Does comprehensive education reduce health inequalities?
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ABSTRACT:
SUBMITTER: Popham F
PROVIDER: S-EPMC8215301 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Governments are incentivized to develop and implement health action programs focused on equity to ensure progress with effective strategies or interventions. OBJECTIVE:Identify and synthesize strategies or interventions that facilitate the reduction of health inequalities. METHODS:A systematic search strategy was carried out up until August 2019 in MEDLINE (Ovid), Embase (Elsevier), Cochrane Database of Systematic Reviews, LILACS, Scopus, Scielo and Epistemonikos. In addition, a snowball strategy was used. Literature reviews (LRs) of experimental and quasi-experimental studies were included. The identified interventions and outcomes were categorized based on the recommendation by the Cochrane group in "Effective Practice and Organization of Care". The quality of the included LRs was evaluated using the AMSTAR 2 tool. RESULTS:Four thousand ninety-five articles were identified, of which 97 were included in the synthesis of evidence. Most of the studies included focused on the general population, vulnerable populations and minority populations. The subjects of general health and healthy lifestyles were the most commonly addressed. According to the classification of the type of intervention, the domain covered most was the delivery arrangements, followed by the domain of implementation strategies. The most frequent group of outcomes was the reported outcome in (clinical) patients, followed by social outcomes. CONCLUSION:The strategies that facilitate the reduction of health inequalities must be intersectoral and multidisciplinary in nature, including all sectors of the health system. It is essential to continue generating interventions focused on strengthening health systems in order to achieve adequate universal health coverage, with a process of comprehensive and quality care.
| S-EPMC7594271 | biostudies-literature
Project description:There is some evidence that home safety assessment and modification (HSAM) is effective in reducing falls in older people. But there are various knowledge gaps, including around cost-effectiveness and also the impacts at a health district-level.A previously established Markov macro-simulation model built for the whole New Zealand (NZ) population (Pega et al 2016, Injury Prevention) was enhanced and adapted to a health district level. This district was Counties Manukau District Health Board, which hosts 42,000 people aged 65+ years. A health system perspective was taken and a discount rate of 3% was used for both health gain and costs. Intervention effectiveness estimates came from a systematic review, and NZ-specific intervention costs were extracted from a randomized controlled trial. In the 65+ age-group in this health district, the HSAM program was estimated to achieve health gains of 2800 quality-adjusted life-years (QALYs; 95% uncertainty interval [UI]: 547 to 5280). The net health system cost was estimated at NZ$8.44 million (95% UI: $663 to $14.3 million). The incremental cost-effectiveness ratio (ICER) was estimated at NZ$5480 suggesting HSAM is cost-effective (95%UI: cost saving to NZ$15,300 [equivalent to US$10,300]). Targeting HSAM only to people age 65+ or 75+ with previous injurious falls was estimated to be particularly cost-effective (ICERs: $700 and $832, respectively) with the latter intervention being cost-saving. There was no evidence for differential cost-effectiveness by sex or by ethnicity: M?ori (Indigenous population) vs non-M?ori.This modeling study suggests that a HSAM program could produce considerable health gain and be cost-effective for older people at a health district level. Nevertheless, comparisons may be desirable with other falls prevention interventions such as group exercise programs, which also provide social contact and may prevent various chronic diseases.
| S-EPMC5598974 | biostudies-literature
Project description:IntroductionImproving oral health and reducing oral health inequalities is an important global health priority. 'Upstream interventions' are a vital part of the collective effort to reduce oral disease burdens, however it is a rather nebulous term. Furthermore, there is little evidence on the effectiveness, impact and sustainability of upstream interventions that have focused on oral health and wider public health measures that impact on oral health. The aim of this scoping review is to systematically map and synthesise evidence on the effectiveness, impact and sustainability of upstream interventions on population oral health and reducing socioeconomic oral health inequalities.Methods and analysisThis scoping review will be conducted in accordance with the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. A detailed search strategy will be used to conduct a comprehensive search of electronic databases: Scopus, Embase and MEDLINE, PsycINFO and CINAHL, ASSIA and Cochrane Database of Systematic Reviews. A search of grey literature will also be completed to identify relevant dissertations, governmental reports and evaluations of implemented policies. Identification and extraction of data will be performed by two pairs of reviewers. Oversight and feedback will be provided by an independent expert advisory group.Ethics and disseminationThis study will review published and available grey literature and does not require an ethics review. The scoping review protocol has been registered with the Open Science Framework. The final report will be circulated and disseminated through publication and feed into the work of the ongoing Lancet Commission on Oral Health. Due to the policy relevance of this work, discussions will take place with key stakeholders regarding the implications of the findings for future policy development.
