scholarly journals Social Determinants of Health–Related Needs During COVID-19 Among Low-Income Households With Children

2020 ◽  
Vol 17 ◽  
Author(s):  
Shreela V. Sharma ◽  
Ru-Jye Chuang ◽  
Melinda Rushing ◽  
Brittni Naylor ◽  
Nalini Ranjit ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Determinants Of Health ◽  
Health Related ◽  
Households With Children ◽  
Low Income Households

Informal Recyclers’ Health Inequities in Vancouver, BC

2018 ◽  
Vol 28 (2) ◽  
pp. 321-343 ◽  
Author(s):  
Josie Wittmer ◽  
Kate Parizeau
Keyword(s):  
Environmental Health ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Service Providers ◽  
Health Inequities ◽  
Well Being ◽  
Determinants Of Health ◽  
Access To Health ◽  
Health Related

We explore informal recyclers’ perceptions and experiences of the social determinants of health in Vancouver, Canada, and investigate the factors that contribute to the environmental health inequities they experience. Based on in-depth interviews with 40 informal recyclers and 7 key informants, we used a social determinants of health framework to detail the health threats that informal recyclers associated with their work and the factors that influenced their access to health-related resources and services. Our analysis reveals that the structural factors influencing environmental health inequities included insufficient government resources for low-income urbanites; the potential for stigma, clientization, and discrimination at some health and social service providers; and the legal marginalization of informal recycling and associated activities. We conclude that Vancouver's informal recyclers experience inequitable access to health-related resources and services, and they are knowledgeable observers of the factors that influence their own health and well-being.

scholarly journals Health-Predictive Social-Environmental Stressors and Social Buffers Are Place Based: A Multilevel Example From San Bernardino Communities

2019 ◽  
Vol 10 ◽  
pp. 215013271983562 ◽  
Author(s):  
Kristen N. Arthur ◽  
Synnøve F. Knutsen ◽  
Rhonda Spencer-Hwang ◽  
David Shavlik ◽  
Susanne Montgomery
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Health Care Access ◽  
Household Income ◽  
Interdisciplinary Collaboration ◽  
Determinants Of Health ◽  
Community Safety ◽  
Health Related ◽  
Race Ethnicity

Significant evidence demonstrates the powerful effects social determinants have on health-related perceptions, behaviors, and health outcomes. However, these factors are often studied out of context, despite the acknowledgement that social determinants of health are place based. This research aimed to demonstrate that health-related perceptions are dependent on where one lives. Via a community-based participatory study, participants were randomly selected from 3 residential regions varying distances from a freight railyard (nearest n = 300, middle n = 338, farthest n = 327), all mostly low-income, predominately Latino areas. Interview-administered surveys with adults were collected by bilingual trained community members (87% response) in English/Spanish. Adjusted-logistic regression models assessed residential region as a predictor of stressors (perceptions of community safety, community noise disturbance, health care access, food insecurity) and buffers (3 neighborhood cohesion variables), after adjusting for household income, race/ethnicity, gender, and age. Each region experienced a unique amalgam of stressors and buffers. In general, the region closest to the railyard experienced more stressors (odds ratio [OR] = 1.58; 95% CI 1.12-2.20) and less buffers (OR = 0.69; 95% CI 0.49-0.96) than the region furthest from the railyard. More than half of participants in each region reported 2 or more stressors and 2 or more buffers. In this seemingly homogenous study population, place remained important in spite of traditionally used socioeconomic factors, such as household income and race/ethnicity. Social determinants of health should be studied with regard to their environmental context, which will require interdisciplinary collaboration to improve multilevel research methods. Including the study of social buffers will also promote sustainable, positive change to reduce health disparities.

scholarly journals Pushing poverty off limits: quality improvement and the architecture of healthcare values

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Polly Mitchell ◽  
Alan Cribb ◽  
Vikki Entwistle ◽  
Guddi Singh
Keyword(s):  
Quality Improvement ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Deprivation ◽  
Ethical Dilemmas ◽  
Determinants Of Health ◽  
Ethical Challenges ◽  
The Social ◽  
Significant Burden ◽  
Health Related

Abstract Background Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative (PSI) into paediatric practice using the discourse and methodology of healthcare quality improvement (QI). Discussion Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. Conclusions We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods.

