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Housing as a determinant of health equity: A conceptual model.

ABSTRACT: Housing is a major pathway through which health disparities emerge and are sustained over time. However, no existing unified conceptual model has comprehensively elucidated the relationship between housing and health equity with attention to the full range of harmful exposures, their cumulative burden and their historical production. We synthesized literature from a diverse array of disciplines to explore the varied aspects of the relationship between housing and health and developed an original conceptual model highlighting these complexities. This holistic conceptual model of the impact of housing on health disparities illustrates how structural inequalities shape unequal distribution of access to health-promoting housing factors, which span four pillars: 1) cost (housing affordability); 2) conditions (housing quality); 3) consistency (residential stability); and 4) context (neighborhood opportunity). We further demonstrate that these four pillars can lead to cumulative burden by interacting with one another and with other structurally-rooted inequalities to produce and reify health disparities. We conclude by offering a comprehensive vision for healthy housing that situates housing's impact on health through a historical and social justice lens, which can help to better design policies and interventions that use housing to promote health equity.

SUBMITTER: Swope CB

PROVIDER: S-EPMC7146083 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Housing as a determinant of health equity: A conceptual model.

Swope Carolyn B CB Hernández Diana D

Social science & medicine (1982) 20190925

Housing is a major pathway through which health disparities emerge and are sustained over time. However, no existing unified conceptual model has comprehensively elucidated the relationship between housing and health equity with attention to the full range of harmful exposures, their cumulative burden and their historical production. We synthesized literature from a diverse array of disciplines to explore the varied aspects of the relationship between housing and health and developed an original ...[more]

PMID: 31675514

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Project description:BackgroundExisting research on health equity falls short of identifying a comprehensive set of indicators for measurement across health systems. Health systems in the ASEAN region, in particular, lack a standardised framework to assess health equity. This paper proposes a comprehensive framework to measure health equity in the ASEAN region and highlights current gaps in data availability according to its indicator components.MethodsA comprehensive literature review was undertaken to map out a core set of indicators to evaluate health equity at the health system level. Secondary data collection was subsequently conducted to assess current data availability for ASEAN states in key global health databases, national health accounts, and policy documents.ResultsA robust framework to measure health equity was developed comprising 195 indicators across Health System Inputs and Processes, Outputs, Outcomes, and Contextual Factors. Total indicator data availability equated to 72.9% (1423/1950). Across the ASEAN region, the Inputs and Processes sub-component of Health Financing had complete data availability for all indicators (160/160, 100%), while Access to Essential Medicine had the least data available (6/30, 20%). Under Outputs and Outcomes, Coverage of Selected Interventions (161/270, 59.63%) and Population Health (350/350, 100%) respectively had the most data available, while other indicator sub-components had little to none (≤ 38%). 72.145% (384/530) of data is available for all Contextual Factors. Out of the 10 ASEAN countries, the Philippines had the highest data availability overall at 77.44% (151/195), while Brunei Darussalam and Vietnam had the lowest data availability at 67.18% (131/195).ConclusionsThe data availability gaps highlighted in this study underscore the need for a standardised framework to guide data collection and benchmarking of health equity in ASEAN. There is a need to prioritise regular data collection for overlooked indicator areas and in countries with low levels of data availability. The application of this indicator framework and resulting data availability analysis could be conducted beyond ASEAN to enable cross-regional benchmarking of health equity.

Project description:BackgroundDue to striking disparities in the implementation of healthcare innovations, it is imperative that researchers and practitioners can meaningfully use implementation determinant frameworks to understand why disparities exist in access, receipt, use, quality, or outcomes of healthcare. Our prior work documented and piloted the first published adaptation of an existing implementation determinant framework with health equity domains to create the Health Equity Implementation Framework. We recommended integrating these three health equity domains to existing implementation determinant frameworks: (1) culturally relevant factors of recipients, (2) clinical encounter or patient-provider interaction, and (3) societal context (including but not limited to social determinants of health). This framework was developed for healthcare and clinical practice settings. Some implementation teams have begun using the Health Equity Implementation Framework in their evaluations and asked for more guidance.MethodsWe completed a consensus process with our authorship team to clarify steps to incorporate a health equity lens into an implementation determinant framework.ResultsWe describe steps to integrate health equity domains into implementation determinant frameworks for implementation research and practice. For each step, we compiled examples or practical tools to assist implementation researchers and practitioners in applying those steps. For each domain, we compiled definitions with supporting literature, showcased an illustrative example, and suggested sample quantitative and qualitative measures.ConclusionIncorporating health equity domains within implementation determinant frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally addressing implementation and equity barriers simultaneously. These practical guidance and tools provided can assist implementation researchers and practitioners to concretely capture and understand barriers and facilitators to implementation disparities.