| S-EPMC9226867 | biostudies-literature
Project description:Although inadequate health literacy has been associated with lower asthma medication knowledge and worse metered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown.In this prospective cohort study of adults hospitalized for severe asthma exacerbations at two inner-city hospitals, we examined the relationship between inadequate health literacy and difficulties learning and retaining instructions about discharge medications and appropriate MDI technique.At hospital discharge, participants received one-on-one, 30-min, guideline-based, written and oral instruction about their asthma discharge regimen as well as appropriate MDI technique.Seventy-three patients were enrolled. Inadequate health literacy was identified in 16 (22%) participants. Before instruction, inadequate health literacy was associated with lower asthma medication knowledge (5.2/10 vs. 7.2/10, p < 0.001) and worse MDI technique (3.2/6 vs. 3.9/6, p = 0.03). However, inadequate health literacy was not associated with difficulty learning (p = 0.33) or retaining (p = 0.35) instructions about the discharge regimen. Similarly, inadequate health literacy was not associated with difficulty learning (p = 0.26) or retaining (p = 0.97) appropriate MDI technique. Results were similar in multivariable models adjusted for demographic characteristics and asthma severity indicators.These findings suggest that inadequate health literacy is a surmountable barrier to learning and remembering key asthma self-management skills.
| S-EPMC2718412 | biostudies-other
Project description:Comprehensive school health (CSH) is embraced internationally as the most effective way of promoting the health of students and the school community. It is a framework for supporting improvements in students' educational outcomes while addressing their well-being in a planned, holistic way. While many successful CSH initiatives are brought about by passionate individuals at the grassroots level, these initiatives benefit greatly from effective cross-sector collaborations within and among governments to coordinate policy and funding from the health and education sectors. Governments represent just one group of professionals within the myriad of players involved in implementing CSH in Canada. To be effective contributors to the model, all levels of government need to work together to reduce duplication while at the same time minimizing gaps in the policies and practices that support school health promotion. Collaboration between the health and education sectors within and across governmental boundaries is proving to be an effective mechanism for achieving this. In its first five-year mandate, the Pan Canadian Joint Consortium for School Health has broken new ground in horizontal integration and, as a result, has identified a set of key factors necessary for successful cross-sector collaboration.
| S-EPMC6973905 | biostudies-literature
Project description:Despite a wealth of research and policy initiatives, progress in tackling the UK's health inequalities has been limited. This article explores whether there appears to be consensus among researchers about the kinds of policies likely to reduce health inequalities.Ninety-nine proposals for addressing health inequalities were identified from multiple sources. Forty-one researchers participated in a survey assessing the extent to which they believed each proposal would reduce health inequalities, based on three criteria. The 20 proposals generating most support were employed in a second stage, in which 92 researchers indicated which proposals they felt would have the greatest impact on reducing health inequalities.Some consensus exists among researchers about the policy approaches likely to reduce UK health inequalities: a more progressive distribution of income/wealth, greater investment in services for deprived communities, plus regulatory policies to limit the impact of lifestyle-behavioural risks. However, researchers' support for proposals varies depending whether they are asked to express their expert opinion or to comment on the strength of the available evidence.When consulting researchers about health inequalities, policymakers need to consider whether they are seeking research-informed expertise or assessments of the available evidence; these questions are likely to yield different responses.
| S-EPMC4340326 | biostudies-other
Project description:The development of air quality management (AQM) strategies provides opportunities to improve public health and reduce health inequalities. This study evaluates health and inequality impacts of alternate SO2 control strategies in Detroit, MI, a designated non-attainment area. Control alternatives include uniform reductions across sources, ranking approaches based on total emissions and health impacts per ton of pollutant emitted, and optimizations that meet concentration and health goals. Using dispersion modeling and quantitative health impact assessment (HIA), these strategies are evaluated in terms of ambient concentrations, health impacts, and the inequality in health risks. The health burden attributable to SO2 emissions in Detroit falls primarily among children and includes 70 hospitalizations and 6,000 asthma-related respiratory symptom-days annually, equivalent to 7 disability-adjusted life years (DALYs). The health burden disproportionately falls on Hispanic/Latino residents, residents with less than a high school diploma, and foreign-born residents. Control strategies that target smaller facilities near exposed populations provide the greatest benefit in terms of the overall health burden reductions and the inequality of attributable health risk; conventional strategies that target the largest emission sources can increase inequality and provide only modest health benefits. The assessment is novel in using spatial analyses that account for urban scale gradients in exposure, demographics, vulnerability, and population health. We show that quantitative HIA methods can be used to develop AQM strategies that simultaneously meet environmental, public health, and environmental justice goals, advancing AQM beyond its current compliance-oriented focus.