Using Community-Level Mental Health Surveillance Data to Examine the Relationship of Depression Prevalence to Social Determinants of Health and Access to Mental Health Services

2013 ◽  
Vol 32 (1) ◽  
pp. 43-57 ◽  
Author(s):  
Shawn R. Currie ◽  
Kirsten Fiest ◽  
Lindsay Guyn
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Community Level ◽  
Determinants Of Health ◽  
Treatment Access ◽  
Depression Prevalence

The effect of social determinants of health on depression prevalence and treatment access was examined using community survey and administrative data on mental health service users in the Calgary Health Region (CHR). Consistent with national prevalence data, depression was significantly associated with female gender, younger age, and health risk factors such as smoking, hypertension, and obesity. The prevalence of depression causing interference in daily functioning across 19 social districts (subregions within the CHR) was significantly related to community-level indicators of single-parent status, low-income families, and low educational achievement in each district. Disparities in treatment access were also found with persons living in the most impoverished districts having the lowest rates of accessing professional mental health services.

scholarly journals Screening for poverty and intervening in a primary care setting: an acceptability and feasibility study

2019 ◽  
Vol 36 (5) ◽  
pp. 634-638
Author(s):  
Andrew D Pinto ◽  
Madeleine Bondy ◽  
Anne Rucchetto ◽  
John Ihnat ◽  
Adam Kaufman
Keyword(s):  
Primary Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Determinants Of Health ◽  
Health Concern ◽  
Evidence Based ◽  
Health Providers ◽  
Financial Benefits ◽  
The Social

Abstract Background A movement is emerging to encourage health providers and health organizations to take action on the social determinants of health. However, few evidence-based interventions exist. Digital tools have not been examined in depth. Objective To assess the acceptability and feasibility of integrating, within routine primary care, screening for poverty and an online tool that helps identify financial benefits. Methods The setting was a Community Health Centre serving a large number of low-income individuals in Toronto, Canada. Physicians were encouraged to use the tool at every possible encounter during a 1-month period. A link to the tool was easily accessible, and reminder emails were circulated regularly. This mixed-methods study used a combination of pre-intervention and post-intervention surveys, focus groups and interviews. Results Thirteen physicians participated (81.25% of all) and represented a range of genders and years in practice. Physicians reported a strong awareness of the importance of identifying poverty as a health concern, but low confidence in their ability to address poverty. The tool was used with 63 patients over a 1-month period. Although screening and intervening on poverty is logistically challenging in regular workflows, online tools could assist patients and health providers identify financial benefits quickly. Future interventions should include more robust follow-up. Conclusions Our study contributes to the evidence based on addressing the social determinants of health in clinical settings. Future approaches could involve routine screening, engaging other members of the team in intervening and following up, and better integration with the electronic health record.

scholarly journals Implementation and impact of an online tool used in primary care to improve access to financial benefits for patients: a study protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e015947 ◽  
Author(s):  
Anjana Aery ◽  
Anne Rucchetto ◽  
Alexander Singer ◽  
Gayle Halas ◽  
Gary Bloch ◽  
...  
Keyword(s):  
Primary Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Online Survey ◽  
Determinants Of Health ◽  
Advisory Group ◽  
Online Tool ◽  
Financial Benefits ◽  
The Social

ObjectivesAddressing the social determinants of health has been identified as crucial to reducing health inequities. However, few evidence-based interventions exist. This study emerges from an ongoing collaboration between physicians, researchers and a financial literacy organisation. Our study will answer the following: Is an online tool that improves access to financial benefits feasible and acceptable? Can such a tool be integrated into clinical workflow? What are patient perspectives on the tool and what is the short-term impact on access to benefits?MethodsAn advisory group made up of patients living on low incomes and representatives from community agencies supports this study. We will recruit three primary care sites in Toronto, Ontario and three in Winnipeg, Manitoba that serve low-income communities. We will introduce clinicians to screening for poverty and how benefits can increase income. Health providers will be encouraged to use the tool with any patient seen. The health provider and patient will complete the online tool together, generating a tailored list of benefits and resources to assist with obtaining these benefits. A brief survey on this experience will be administered to patients after they complete the tool, as well as a request to contact them in 1 month. Those who agree to be contacted will be interviewed on whether the intervention improved access to financial benefits. We will also administer an online survey to providers and conduct focus groups at each site.Ethics and disseminationKey ethical concerns include that patients may feel discomfort when being asked about their financial situation, may feel obliged to complete the tool and may have their expectations falsely raised about receiving benefits. Providers will be trained to address each of these concerns. We will share our findings with providers and policy-makers interested in addressing the social determinants of health within healthcare settings.Trial registration numberClinicaltrials.gov:NCT02959866. Registered 7 November 2016. Retrospectively registered. Pre-results.

