Social justice, epidemiology and health inequalities
TL;DR: It is important to recognise that epidemiology and public health have a crucial role to play in providing evidence to improve health of society and reduce inequalities, and evidence strongly supports social causation.
Abstract: A lifetime spent studying how social determinants of health lead to health inequalities has clarified many issues. First is that social stratification is an appropriate topic of study for epidemiologists. To ignore it would be to ignore a major source of variation in health in society. Not only is the social gradient in health appropriate to study but we have made progress both in understanding its causes and what can be done to address them. Post-modern ‘critical theory’ raises questions about the social construction of science. Given the attack on science by politicians of bad faith, it is important to recognise that epidemiology and public health have a crucial role to play in providing evidence to improve health of society and reduce inequalities. Evidence gives grounds for optimism that progress can be made both in improving the health of the worst-off in society and narrowing health inequalities. Theoretical debates about ‘inequality of what’ have been helpful in clarifying theories that drive further gathering of evidence. While it is important to consider alternative explanations of the social gradient in health—principal among them reverse causation—evidence strongly supports social causation. Social action is by its nature political. It is, though, a vital function to provide the evidence that underpins action.
Citations
More filters
6,977 citations
TL;DR: The social impact of the lockdown is related to gender, age and socioeconomic conditions, and women and young people had worse mental health outcomes during lockdown.
Abstract: Objective Lockdown has impacts on people’s living conditions and mental health. The study aims to assess the relations between social impact and mental health among adults living in Spain during COVID-19 lockdown measures, taking a gender-based approach into account. Design, setting and participants We conducted a cross-sectional study among adults living in Spain during the lockdown of COVID-19 with an online survey from 8 April to 28 May 2020. The main variable was mental health measured by Generalized Anxiety Disorder Scale for anxiety and the Patient Health Questionnaire for depression. Sex-stratified multivariate ordinal logistic regression models were constructed to assess the association between social impact variables, anxiety and depression. Results A total of 7053 people completed this survey. A total of 31.2% of women and 17.7% of men reported anxiety. Depression levels were reported in 28.5% of women and 16.7% of men. A higher proportion of anxiety and depression levels was found in the younger population (18–35 years), especially in women. Poorer mental health was mainly related to fear of COVID-19 infection, with higher anxiety levels especially in women (adjusted ordinal OR (aOR): 4.23, 95% CI 3.68 to 4.87) and worsened economy with higher levels of depression in women (aOR: 1.51, 95% CI 1.24 to 1.84), and perceived inadequate housing to cope with lockdown was especially associated with anxiety in men (aOR: 2.53, 95% CI 1.93 to 3.44). Conclusion The social impact of the lockdown is related to gender, age and socioeconomic conditions. Women and young people had worse mental health outcomes during lockdown. It is urgent to establish strategies for public health emergencies that include mental health and its determinants, taking a gender-based approach into account, in order to reduce health inequities.
104 citations
TL;DR: This Perspective aims to highlight potential opportunities and challenges for machine learning within a holistic view of health, and builds on research in population and public health that focuses on the mechanisms between different cultural, social and environmental factors and their effect on the health of individuals and communities.
Abstract: Until now, much of the work on machine learning and health has focused on processes inside the hospital or clinic. However, this represents only a narrow set of tasks and challenges related to health; there is greater potential for impact by leveraging machine learning in health tasks more broadly. In this Perspective we aim to highlight potential opportunities and challenges for machine learning within a holistic view of health and its influences. To do so, we build on research in population and public health that focuses on the mechanisms between different cultural, social and environmental factors and their effect on the health of individuals and communities. We present a brief introduction to research in these fields, data sources and types of tasks, and use these to identify settings where machine learning is relevant and can contribute to new knowledge. Given the key foci of health equity and disparities within public and population health, we juxtapose these topics with the machine learning subfield of algorithmic fairness to highlight specific opportunities where machine learning, public and population health may synergize to achieve health equity. Algorithmic solutions to improve treatment are starting to transform health care. Mhasawade and colleagues discuss in this Perspective how machine learning applications in population and public health can extend beyond clinical practice. While working with general health data comes with its own challenges, most notably ensuring algorithmic fairness in the face of existing health disparities, the area provides new kinds of data and questions for the machine learning community.
76 citations
TL;DR: Comprehensive HL has a considerable potential for health promotion to improve population health and tackle the health gap but comprehensive HL measurement should be standardised in every country to allow for designing adequate measures for the specific situation of the country and also for benchmarking.
Abstract: Background/Research Question:In the health literacy (HL) discourse there is debate about the ways by which HL is impacting health. Three different, logically non-exclusive hypotheses are proposed: ...
65 citations
Cites background from "Social justice, epidemiology and he..."