| S-EPMC6136662 | biostudies-literature
Project description:This work investigates whether genetic makeup moderates the effects of education on health. Low statistical power and endogenous measures of environment have been obstacles to the credible estimation of such gene-by-environment interactions. We overcome these obstacles by combining a natural experiment that generated variation in secondary education with polygenic scores for a quarter-million individuals. The additional schooling affected body size, lung function, and blood pressure in middle age. The improvements in body size and lung function were larger for individuals with high genetic predisposition to obesity. As a result, education reduced the gap in unhealthy body size between those in the top and bottom terciles of genetic risk of obesity from 20 to 6 percentage points.
| S-EPMC6196527 | biostudies-literature
Project description:BackgroundThis study aims to establish whether health reporting differs by education level and, if so, to determine the extent to which this biases the measurement of health inequalities among older Europeans.MethodsData are from the Survey of Health, Ageing and Retirement in Europe (SHARE) covering eight countries. Differential reporting of health by education is identified from ratings of anchoring vignettes that describe fixed health states. Ratings of own health in six domains (mobility, pain, sleep, breathing, emotional health and cognition) are corrected for differences in reporting using an extended ordered probit model. For each country and health domain, we compare the corrected with the uncorrected age-sex standardized high-to-low education rate ratio for the absence of a health problem.ResultsBefore correction for reporting differences across the 48 combinations of country by health domain, there was no inequality in health by education (P > 0.05) in 32 of 48 cases. However, there were reporting differences by education (P < 0.05) in 29 out of 48 cases. In general, higher educated older Europeans are more likely to rate a given health state negatively (except for Spain and Sweden). Correcting for these differences generally increases health inequalities (except for Spain and Sweden) and results in the emergence of inequalities in 18 cases (P < 0.05), which may be considered 'statistically significant'. The greatest impact is in Belgium, Germany and The Netherlands, where inequalities (P < 0.05) appear only after adjustment in four of the six health domains.ConclusionsThese results emphasize the need to account for differences in the reporting of health. Measured health inequalities by education are often underestimated, and even go undetected, if no account is taken of these reporting differences.
| S-EPMC2734070 | biostudies-literature
Project description:BackgroundCOVID-19 vaccines significantly reduce rates of hospitalization and death for those infected with the SARS-CoV-2 virus. Those facing social oppression, including people of color, experience heightened risk for COVID-19 and comorbidities, but are often mistrustful of governmental agencies and initiatives, contributing to low vaccine uptake and a reluctance to access vital health care services. Dialogue-based health literacy interventions may mitigate mistrust and increase access to health services and information, subsequently increasing rates of vaccination and other behaviors that reduce COVID-19 risk.ObjectiveTo improve health literacy and reduce COVID-19 disparities, the Westchester County Department of Health, in partnership with two universities, community- and faith-based organizations, and the Westchester County Department of Correction, co-developed a health education program for community members, correctional officers, and incarcerated jail residents in Westchester, New York. Specific objectives are to increase preventative health behaviors, positive attitudes toward use of public health protocols, full vaccination or intentions to vaccinate, health care information understanding, health provider care access, clear communication with health care providers, and personal health care decision-making.MethodsGrounded in dialogic learning, the program entails training community-based "trusted messengers" and correctional officers to lead health information sessions in community and correctional settings. During the grant period, the program intends for 80 community-based trusted messengers to receive training from the Department of Health and will be expected to reach a goal of 100 members (N=8000) of their communities. Correctional staff with experience delivering educational programs will be trained to facilitate sessions among 400 correctional facility residents and 600 correctional staff.ResultsPre-post surveys will assess changes in health behaviors, attitudes, and perceptions. The program has been administered in the correctional facility since February 2022, with information sessions expected to cease for correctional staff and residents in June 2022 and November 2022, respectively. An initial cohort of community-based trusted messengers began training in February 2022, and information sessions have been scheduled in various virtual and community settings since March 2022. As of April 2022, the two-pronged health education program has reached 439 correctional officers, 98 jail residents, and 201 community members countywide. Program evaluation findings will be released in future publications after study implementation is complete.ConclusionsFew studies have evaluated the combined effects of training-of-trainers (ToT) and dialogical learning models on behavior and health literacy. As the first known COVID-19-specific dialogue-based health education program that applies a ToT model in the community-based, correctional, and virtual settings simultaneously, this study fills a gap in current knowledge about health literacy and health behavior in marginalized populations. Thus, this evidence-based framework can remedy COVID-19 disparities while also addressing risks for a host of health-related issues at the community level, potentially serving as a best-practice model for future health programs.International registered report identifier (irrid)PRR1-10.2196/37713.
| S-EPMC9591706 | biostudies-literature