How local health departments work towards health equity

BackgroundHealth inequities are exacerbated when health promotion programs and resources do not reach selected populations. Local health departments (LHDs)¹ have the potential to address health equity via engaging priority populations in their work. However, we do not have an understanding of what local agencies are doing on this front.MethodsIn the summer of 2016, we collaborated with informants from thirteen LHDs across North Carolina. Via semi-structured interviews, the research team asked informants about their LHD’s understanding of health equity and engaging priority populations in program planning, implementation, and evaluation.FindingsAll informants discussed that a key function of their LHD was to improve the health of all residents. LHDs with a more comprehensive understanding of health equity engaged members of priority populations in their organizations’ efforts to a greater extent than LHDs with a more limited understanding. Additionally, while all LHDs identified similar barriers to engaging priority populations, LHDs that identified facilitators more comprehensively engaged members of the priority population in program planning, implementation, and evaluation.ConclusionsLHDs are ideally situated between the research and practice worlds to address health equity locally. To promote this work, we should ensure LHDs hold an understanding of health equity, have the means to realize facilitators of health equity work, and recognize the complex context in which health equity work exists.     

Are Hearing Voices Networks Compatible with Cognitive Behavioural Therapy for Psychosis?

The most extensively evaluated intervention for auditory hallucinations is Cognitive Behavioural Therapy for Psychosis (CBTp), which is usually delivered in statutory settings by experienced clinicians. In contrast, peer support networks, such as the Hearing Voices Network (HVN), operate informally using peers to normalise and manage voices. This article compares these two approaches to identify points of synergy and difference. Its analysis suggests the two approaches share many features, but also deviate in important ways that could compensate for each other. Instead of competing with each other as might first be thought, they may actually be complementary. Further, HVN may align comfortably with the values and principles of social work. Social workers seeking to engage with voice hearers may be advised to study the underlying principles of each approach to guide the way in which they can capitalise on intervention opportunities to better assist voice hearers.     

The relationship between the community participation of disabled youth and socioeconomic factors: mixed-methods approach in rural Sri Lanka

Mixed methods were applied to examine the association of community participation by disabled youth with socioeconomic factors in rural Sri Lanka. There was a significant association between community participation and socioeconomic factors in the quantitative survey (n = 116): participants living in socioeconomically disadvantaged conditions had lower levels of community participation than those living without these disadvantages. Consistent with the findings of the survey, previous educational experiences, household economic conditions, and perceived resource information were common themes in the qualitative study (n = 26). The dynamics of these factors, including marginalisation of disabled youth within the household, were also observed.     

Dialogic communication in the health care context: A case study of Kaiser Permanente's social media practices

This case study examines how one of the largest not-for-profit health care organizations in the US, Kaiser Permanente, uses social media to communicate with its stakeholders. Through content analysis and interviews, this study identifies the communication models reflected in a sample of social media posts and examines the organization's approach to using social media. The study finds evidence of both one-way and two-way communication models, as well as principles of dialogic communication. The implications of these findings are discussed.     

Three faces of international inequality

Recent studies of international inequality have focused mostly on the trend in international income inequality. This article extends the analysis of international inequality to also include inequalities in education and health. Analyses of time-series data for more than 100 countries show that international income inequality declined from 1980 to 2003 as several large, poor Asian countries outpaced many Western countries in national income growth. By contrast, international health inequality followed a U-shaped trend, falling in the 1980s before rising in the 1990s. The turnaround in health inequality coincides with a trend of declining life expectancy in sub-Saharan Africa. International educational inequality experienced the sharpest recent decline, spurred by the global expansion of formal schooling. These findings confirm that there is more to international inequality than income inequality alone and suggest that patterns of inequality in the current era of globalization are likely more complex than many leading theories suggest.     

Person, Perception, and Place: What Matters to Health and Quality of Life

Interest in understanding how characteristics associated with where people live, in addition to the characteristics of the people themselves, affect health outcomes has risen sharply in recent years. While much of the research examining this question focus on teasing apart effects of place and individual on outcomes, less attention has been paid to examining how individuals’ perceptions of where they live may provide some clues to better understanding the influence of place on outcomes. We present findings from analysis undertaken that incorporate the subjective responses of individuals, residing in three socially contrasting neighbourhoods, to their local environment. Our first question addressed whether perceptions related to neighbourhood and city of residence matter to self rated health and quality of life independent of individual characteristics, while the second question examined whether the perceptions and individual characteristics are modified by the neighbourhood socio-economic context. Our results show that perceived neighbourhood characteristics, in addition to individual sociodemographic factors, are significant correlates of self rated health and quality of life. Moreover, we show that the type of perceived neighbourhood characteristics and the magnitude of their influence on self rated health and quality of life vary depending on whether they live in high- versus low-socioeconomic status neighbourhoods.

Does parents’ valuation of children’s health mimic their valuation of own health?

A single latent variable model of health status and therapeutic health care utilization is estimated for parents and own children of 6,557 US households. The equation system that identifies latent health status simultaneously determines a number of indicators of general health, including presence of morbidity symptoms, mobility limitations, medication needs, and utilization of therapeutic health care services. The main goal of the paper was to obtain an unbiased estimate of parents’ marginal substitution rate between own and child health. Results indicate that parents’ valuation of their children’s health exceeds their valuation of own health by almost twofold on average.

以人口健康观看我国健康保障制度改革

人口健康观是将健康的概念由个体健康拓展到以人口为基础的群体层面的一种新理念．它关注的是健康而不是疾病。从人口健康观看,我国健康保障制度改革存在着许多认识上的误区,应该以社区健康为中心重建健康保障制度。     

Seclusion,decision-making power,and gender disparities in adult health: Examining hypertension in India

Research on the social determinants of health in developing countries is increasingly focusing on the importance of gender. Cardiovascular conditions such as hypertension are a growing concern in developing countries, where they are now the leading cause of death. Researchers have documented differences in hypertension between men and women, but the importance of gendered practices in shaping these differences has been left unexamined. Using national data from the India Human Development Survey 2005 (N = 101,593), this study assesses the moderating role of two salient and widespread gendered practices—women’s seclusion and decision-making power—on hypertension disparities between women and men. Both seclusion and low decision-making power are associated with increased odds of hypertension for women, but in the case of seclusion reduced hypertension for men. Results also show the gender gap in hypertension is exacerbated with women’s seclusion and low decision-making power.