International Journal for Equity in Health最新文献

Background: Neonatal disorders remain a leading cause of loss of healthy life years worldwide, second only to COVID-19 in 2021, although most neonatal deaths are preventable. The neonatal mortality rate (NMR), a key indicator of the 2030 Sustainable Development Agenda, varies widely within and between countries, reflecting social conditions that shape neonatal survival. This study examined the magnitude and temporal trends of ecosocial inequalities in Peru's NMR from 2007 to 2021, their relationship with selected social determinants, and changes in the epidemiological profile of neonatal deaths.

Methods: An ecological study was conducted using data from Peru's 25 regions (2007-2021). Temporal trends in NMR and inequalities along a social gradient defined by monetary poverty, unmet basic needs, and food insecurity were analyzed. Absolute and relative inequalities were measured using the slope index of inequality (SII) and concentration index (CIx). Inflection points in trends were identified with joinpoint regression, and monotonic associations between NMR (and its inequalities) and contextual variables were assessed using Spearman's rank correlation. Changes in the epidemiological profile of neonatal deaths were evaluated with the Chi-square test.

Results: Peru's NMR declined from 10.3 to 8.8 deaths per 1,000 live births between 2007 and 2021, with the steepest reduction around 2010-2014. Most regions experienced decreases, except Huancavelica, Pasco, and Puno. Cross-regional inequalities showed a persistent pro-rich pattern, indicating survival disadvantages in regions with higher unmet basic needs. National NMR trends correlated positively with unmet basic needs and monetary poverty and negatively with current health expenditure per capita. During the COVID-19 years, inequalities narrowed as NMR fell in poorer regions and rose in richer ones. The epidemiological profile shifted toward a higher proportion of deaths from extreme prematurity and low birth weight.

Conclusions: From 2007 to 2021, Peru achieved a decline in neonatal mortality, but pro-rich regional inequalities persisted, and the burden remained concentrated in highland regions. During the COVID-19 period, the downward trend continued while inequalities narrowed, in parallel with reductions in poverty and increases in health expenditure. These ecological findings highlight the importance of monitoring health inequalities alongside national averages to support accountability toward the SDG commitment to "leave no one behind."

There are limited frameworks for health services researchers to draw on that engage with critical disability theory while considering health services needs of disabled people, despite the quantity of research about disabled people. Research about people with disabilities without inclusion of their perspectives is directly in conflict with the disability rights movement and perpetuates inequity. One mean to include disabled perspectives in research is through disability theory engagement. Through this non-systematic critical review of existing literature, we position critical disability theory in the context of health services research and exemplify why this is a vital consideration when research investigates people with disabilities. We present four tenets of the theory: lived/living experience, intersectionality, structural violence, and ableism, and explore how these can contextualise disabled experiences of healthcare access. We demonstrate how to apply critical disability theory to the Levesque Framework, a commonly used health services access framework. By bridging the gap of critical disability theory inclusion in health services research, we help shift the needle towards improved disability engagement in research and healthcare access equity for people with disabilities.

Background: Podoconiosis, a neglected tropical skin disease causing lower-limb lymphedema, disproportionately affects rural populations in low-income countries and has profound physical and psychosocial consequences. Despite its significant impact, the interplay between stigma and illness management in podoconiosis remains under-explored. This study examines the lived experiences of stigma and illness management pathways among patients in rural Ethiopia, highlighting the complex social determinants shaping these processes.

Methods: Using an intersectional-hermeneutic framework, we conducted in-depth interviews with 21 purposively selected patients representing diverse genders, ages, and disease stages. Data were analysed iteratively following Gadamer's interpretive approach.

Results: Three key phases of patients' journeys emerged from the findings: overlooking initial symptoms; disfigurement, disease re-branding, stigma, and active resistance; and despair and acceptance. These phases demonstrate the dynamic trajectory of stigma and illness management as patients employ varied coping strategies throughout disease progression. The findings reveal significant disparities in stigma experiences and management strategies mediated by intersecting social determinants of health.

Conclusion: This study advances the understanding of podoconiosis' complex psychosocial dimensions and offers actionable insights for designing contextually appropriate public health interventions. It underscores the urgent need for targeted interventions to address the root causes of stigma and the barriers to care. Community-based education to dispel misconceptions, improved healthcare accessibility, and culturally adapted support systems could improve care practices and mitigate the multifaceted impacts of podoconiosis on marginalized populations.

