International journal of social determinants of health and health services最新文献

Intense armed conflict in Gaza gives rise to record-breaking humanitarian catastrophe. More than destructions of physical residence, the cost to health and well-being remains pressing concerns among people displaced by war. While the international community provide various forms of assistance, deliveries are challenged as blockades, according to reports, are in effect. Access to aid is reported to have been effectively restricted. Alongside with this are the reports of violations of medical neutrality - the targeting of medical facilities, making access to healthcare, treatment, and medical supplies extremely difficult if not impossible. Drawing on the WHO's framework of social determinants of health in conflict settings, this article situates the Gaza violence as a clear and profound case of how conflict dismantles the structural foundations of health and well-being. While mere peace does not guarantee positive health outcomes, peace inherits a cardinal role when war involves aid restrictions and breaches of medical neutrality. Peace becomes more fundamental to health and well-being under these cases of conflict environment. This is not to argue that peace is alternative to health. Rather, as drawn from the Gazan experience, peace is argued to be the foundation of health, indivisible to it. Peace, therefore, precedes health.

Wars have multiple complex effects on population health. Countries suffer extensively from disruptions to their societies, economies, and environment. Understanding the pathways of disruption helps to adapt and mitigate the catastrophic effects of war. We used a previously published 12-dimensional framework on the health impacts of war to derive pathways of influence under three phases. The first phase, before overt aggression, includes economic sanctions, trade wars, and embargoes, often combined with covert military action and disrupted supply chains, infrastructure, and health services. The second phase of overt aggression has multiple direct and indirect effects on health: (a) morbidity and mortality; (b) population displacements with psychosocial implications; (c) opportunity costs from military expenditures often reversing economic growth and widening inequalities; (d) environmental degradation; (e) air and soil pollution from explosives; (f) destroyed infrastructure include housing, basic amenities, and health infrastructure; (g) destroyed arable land, deforestation, and loss of biodiversity; (h) and contamination of water sources. The third phase occurs during peace negotiations and when peace appears and consists of long-term effects. The latter includes transgenerational impacts on human well-being. Considering the wide health, social, and environmental implications of wars lasting for generations, we reiterate the call for an "end to all wars."

People often describe the ongoing catastrophic situation in Palestine, particularly in the Gaza Strip, as a political and humanitarian crisis. However, a recent report (A/HRC/59/23) by United Nations Special Rapporteur Francesca Albanese highlights the necessity of understanding the complex commercial practices of corporations that contribute-directly or indirectly-to this catastrophe. The report reveals a critical yet often overlooked aspect of public health ethics: corporate complicity in unprecedented human suffering. This article demonstrates how commercial entities contribute to public health harms, with Palestine serving as a significant and urgent case study. Using the commercial determinants of health framework, this article argues that corporate practices-such as supplying goods and services, maintaining operations or financing actors implicated in international crimes to actors implicated in international crimes through military operations in occupied territories-can constitute complicity in serious human rights violations. These actions typically occur within legal and ethical grey areas, exacerbated by gaps in global governance, opaque corporate structures, and weak accountability mechanisms. The article advocates identifying and including complicity as a fundamental practice used by commercial entities primarily for profit. It also emphasises the need to expand research, advocacy, and regulatory oversight to address the intersection of corporate power, armed conflict, and population health.

The authors of this commentary published two peer-reviewed online articles in 2020 and 2022 on the U.S. Agency for Healthcare Research and Quality (AHRQ) PSNet that were removed by the Trump administration because they violated White House policy on websites that "inculcate or promote gender ideology." Ours were among thousands of articles and websites that had been removed or censored during the first month of the Trump administration. We describe the details of this censorship of our two articles one on suicide prevention, the other on endometriosis diagnosis challenges, neither of which was directly related to LGBT issues but used what are now banned terms. We further discuss the historical and political context of this removal, and the subsequent merger of AHRQ into a new Trump administration "Office of Strategy" that purports to target "the effectiveness of federal health programs" for improvement. In light of these censorship actions, large scale staff layoffs, and this reorganization, the fate of AHRQ's mission, current activities, and future project funding is currently uncertain. We offer strategic suggestions for resisting such attacks on academic freedom and restoring scientific integrity for patient safety, quality, and public health.

