International Journal for Equity in Health最新文献

The 2025 clade IIb mpox outbreak in Sierra Leone, intersecting with a significant HIV burden, is not merely a health crisis but a stark manifestation of deep-seated global health inequities. This commentary argues that the response to this outbreak reveals a familiar and fatal pattern: the neglect of diseases within marginalized populations until they threaten high-income countries. Through analyzing disparities in clinical outcomes, diagnostic and therapeutic access, and containment policies, we critique the reactive, charity-based model of global health. We propose a paradigm shift towards proactive equity, centered on the establishment of a permanent infectious disease Equity Fund to ensure the rapid, equitable distribution of vaccines, therapeutics, and diagnostics for future outbreaks, transforming a moment of crisis into an opportunity for durable change.

Background: The intertwined challenges of climate change and malnutrition amplify each other, with climate change exacerbating malnutrition, particularly in vulnerable populations; and food systems significantly contributing to emissions and environmental degradation. Addressing these issues together offers opportunities for shared gains, yet funding streams for these sectors remain siloed and misaligned.

Objective: This study developed a scoring methodology to assess the compatibility of climate funds with financing nutrition-related actions where synergies align with climate funds' primary goals, referred to as the "scope for nutrition integration".

Methods: Using the Climate Funds Update database, 18 active climate funds were systematically reviewed and rated based on their potential for financing nutrition-related activities. The study included a descriptive characterization of funds to identify entry points and understand their geographic reach, size, and focus. The scoring methodology considered four criteria: mandate alignment with nutrition objectives, flexibility in funding structure, visibility of nutrition action, and publicly available precedents for nutrition-related projects.

Results: Out of the 18 climate funds analyzed, 12 had strong scope for nutrition integration, 3 had some scope, and 3 had limited scope. Many of these funds offer promising opportunities given their large financing availability. Most funds' descriptive characterization revealed a focus on equity and inclusion, representing important entry points for integrating nutrition-related activities even in funds with seemingly less integration potential. Climate funds with comprehensive climate action approaches combining mitigation, adaptation, and resilience exhibited the strongest alignment with nutrition integration potential. Mitigation funds were the most limited in their scope for financing nutrition-related activities, but important untapped opportunities exist for nutrition-smart climate mitigation. A case study of the Green Climate Fund's investment in Burundi highlights how climate finance can support both climate adaptation and improved nutrition outcomes, emphasizing the need for purposeful, evidence-based integration of nutrition.

Conclusions: This paper provides a practical framework for identifying opportunities to integrate nutrition-related activities within climate financing, aiming to enhance resilience, strengthen adaptation efforts, and advance climate mitigation goals through a nutrition lens. By doing so, global stakeholders can address the dual crises of climate change and malnutrition, driving transformative outcomes for people and the planet.

Background: Eating disorders (EDs) in older adults remain underrecognised due to persistent stereotypes framing them as conditions of youth. This study investigates how general practitioners (GPs) in Austria perceive, diagnose, and manage EDs in patients aged 65 and over, and explores the potential role of ageism in the context of clinical decision-making.

Methods: A vignette-based, semi-structured interview design was used with nine Austrian GPs experienced in treating older patients. The vignette described an older woman presenting with symptoms of Anorexia Nervosa. Data were analysed using a content-structuring qualitative approach, identifying patterns in awareness, diagnostic reasoning, and treatment practices.

Results: Two overarching themes emerged: (1) Awareness and knowledge of EDs in later life and (2) Diagnostics, treatment, and differential diagnosis. Most GPs reported little familiarity with EDs in older adults, often attributing appetite or weight loss to ageing or somatic illness. Gendered stereotypes shaped perceptions, with older women viewed as less concerned with appearance and older men's EDs largely invisible. Diagnostic challenges included the absence of validated screening tools for older populations, symptom masking by multimorbidity, and reliance on physical rather than psychiatric explanations. Treatment pathways varied, ranging from interdisciplinary collaboration to psychiatric referral or antidepressant initiation, often targeting depression rather than the ED itself.

Conclusions: The underrecognition of EDs in older adults reflects structural gaps, ageist and gendered assumptions, and lack of tailored clinical guidelines. Age- and gender-sensitive screening tools, specific treatment pathways, targeted GP training, and public health campaigns are needed to improve detection and care for this underserved population.