Background: Studies indicate racial and ethnic inequities in pain assessment, management and treatment in maternal and newborn care. Namely, racially and ethnically marginalised womxn are less likely to receive pain relief in labour and the post-partum period, and are more likely to experience severe perinatal outcomes such as uterine rupture. This inequity may be explained by racial/ethnic bias in maternal and newborn care professionals' pain assessment, management and treatment. The aim of this study was to investigate the role of racial/ethnic bias in the assessment, management and treatment of pain among maternal and newborn care professionals in the Netherlands by researching the association between race/ethnicity, language barrier, and response time to pain, and exploring racial thinking and notions of ethnic differences in pain assessment, management, and treatment.

Methods: This is a mixed methods study. The quantitative part of this study was a prospective, nationwide population-based cohort study in which cases of uterine rupture were collected through the Netherlands Obstetric Surveillance System (NethOSS), retrospectively investigating the association between categories of race/ethnicity, language barrier, the difference in the response time to pain, and maternal and perinatal outcomes up to 28 days post-partum. The qualitative part was an explorative study to investigate racial and ethnic bias in pain assessment, management and treatment among maternal and newborn care professionals using semi-structured interviews and thematic analysis.

Results: The quantitative results indicated that caesarean section was significantly more frequently performed in more than 180 min after the first complaint of pain in the non-Western category compared to the Western category. The qualitative analysis showed the simultaneous presence and unawareness of stereotypes and assumptions about how womxn of different racial/ethnic groups experience and express pain among maternal newborn care professionals. The findings provide insight in how these stereotypes and assumptions affect decision-making about pain assessment, management and treatment.

Conclusions: The results of this study provide a starting point to investigate racial and ethnic inequity in maternal and newborn care in the Netherlands, and to address the ways that these differences can be mitigated. Our findings underscore the disavowal of the role of racial thinking and notions of ethnic differences in pain assessment, management, and treatment, and highlights the need for critical reflection on the role of maternal and newborn care in shaping, causing, maintaining, sustaining, and (re)producing racial/ethnic inequity.

Background: The widespread promotion of oral contraceptives raises concerns about side effects, informed choices, and contraceptive coercion, which contribute to gynecological violence influenced by systemic factors. The link between gynecological violence and oral contraceptives is understudied and rarely examined through systemic violence theories.

Methods: To address this gap, we explored how a continuum of symbolic, structural, and slow violence manifests in the physical body by drawing on qualitative online interviews with 19 former oral contraceptive users and six gynecologists in Germany. Data were analyzed using reflexive thematic analysis informed by symbolic, structural, and slow violence theories. This process involved iterative coding, theme development, and discussions within the research team.

Results: Using the conceptual framework of gynecological violence, we show how the dominance of medical and pharmaceutical knowledge, systemic neglect of contraceptive counseling, and prioritization of oral contraceptives over other methods of contraception contribute to a cycle of symbolic and structural violence, ultimately harming users through slow violence.

Conclusion: To promote more equitable and inclusive contraceptive counseling, we recommend advancing gender-responsive research, expanding the rights-based and psychosocial counseling offered by different health professionals (and not just physicians), and enhancing gynecology training programs to better prepare gynecologists for contraceptive counseling. Ultimately, these measures aim to transform contraceptive care into a more equitable, informed, and patient-centered practice.

Personalized medicine (PM), which aims to tailor healthcare interventions to individual biological profiles, has emerged as a transformative approach in modern medicine. The rapid advancement of digital health technologies is playing an increasingly vital role in enabling this precision-driven model of care. This paper examines the potential of PM to transform healthcare and its implications for health equity, focusing on the cost barriers and ethical dilemmas that hinder its equitable implementation. It argues that while PM holds promise for revolutionizing treatment strategies by tailoring interventions to individual characteristics, the integration of artificial intelligence (AI) is increasingly central to achieving this goal. However, the reliance on advanced technologies, robust datasets, and specialized expertise can exacerbate existing disparities in healthcare access, particularly in low- and middle-income countries (LMICs). The paper discusses the ethical considerations related to unequal access to PM, drawing on ethical theories to examine how these disparities might widen health inequities. It also explores innovative solutions and global health initiatives aimed at improving access, which may help align the benefits of PM with the goal of health equity.