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

For-profit nursing home (NH) chains have become increasingly financialized in order to maximize short-term profits. This descriptive case study focused on the wealth extraction from a mid-sized for-profit California NH chain, from its founding in 1999 until its sale in 2021. The chain had individual founders/owners, a private equity owner, and a real estate group owner. The aims were to analyze the chain's (a) history and profits, organizational structure, and board; (b) management, operations, and strategies; (c) financial status; and (d) quality outcomes. Qualitative and quantitative data were collected and analyzed from multiple public and private sources. The company grew to 63 NHs and related companies with an estimated enterprise value of US$1.3 billion in 2020, while making substantial profits for its owners. The private equity owners had a strong, direct influence on the chain's organizational structure, board, management, operations, strategies, and financial controls from 2016-2020. Its cost controls appeared to be associated with a negative impact on NH nurse staffing levels, nursing wages, turnover rates, resident complaints, penalties, and litigation. Future research should study NH policies that improve ownership and financial transparency while ensuring that government funds are used for NH residents and care providers.

In India, poor child health is a pertinacious issue. This article investigates the impact of water and sanitation, maternal health care service utilization (MHCSU) and breastfeeding practices on under-five child health outcomes (CHOs) in India using the two rounds of the Indian Demographic and Health Survey (DHS), 2015-2016 and 2019-2021. In 2019-2021, unprotected sources of drinking water were associated with an increased prevalence of under-five wasting. Unimproved sanitation facilities were likely to increase the prevalence of under-five stunting; however, unlike in DHS 2015-2016, it had no statistically significant effect on wasting and underweight (2019-2021). Mothers who had not received at least four antenatal care visits were more likely to have stunted and underweight children (2019-2021). The absence of early initiation of breastfeeding was associated with an increased prevalence of under-five wasting and underweight but did not influence CHOs (2015-2016). In 2019-2021, the absence of exclusive breastfeeding for the initial six months was associated with increased odds of stunting and underweight among children. To improve CHOs, policymakers must focus on providing financial, material, and human resources along with soft knowledge to provide hygiene education and promote MHCSU, breastfeeding practices, engagement with frontline health workers and women's empowerment.

Low employment quality and precarious employment have been associated with adverse mental health outcomes, yet the extent to which this association may be explained by the experience of unemployment "scarring" has not yet been explored. From a life course perspective, understanding this possible confounding is necessary. Drawing on the United Kingdom's Understanding Society dataset and using latent class analysis, we derived a typology of employment quality across six dimensions and assessed the links between individuals' employment quality, unemployment history, and mental well-being and psychological distress. Our results show that precarious types of employment as well as a higher quality "protected part-time" were linked to low mental well-being, though important gender differences were noted. Accounting for past unemployment did not fully explain these associations. No such adverse associations were observed for increased psychological distress. Our results help further the understanding of employment quality as a social determinant of health and highlight the need for both life course and gender-sensitive research in this area.

Precarious employment (PE) is a major determinant of population health and contributor to health and social inequities. The purpose of this article is to synthesize and critically appraise available evidence on labor market initiatives addressing PE identified through a systematic review. Of the 21 initiatives reviewed, grouped into four categories-labor market policies, legislation, and reforms; union strategies; apprenticeships and other youth programs; social protection programs-10 showed consistently positive outcomes and 11 a combination of negative, mixed, or inconclusive outcomes. In addition to reviewing the key findings, we discuss public health implications and recommendations related to PE and the implementation and evaluation of initiatives. Given the wide diversity of initiatives, implementation approaches, evaluation methods, and socioeconomic and historical contexts characterizing the labor markets of the countries studied, we refrain from making recommendations regarding the most effective initiatives to address PE. Instead, we discuss several implications concerning the four types of initiatives to further support those searching for solutions to address PE. We strongly recommend tailoring adopted initiatives to local contexts to match a country's specific PE problems and unique labor market and socioeconomic context.

Black Canadians frequently experience significant challenges when attempting to access mental health care, resulting in discrepancies in mental health outcomes. This article describes a scoping review that aimed to understand the range and nature of research conducted on the mental health of black Canadians and to identify the gaps in this literature. An established methodological framework guided the scoping review process. We searched research databases (CINAHL, Embase, Global Health, MEDLINE, PsycINFO, Scopus, Sociological Abstracts, and Web of Science) and grey literature sources for peer-reviewed articles and grey reports on the health of black Canadians. Of the 14 121 articles screened, 43 were included in the review. Our review found spiritual support, resilience, collective culture, and culturally congruent support as facilitators of positive mental health of black people in Canada, while stigmatization, misconceptions, low uptake of mental services, and difficulties accessing mental health services were the most significant barriers. Strategies for improving the mental health of black people in Canada center on social, emotional, and community support. Our findings indicate the need for black stakeholder involvement in awareness creation and knowledge improvement, which will help to dispel the myths and misconceptions about mental health in black populations.

Acknowledging and valuing the lived experiences of scholars from the Global South is crucial for more nuanced, refined, and equitable approaches to and interpretations of research. The sheer lack of Tibetan scholars authoring and leading studies within the Tibetan diaspora is especially concerning. The paucity of Tibetan scholars in tuberculosis (TB) discourse is a marker and product of the colonization of academic global health and of global inequities in opportunity and credibility. The lack of Tibetan voices, advocates and scholars alike, in the TB discourse creates ambiguities and misinterpretations, and a general unwillingness to dig deeper into the social, cultural, economic, and historical contexts under which TB thrives in this community. It also symbolizes the lack of opportunity faced by many scholars based in the Global South. Efforts to decolonize global health must also parallel efforts to address other related injustices.

In the current era of multiple, overlapping global crises, it is essential to consider the political economy of health within the broader framework of global interconnectedness. In this article, we employ the polycrisis concept to understand the impacts of the multifaceted, concurrent, and synergistic contemporary global crises on global health and health inequalities. A polycrisis occurs when crises in multiple diverse global systems become causally entangled, compounding their effects. Despite its potential relevance and analytical insights, the polycrisis concept has rarely been applied in public health research. This article fills that gap, and through reviewing the impacts of past economic, environmental, health, and political crises, we argue that the polycrisis is creating a complex web of challenges that are likely to amplify existing and future health inequalities. We conclude by discussing strategies to mitigate these impacts and suggest pathways for research to ensure that the future is not inevitably unequal.