Background: Ultra-Orthodox Jewish (UO) communities often show suboptimal and delayed vaccine uptake, leading to recurrent outbreaks. Health equity efforts often treat minorities as uniform, overlooking internal diversity. The UO population comprises distinct subgroups with varying social norms; how this impact on vaccination is not described. We use Safed, a UO-majority city with low vaccination coverage as a case study to examine subgroup differences in vaccination behavior and attitudes.

Methods: In 2023-24, a cross-sectional survey was conducted among parents of children aged 0-10. Respondents were categorized as Litvish, Hasidic, Sephardic, non-mainstream UO, or non-UO. The survey assessed DTP and MMR vaccination status, vaccination attitudes using a validated hesitancy index, sources of information and trust. subgroups were compared using chi-square tests, t-tests, and ANOVA.

Results: 318 parents participated (201 UO). MMR coverage ranged from 100% (Litvish) to 60% (non-mainstream, p < 0.001); DTP showed a similar gap (100% vs. 65.9%, p < 0.01). Significant differences in vaccine attitudes were found among UO subgroups (p < 0.001), with the Litvish showing the least hesitancy and non-mainstream groups the most. Information from healthcare professionals was sought by 36.8% of Litvish vs. 24.6% of non-mainstream. Religious authorities were the primary source of information for 68.8% of Litvish vs. 36.2% of non-mainstream respondents (p = 0.007). Trust in rabbis and healthcare professionals varied significantly between UO subgroups.

Conclusions: Significant intra-UO variation in vaccination attitudes and behavior challenges the assumption of community uniformity. Local health services should identify and consider the particulars of their population to deliver equitable and effective vaccine programmes.

Background: Despite well-known benefits, cardiac rehabilitation (CR) programs suffer from non-participation, and travel distance is repeatedly reported as a participation barrier. Based on individual-level data, the objective of this study was to evaluate geographic proximity to exercise-based CR and assess how geographic and sociodemographic disparities were affected by decentralisation of services from hospitals to primary care.

Methods: Based on nationwide individual-level Danish data, travel distance, calculated as the shortest route along the road network, was used to assess geographic proximity to exercise-based CR. Travel distance was mapped using Inverse Distance Weighting to produce a surface map. Boxplots were used to illustrate the distribution of travel distance within the study population, and sociodemographic disparities in median travel distance were evaluated by assessment of the concentration index.

Results: The study included 2,460,639 addresses and 3,693,053 residents (≥ 30 years old). Overall, the median travel distance to exercise-based CR was reduced with ≥ 40% after decentralisation. Non-central and rural parts of the country benefitted most. Inequality in travel distance associated with older age and multimorbidity was eliminated, while inequality associated with low educational level was significantly reduced.

Conclusions: Based on unique national data, this study is the first to demonstrate how decentralisation increased geographic proximity to exercise-based CR. Remote and rural areas, and certain vulnerable groups benefitted particularly, leading to reduced inequality in geographic proximity after decentralisation. With lack of geographic proximity being a known barrier to participation in CR programs, the study supports decentralisation of services as an instrument to be considered in an ongoing strive to improve CR participation, overall and within vulnerable groups. Moreover, the results may serve as a general illustration of what can be achieved by decentralisation, regardless of the specific service.

Background: Advance care planning (ACP) is a critical process for ensuring person-centred end-of-life care, yet it remains underutilized among people with intellectual disabilities (ID). Understanding caregivers' perspectives is essential to identify barriers and facilitators to ACP implementation and improve practice. This study aimed to examine how professional caregivers in Austria perceive and experience ACP for people with ID, including its current use, barriers, facilitators, and strategies to improve uptake.

Methods: A cross-sectional survey was conducted using a structured online form comprising multiple-choice and open-ended questions. Data were collected from 125 professional caregivers across Austria who were primary caregivers of at least one adult with ID and proficient in German. Quantitative data were analysed descriptively, while qualitative responses to open-ended questions were subjected to content analysis.

Results: A total of 33.6% of caregivers reported engaging in ACP discussions, with considerable barriers including cognitive and communicative challenges, emotional discomfort, and structural constraints. Facilitators included person-centred communication, interdisciplinary collaboration, and targeted training. Notably, 83.2% of caregivers expressed interest in ACP training.

Conclusions: ACP is rarely practiced in the care of people with ID in Austria. However, caregivers identified clear pathways to improve implementation, particularly through training, use of tailored communication methods, and systemic support within care institutions. Promoting inclusive ACP practices is essential to uphold the autonomy and health equity of people with ID, ensuring their voices are heard in decisions about their future and end-of-life care.