accessibility issues. Deep engagement with at-risk people and critical reflection on mainstream accepted standpoints is required. This paper outlines issues associated with engaging with medically assisted reproduction encountered by Aboriginal families living with Machado-Joseph Disease in some of the most remote areas of Australia. It is the right of these families to access such technologies regardless of where they live. Current barriers to access raise important questions for service providers with implications for practice as new technologies increasingly become part of standard medical care.

Accelerating HPV vaccination in Africa for health equity.

Cervical cancer is a preventable disease that continues to burden socioeconomically underserved regions, especially in Africa. Vaccination of adolescents who have never had sex with prophylactic human papillomavirus (HPV) vaccines proves effective in preventing the disease. However, vaccine accessibility and availability are two persistent challenges in low-resource settings. For this commentary, a trend analysis is conducted for national HPV vaccination and coverage rates in Africa, a region with high burden of the disease. This is in consideration of the World Health Organization (WHO) strategy to vaccinate 90% of adolescent girls by the age of 15, as part of strategy to eliminate cervical cancer by 2030. The analysis estimated that the rate of incorporating HPV vaccination in national immunization programs in Africa occurs slowly, at a mean wait time of 12 years with estimated coverage rate of 52%. A policy change that harnesses strategic approaches, such as a regionalized vaccination program, is recommended to hasten HPV vaccination for the rest of African countries without a national program.