Project description:BackgroundIn 2002–2003, a Needs, Gaps and Opportunities Assessment (NGOA) was conducted to investigate relationships between socio-economic dimensions of housing and health. Recent reviews of the literature point to a dearth of research on the socioeconomic dimensions of housing and health, despite its potential for promoting health.MethodsThe NGOA sought to identify research needs and gaps, and future opportunities for research in housing, socio-economic status and health. The methods used included a literature scan, a scan of research capacity, eight regional stakeholder workshops across Canada, and an open-ended e-mail survey of stakeholders. In this paper, we report the findings of the stakeholder consultations.FindingsThe main finding of the NGOA was that there is a significant dearth of research on housing as a socio-economic determinant of health but enormous potential for conducting high-impact, longitudinal and quasi-experimental research in the area. Of particular interest to stakeholder participants in the NGOA were the economic aspects of housing and health; the impact of housing on health for vulnerable subgroups (e.g., Aboriginal peoples, immigrants, children, seniors); the role of socio-economically and ethnically mixed communities; and the interaction between socio-economic aspects of housing and biophysical hazards in the home.ConclusionThe NGOA demonstrated that there is a substantial audience eager for knowledge on housing as a socio-economic determinant of health and that such knowledge could make an immediate impact on policy decision-making and program operation. Although knowledge gaps are substantial, the NGOA clearly identifies opportunities for high-impact, longitudinal and quasi-experimental research. Recently signed federal-provincial funding agreements for housing make the findings of the NGOA timely. Moreover, the NGOA results demonstrate how research on housing as a socio-economic determinant of health could be a strategy for improving our understanding of the effects of social environments on health and for reducing health disparities.Electronic Supplementary MaterialSupplementary material is available for this article at 10.1007/BF03405392 and is accessible for authorized users.

Project description:BackgroundDespite the wealth of frameworks on social determinants of health (SDOH), two current limitations include the relative superficial description of factors affecting health and a lack of focus on measuring health equity. The Health Equity Measurement Framework (HEMF) addresses these gaps by providing a more encompassing view of the multitude of SDOH and drivers of health service utilisation and by guiding quantitative analysis for public health surveillance and policy development. The objective of this paper is to present the HEMF, which was specifically designed to measure the direct and indirect effects of SDOH to support improved statistical modelling and measurement of health equity.MethodsBased on a framework synthesis, the HEMF development involved initially integrating theoretical components from existing SDOH and health system utilisation frameworks. To further develop the framework, relevant publications on SDOH and health equity were identified through a literature review in major electronic databases. White and grey literatures were critically reviewed to identify strengths and gaps in the existing frameworks in order to inform the development of a unique health equity measurement framework. Finally, over a two-year period of consultation, scholars, health practitioners, and local policy influencers from municipal and provincial governments provided critical feedback on the framework regarding its components and causal relationships.ResultsThis unified framework includes the socioeconomic, cultural, and political context, health policy context, social stratification, social location, material and social circumstances, environment, biological factors, health-related behaviours and beliefs, stress, quality of care, and healthcare utilisation. Alongside the HEMF's self-exploratory diagram showing the causal pathways in-depth, a number of examples are provided to illustrate the framework's usefulness in measuring and monitoring health equity as well as informing policy-making.ConclusionsThe HEMF highlights intervention areas to be influenced by strategic public policy for any organisation whose purview has an effect on health, including helping non-health sectors (such as education and labour) to better understand how their policies influence population health and perceive their role in health equity promotion. The HEMF recognises the complexity surrounding the SDOH and provides a clear, overarching direction for empirical work on health equity.

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Housing as a determinant of health equity: A conceptual model.

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Housing as a determinant of health equity: A conceptual model.

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