scholarly journals The Impact of “See the City You Serve” Field Trip: An Educational Tool for Teaching Social Determinants of Health

2017 ◽  
Vol 9 (1) ◽  
pp. 118-122 ◽  
Author(s):  
Aileen Y. Chang ◽  
Tracie L. Bass ◽  
Monique Duwell ◽  
Jeffrey S. Berger ◽  
Raksha Bangalore ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Field Trip ◽  
Determinants Of Health ◽  
Basic Knowledge ◽  
Rank Test ◽  
Community Resources ◽  
Community Partners ◽  
The Impact

ABSTRACT Background  There has been limited evaluation of tools for teaching social determinants of health (SDOH). Objective  We evaluated a field trip as a tool for teaching SDOH to incoming medical interns. Methods  Incoming interns from The George Washington University participated in a bus field trip of Washington, DC, guided by community partners. The field trip introduced trainees to local neighborhoods. Pre- and postactivity surveys developed by the authors were analyzed using a Wilcoxon signed rank test. Reflection responses were recorded and counted for recurrent themes. Results  Incoming interns participated in 2015 (85 of 90, 94%) and in 2016 (96 of 116, 83%). Postactivity, basic knowledge of DC geographic health disparities increased, and a greater percentage of interns reported being at least somewhat comfortable understanding the neighborhoods from which their patients come (2015: 58% versus 89%, P < .0001; 2016: 65% versus 88%, P < .0001); identifying challenges to health care that affect low-income patients (2015: 74% versus 90%, P < .0023); describing community resources (2015: 29% versus 67%, P < .0001; 2016: 29% versus 50%, P < .0001); and referring patients to local community resources (2015: 25% versus 64%, P < .0001; 2016: 36% versus 52%, P < .0001). Interns reported that this experience improved their understanding of patients' background and local resources, and that they would change the way they practice. Conclusions  A bus field trip guided by community partners is a feasible way to increase residents' perception of their understanding of local disparities and comfort in addressing SDOH.

scholarly journals Unsafe abortion: social determinants and health inequities in a vulnerable population in São Paulo, Brazil

2012 ◽  
Vol 28 (4) ◽  
pp. 709-719 ◽  
Author(s):  
Carmen L. B. Fusco ◽  
Rebeca de Souza e Silva ◽  
Solange Andreoni
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Multinomial Logistic Regression ◽  
Health Inequities ◽  
Sao Paulo ◽  
Demographic Characteristics ◽  
Determinants Of Health ◽  
Unsafe Abortion ◽  
São Paulo

This cross-sectional population-based study in a peripheral low-income community in São Paulo, Brazil, aimed to estimate the prevalence of unsafe abortion and identify the socio-demographic characteristics associated with it and its morbidity. The article discusses the study's results, based on univariate and multiple multinomial logistic regression analyses. The final regression models included: age at first intercourse < 16 years (OR = 4.80); > 2 sex partners in the previous year (OR = 3.63); more live born children than the woman's self-reported ideal number (OR = 3.09); acceptance of the abortion due to insufficient economic conditions (OR = 4.07); black ethnicity/color (OR = 2.67); and low schooling (OR = 2.46), all with p < 0.05. The discussion used an approach to social determinants of health based on the concept and model adopted by the WHO and the health inequities caused by such determinants in the occurrence of unsafe abortion. According to the findings, unsafe abortion and socio-demographic characteristics are influenced by the social determinants of health described in the study, generating various levels of health inequities in this low-income population.

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