International Journal for Equity in Health最新文献

Background: The Municipal Sustainable Development Health Index (MSDHI) was developed to monitor achieving health-related targets outlined in the 2030 Agenda. This study aims to support effective, comprehensive, and context-sensitive policy formulation at the local level by developing a local index that accounts for regional health inequalities. The study addresses critical gaps in existing health equity assessments at the municipal level, where disparities exist in health outcomes due to regional inequalities.

Methods: This article presents a methodological framework for calculating the index, based on secondary administrative data from various public information systems in Brazil. The MSDHI was estimated for all 5,570 Brazilian municipalities for the period from 2018 to 2022. Its construction followed a systematic eight-step procedure, ensuring consistency and reliability of the results. The municipal index combines multiple health-related indicators: values equal to 1 indicate the best national results, whereas values close to 0 indicate a greater distance from the best outcomes. The same interpretation applies to the thematic indexes: (1) Reproductive and maternal health, (2) Newborn and child health, (3) Infectious diseases, (4) non-communicable diseases, (5) Injuries and violence, (6) Environmental risks, and (7) Universal health coverage and health systems. The results of the MSDHI and its thematic indexes were classified in three tiers: Tier 1 (0 to 0.40) - insufficient; Tier 2 (0.41 to 0.69) - moderated; and Tier 3 (0.70 to 1.00) - adequate.

Results: The construct evaluation indicated positive correlations with life expectancy, HDI-M, IDB, and GDP, and a negative correlation with mortality rate. However, the magnitude of the correlations was low, suggesting that the MSDHI may be capturing additional dimensions beyond those reflected in the selected indicators. An applicability assessment was performed for the municipalities of the State of Minas Gerais, Brazil, indicating that the municipal index and the thematic indexes can identify sustainable health scenarios and highlight areas of inequality.

Conclusions: The MSDHI is a valuable tool for local governments and policymakers to effectively implement the 2030 Agenda. Future studies should focus on developing an annual index and integrating the MSDHI into policy prioritization methods.

Background: Increasing global migration creates new challenges for multicultural societies in providing equitable care. Culturally and linguistically diverse (CALD) people who move into care homes find themselves in an environment where health professionals do not speak their language and the access to cultural activities is limited. This may increase loneliness and social isolation. When designing care home environments for CALD residents with dementia, culture is a key consideration. The aim of this integrative review is to highlight what elements of the care home environment are reported to meet culture-specific needs of CALD residents with dementia, and how.

Methods: A search strategy which included terms for care homes, forms of dementia and CALD people was developed, and a systematic search was carried out in six databases. Eligible articles were original peer-reviewed studies published between 2013 and 2024 and contained examples of how care home environments have been used to meet culture-specific needs of CALD residents. All screenings and extractions were carried out by two independent researchers.

Results: The search resulted in 4311 records. After the screening process, 27 articles met the eligibility criteria. The review findings are categorized according to components of the WHO's International classification of functioning, disability and health (ICF). Results linked to the ICF component Activities and participation stress the importance of communication in the resident's preferred language, social and supportive relationships and culturally relevant activities, while the component Environmental factors highlights the significance of ethnic food and support from culturally competent care professionals and family members.

Conclusions: This integrative review underlines the complexity of using environments to meet culture-specific needs of CALD residents with dementia. The findings highlight the importance of bilingual staff, culturally relevant activities and inclusive environments in enhancing communication, building interpersonal relationships and reducing frustration among CALD residents. Collaborations between culturally competent staff, family members and members of cultural communities also facilitate meeting social and cultural needs of these residents. This review offers suggestions on how environments in care homes can be adapted for CALD residents and encourages further research to find practical solutions for equitable care.

Registration: A study protocol is registered on Prospero (CRD42023492906).

Background: With the widespread adoption of digital technologies in healthcare, digital exclusion-the phenomenon in which individuals are excluded from digital technologies due to a lack of access, skills, motivation, and other factors-has emerged as a significant contributor to health inequities. However, conceptual ambiguity, inconsistent measurement approaches, and an unclear impact on health outcomes within healthcare settings limit the development of effective strategies to address digital exclusion. This scoping review aims to clarify the concept and dimensions of digital exclusion in healthcare, examine its measurement methods, and understand its effects on health.

Methods: A scoping review was conducted following the PRISMA-ScR guidelines for reporting. A systematic search was performed in PubMed, CINAHL, Emerald, Web of Science Core Collection, PsycINFO, Ovid, Embase, IEEE Xplore, and Google Scholar for English-language literature published up to December 1, 2024. Two independent reviewers performed screening and data extraction, and findings were synthesized narratively using thematic analysis.

Result: The initial search retrieved 3,392 studies. A total of 39 studies were finally included. The concept of digital exclusion can be categorized into three levels focusing on access, user capabilities, and meaningful outcomes. Thematic analysis identified five core dimensions: affordability barriers, technical resource barriers, digital competence, psychological barriers, and usage and support barriers. Nineteen assessment tools were identified, including 16 individual-level and 3 population-level instruments. However, most lacked validation and were not designed specifically for healthcare contexts. Evidence indicates that digital exclusion is associated with various adverse health outcomes, including restricted access to medical resources, psychosocial problems, cognitive and functional decline, and increased disease risk and poorer prognosis.

Conclusion: Digital exclusion in healthcare is a multidimensional, complex phenomenon with significant negative impacts on health. Future research should deepen conceptual understanding within healthcare contexts, develop validated clinical assessment tools, and investigate mechanisms through which digital exclusion affects a broad range of health outcomes, thereby promoting equitable access to digital health services.

Background: Community-based approaches have proven effective in improving early access to diagnosis for Chagas disease (CD). This study aimed to assess whether such strategies could reduce the number of patients lost to follow-up and contribute to the detection of concomitant Strongyloides stercoralis infection.

Methods: The intervention was implemented at the Consulate General of Bolivia in Barcelona and began with awareness-raising activities about CD. The Public Health and Community team (eSPiC) subsequently offered on-site serological screening for CD, as well as diagnostic confirmation, antiparasitic treatment, and follow-up at the Drassanes-Vall d'Hebron International Health Unit (USIDVH).

Results: Of the 325 participants, 96.3% were adults of Bolivian origin residing in Catalonia, Spain. The mean age was 43 years, and 64.3% were women. Forty-two participants (13.5%) tested positive for CD and received a follow-up appointment. Of these, 22 (52%) attended the consultation; 10 (45.5%) completed antiparasitic treatment; 4 (18.2%) had been previously treated; 2 (9.1%) were not treated due to medical decision; and 6 (27.3%) were lost to follow-up.

Conclusions: This study suggests that community-based follow-up strategies are advisable, particularly among middle-aged women with primary or secondary education. They facilitate a comprehensive continuum of care-from on-site screening to treatment adherence-which is essential for achieving the Chagas disease targets of the World Health Organization's Road Map for Neglected Tropical Diseases by 2030.

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.