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Social inequalities and health inequity in Morocco.

ABSTRACT: BACKGROUND: According to the last census, Morocco has a population approaching 30 million people. The country has made good progress in the control of preventable childhood diseases but social inequalities and health inequities remain major problems for the third millennium. Despite the progress achieved during the last decade, the country still ranks at the 125th place according to the Human Development Index. This unpleasant position is mainly explained by illiteracy, education and health indicators. METHOD: Our study was based mainly on annual reports and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organisation (WHO), The Moroccan Health Ministry and related papers published in international journals. RESULTS AND DISCUSSION: As indicated by the last Arab Human Development Reports (AHDR 2002, AHDR 2003, AHDR 2004) and implicitly confirmed by the "National Initiative for Human Development" (NIHD) launched in May 2005 by the King of Morocco, many districts and shanty towns, urban or peri-urban, and a multitude of rural communes live in situations characterized by difficult access to basic social services of which education and health are examples. CONCLUSION: Recent evidence showed that improved health is more than a consequence of development. It is a central input into economic and social development and poverty reduction. Serious initiatives for human development should consider the reduction of social inequalities and health inequities as a first priority. Otherwise, the eventual development achieved cannot be sustained.

SUBMITTER: Boutayeb A

PROVIDER: S-EPMC1420301 | biostudies-literature | 2006

REPOSITORIES: biostudies-literature

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Social inequalities and health inequity in Morocco.

Boutayeb Abdesslam A

International journal for equity in health 20060307

<h4>Background</h4>According to the last census, Morocco has a population approaching 30 million people. The country has made good progress in the control of preventable childhood diseases but social inequalities and health inequities remain major problems for the third millennium. Despite the progress achieved during the last decade, the country still ranks at the 125th place according to the Human Development Index. This unpleasant position is mainly explained by illiteracy, education and heal ...[more]

PMID: 16522204

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Project description:BackgroundHousehold financial debt has more than tripled since the 1980s in the United States. The experience of indebtedness is socially structured and there is mounting evidence that debt is linked to decrements in health. However, it is unclear whether debt contributes to social disparities in health.ObjectiveWe examined whether household debt, measured by debt in excess of income and wealth, mediated education-based social inequalities in health, including cardiovascular risk factors (hypertension) and chronic conditions (diabetes, coronary heart disease, and psychiatric problems).MethodWe used longitudinal data from a sample of over 10,500 adults aged 18 years and older surveyed biennially between 1999 and 2015 as part of the Panel Study of Income Dynamics (PSID). We estimated the total effect of education on our health outcomes. To assess mediation by levels of household debt, we then estimated the controlled direct effect of education through pathways not mediated by levels of household debt, after accounting for lagged time-varying confounders and loss to follow-up using marginal structural models.ResultsCompared to respondents with at least a high school education, respondents with less than a high school education reported higher household debts in excess of income and wealth; they also reported a higher incidence of hypertension [risk ratio (RR) = 1.25, 95%CI = 1.13, 1.39), coronary heart disease (RR = 1.42, 95%CI: 1.25, 1.62), diabetes (RR = 1.50, 95%CI: 1.34, 1.68), and psychiatric problems (RR = 1.39, 95%CI: 1.24, 1.56). Compared to the total effects, the controlled direct effects of education on health were attenuated, particularly for death or first onset of hypertension and coronary heart disease, after fixing levels of household debt-to-income and debt-to-wealth.ConclusionOur results provide early evidence that household debt in excess of wealth partly mediates education-based inequalities in hypertension and coronary heart disease in the United States, with less consistent evidence for other chronic conditions.

Project description:Adults and children are willing to sacrifice personal gain to avoid both disadvantageous and advantageous inequity. These two forms of inequity aversion follow different developmental trajectories, with disadvantageous inequity aversion emerging around 4 years and advantageous inequity aversion emerging around 8 years. Although inequity aversion is assumed to be specific to situations where resources are distributed among individuals, the role of social context has not been tested in children. Here, we investigated the influence of two aspects of social context on inequity aversion in 4- to 9-year-old children: (1) the role of the experimenter distributing rewards and (2) the presence of a peer with whom rewards could be shared. Experiment 1 showed that children rejected inequity at the same rate, regardless of whether the experimenter had control over reward allocations. This indicates that children's decisions are based upon reward allocations between themselves and a peer and are not attempts to elicit more favorable distributions from the experimenter. Experiment 2 compared rejections of unequal reward allocations in children interacting with or without a peer partner. When faced with a disadvantageous distribution, children frequently rejected a smaller reward when a larger reward was visible, even if no partner would obtain the larger reward. This suggests that nonsocial factors partly explain disadvantageous inequity rejections. However, rejections of disadvantageous distributions were higher when the larger amount would go to a peer, indicating that social context enhances disadvantageous inequity aversion. By contrast, children rejected advantageous distributions almost exclusively in the social context. Therefore, advantageous inequity aversion appears to be genuinely social, highlighting its potential relevance for the development of fairness concerns. By comparing social and nonsocial factors, this study provides a detailed picture of the expression of inequity aversion in human ontogeny and raises questions about the function and evolution of inequity aversion in humans.