Community health and primary health care (PHC) concepts are contested globally. We analysed 122 Australian federal and state government policy documents relating to women's, Aboriginal community controlled, generalist and workers' community health services from the 1970s to 2022 using institutional theory to understand how ideas and interests had shaped community health and PHC in Australia. We found an initial flourishing of diverse ideas was contested and constrained over time to reflect a more biomedical, general practice-centric approach to PHC. This was influenced by federal government decisions to prioritise general practice, and state governments' emphasis on reducing hospital costs. This reflects the power of established institutions and biomedical framings that have constrained debate over what is possible and what practices can be considered. From the content of the policies we reviewed, community health ideas and a comprehensive vision of PHC have persisted in Aboriginal community controlled health services, in women's health policy, and in Victorian community health services. Since pursuing comprehensive PHC remains a vital global goal to improve population health and health equity, our examination of policy history can shed light on how ideas and interests have shaped community health and PHC, and how future policies could be strengthened.

There is growing concern about the health and overall well-being of societies stemming from neoliberal-oriented governments reducing their management of the economy, weakening programs and supports for the population, and shifting public goods to the private sector. As a result, a polycrisis exists in many nations related to various key social determinants of health. In this paper, we argue the Canadian polycrisis is due to the contradictions within Canadian society between the economic and political imperatives of capital accumulation (ie, profit making) with social reproduction (ie, societal continuity) associated with late-stage global capitalism. These contradictions threaten societal functioning: declining redistribution of income and wealth, reduced social spending, unwillingness to manage the market economy, and unrelenting privatization of activities once part of the public sphere. The result has been a Canadian polycrisis of growing food and housing insecurity, precarious employment, widening income and wealth inequalities, and a healthcare crisis. We argue responding to the polycrisis requires recognizing and dealing with the contradictions generated by neoliberal capitalism through profound reform or even transformation of the economic system toward a post-capitalist, socialist economy. We consider how such reforms or transformations can come about.

Afghan refugee women in the United States are facing mental health challenges due to COVID-19 and the 2021 Taliban takeover. Given the key role of formal support in refugees' mental health, in this study we examined the effectiveness, barriers, and facilitators of formal support from governmental and nongovernmental organizations (NGOs) by interviewing 34 Afghan refugee women and 18 refugee service providers in California. Results indicated sufficient formal support was received by women in areas like food/grocery assistance, COVID-related programs, financial aid, and referral services. However, gaps were identified in areas like support for empowerment (e.g., literacy support), support for social integration (e.g., community centers), stress mitigation and coping support (e.g., domestic violence programs), informational support (e.g., informational workshops) and instrumental support (e.g., occupational skills training). Although barriers like inefficient policies, cultural and language barriers, patriarchal norms, and limited funding negatively impact the effectiveness of formal support to women, facilitators such as increased political attention, contributions of religious communities, and strengthened NGO relationships with local providers could enhance these services. We concluded that while Afghan women's immediate needs were relatively addressed, long-term, culturally competent approaches are required for their integration and well-being, suggesting NGOs focus on cultural competence, communication, capacity building, sustainability, and collaboration.

Israel's escalation of genocidal violence and apartheid policies in Gaza, particularly after October 7, 2023, has intentionally targeted health care systems as part of a strategy to annihilate Palestinian life, which has significantly degraded the lives of Palestinians living in the Gaza Strip. This exploratory study aimed to analyze the health crisis faced by the Palestinian health system following the recent Israeli war on the Gaza Strip. The study involved thirty participants from diverse professions, including doctors, nurses, midwives, hospital administrators, paramedics, pharmacists, humanitarian workers, mothers, and other health care providers from the Gaza Strip. Thematic content analysis of the interview transcripts led to the identification of five main themes: (a) collapse of health care infrastructure; (b) loss of medical personnel and resources; (c) maternal and infant health; (d) the spread of preventable and contagious diseases; and (e) mental health challenges for health care providers and patients. Establishing political freedom, ensuring human rights, and dismantling structural inequities are essential to safeguarding health and survival in Gaza. The health crisis in Gaza is a direct result of Israel's genocidal policies, and addressing this crisis requires ensuring accountability, dismantling apartheid structures, and restoring Palestinian sovereignty.

This study explores the relationship between the degree of social democracy and population health at cross-national and U.S state levels, and the mechanisms underlying the relationship. Both cross-national and state level demonstrate a political gradient of health-as the level of social democracy increases a corresponding benefit in population health is realized; there is, in effect, a social democratic dividend. At the state level, the mechanisms underlying the social democratic dividend reveal a complex interrelated political-health-social-cultural system; a high degree of intercorrelation is found between 37 variables used to examine this system. Such a high degree of intercorrelation is consistent with a socially democratic "positive manifold," the concept that all variables are beneficially aligned toward a common goal. From a social democratic perspective, this concept is when institutions and policies best promote human flourishing and a successful society.