Project description:IntroductionExplanations for health inequalities include material, behavioural and psychosocial pathways. Social relationships are an important determinant of health, and research has consistently found that a lack of support networks may diminish favourable health outcomes. There is some evidence that social network structures, partly shaped by socioeconomic factors, contribute to health inequalities. This protocol will summarise the systematic review process.Methods and analysesThe Systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic database search of MEDLINE, Embase Classic + Embase and PsychINFO using the OvidSP platform will be undertaken. Databases will be searched from the earliest date of entry until 10 June 2022. Articles that have quantitatively assessed the role of social relationships in mediating or moderating health inequalities will be included and any health outcome (mental/physical) will be considered. The database search will be supplemented by reference list screening of all relevant full-text articles identified through the search. Two independent reviewers will be responsible for screening of articles, data extraction and assessment of bias. Observational studies will be risk assessed for bias using a modified version of the Newcastle-Ottawa Quality Assessment Scale, and intervention studies will be assessed using the revised Cochrane risk-of-bias tool. It is anticipated that the eligible studies will be highly variable; therefore, a meta-analysis will only be considered if the available data of the selected studies are similar. If the studies are too heterogeneous, a narrative synthesis of the extracted data will be presented.ConclusionThe results of the systematic review will examine the link between social relationships and health inequalities. The findings of the review will identify gaps in knowledge where further research is needed.Systematic review registrationPROSPERO CRD42020181706.

Project description:BackgroundTo reduce social inequities in health, the World Health Organization's Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever. The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period.MethodsTo meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires.ResultsThe main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented. While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents' behavior, aiming to empower them but without giving them the means to do so.ConclusionsThis research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should clearly state among its objectives the intention to reduce social inequalities in health. The policy should also state that it will be evaluated according to the criteria of proportionate universalism, interprofessional coordination, and actions based on the diversity of parents' needs.

Project description:BackgroundHealth equity, although addressed in several publications dealing with health efficiency analysis, is not easily translated into the operationalization of variables, mainly due to technical difficulties. Some studies provide evidence that it does not influence health outcomes; others demonstrate that its effect is an indirect one, with the hegemony of material living conditions over its social connotation. The aim of this article is to evaluate the role of health equity in determining health outcomes, in an international comparative analysis of the effectiveness and efficiency of health systems.MethodFixed Effects Model Panel and Data Envelopment Analysis, a dynamic and network model, in addition to comparative analysis between methods and health impacts. The effect variables considered in the study were life expectancy at birth and infant mortality, in 2010 and 2015, according to the sociocultural regions of the selected countries. Inequity was assessed both economically and socially. The following dimensions were considered: physical and financial resources, health production (access, coverage and prevention) and intersectoral variables: demographic, socioeconomic, governance and health risks.ResultsBoth methods demonstrated that countries with higher inequity levels (regarding income, education and health dimensions), associated or not with poverty, are the least efficient, not reaching the potential for effective health outcomes. The outcome life expectancy at birth exhibited, in the final model, the following variables: social inequity and per capita health expenditure. The outcome infant mortality comprehended the level of education variable, in association with the following healthcare variabels: care seeking due to diarrhea in children under five, births attended by skilled health professionals and the reduction in the incidence of HIV.ConclusionThe dissociation between the distribution of health outcomes and the overall level of health of the population characterizes a devastating political choice for society, as it is associated with high levels of segregation, disrespect and violence from within. Countries should prioritize health equity, adding value to its resources, since health inequties affect society altogether, generating mistrust and reduced social cohesion.

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Social inequalities and health inequity in Morocco.

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Social inequalities and health inequity in Morocco.

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