...Different possible causal mechanisms on how health literacy is linked to health (Figure 1) are discussed in the scientific literature (10,13,16): health literacy as a specific and direct determinant of health (17,18) as a mediator (19), that is, an intervening variable between other determinants and health, or as a moderator (20), that is, a variable moderating the effects of other determinants on health....
[...]
TL;DR: The OASIS framework may help guide policy makers, healthcare system leaders, clinicians, and researchers to utilize a more unified approach in their efforts to implement and evaluate unmet social need interventions and foster the development of an evidence base to inform healthcare systems to more effectively mitigate the consequences of un met social needs.
Abstract: Social determinants of health (SDoH) are the conditions in which people live and work that shape access to essential social and economic resources. Calls for healthcare systems to intervene on unmet social needs have stimulated several large-scale initiatives across the country. Yet, such activities are underway in the absence of a unifying conceptual framework outlining the potential mechanisms by which healthcare-based unmet social need interventions can improve health outcomes. Drawing on theoretical foundations and empirical evidence about the relationship between unmet social needs and health, the authors developed the OASIS (Outcomes from Addressing SDoH in Systems) conceptual framework to map the known and hypothesized pathways by which unmet social need screening and referral interventions may impact outcomes. The OASIS framework may help guide policy makers, healthcare system leaders, clinicians, and researchers to utilize a more unified approach in their efforts to implement and evaluate unmet social need interventions and thus foster the development of an evidence base to inform healthcare systems to more effectively mitigate the consequences of unmet social needs. Adopting an overarching conceptual framework for addressing unmet social needs by healthcare systems holds promise for better achieving health equity and promoting health at the individual and population levels.
57 citations
References
More filters
Book•
01 Jan 1999
TL;DR: In this paper, Amartya Sen quotes the eighteenth century poet William Cowper on freedom: Freedom has a thousand charms to show, That slaves howe'er contented, never know.
Abstract: In Development as Freedom Amartya Sen quotes the eighteenth century poet William Cowper on freedom: Freedom has a thousand charms to show, That slaves howe'er contented, never know. Sen explains how in a world of unprecedented increase in overall opulence, millions of people living in rich and poor countries are still unfree. Even if they are not technically slaves, they are denied elementary freedom and remain imprisoned in one way or another by economic poverty, social deprivation, political tyranny or cultural authoritarianism. The main purpose of development is to spread freedom and its 'thousand charms' to the unfree citizens. Freedom, Sen persuasively argues, is at once the ultimate goal of social and economic arrangements and the most efficient means of realizing general welfare. Social institutions like markets, political parties, legislatures, the judiciary, and the media contribute to development by enhancing individual freedom and are in turn sustained by social values. Values, institutions, development, and freedom are all closely interrelated, and Sen links them together in an elegant analytical framework. By asking "What is the relation between our collective economic wealth and our individual ability to live as we would like?" and by incorporating individual freedom as a social commitment into his analysis, Sen allows economics once again, as it did in the time of Adam Smith, to address the social basis of individual well-being and freedom.
19,080 citations
Book•
26 Apr 1990TL;DR: In this article, a strategy for redesigning jobs to reduce unnecessary stress and improve productivity and job satisfaction is proposed, which is based on the concept of job redesigning and re-designing.
Abstract: Suggests a strategy for redesigning jobs to reduce unnecessary stress and improve productivity and job satisfaction.
8,329 citations
Additional excerpts
...Before I knew of Amartya Sen, building on the work of Karasek and Theorell [20], I had shown in the Whitehall II study that low control at work provided a partial explanation of the social gradient in health [21]....
[...]
TL;DR: The Commission on Social Determinants of Health (CSDH) as mentioned in this paper was created to marshal the evidence on what can be done to promote health equity and to foster a global movement to achieve it.
7,335 citations
6,977 citations
"Social justice, epidemiology and he..." refers background in this paper
...Sen’s ‘capabilities’ are linked to his basic notion of freedom to lead a life one has reason to value [19]....
[...]
Book•
[...]
TL;DR: In this paper, the authors present an approach to justice that is based on the Demands of Justice, Reason and Objectivity, Human Rights and Global Imperatives, and the Materials of Justice.
Abstract: * Preface * Acknowledgements * Introduction: An Approach to Justice Part I: The Demands of Justice * Reason and Objectivity * Rawls and Beyond * Institutions and Persons * Voice and Social Choice * Impartiality and Objectivity * Closed and Open Impartiality Part II: Forms of Reasoning * Position, Relevance and Illusion * Rationality and Other People * Plurality of Impartial Reasons * Realizations, Consequences and Agency Part III: The Materials of Justice * Lives, Freedoms and Capabilities * Capabilities and Resources * Happiness, Well-being and Capabilities * Equality and Liberty Part IV: Public Reasoning and Democracy * Democracy as Public Reason * The Practice of Democracy * Human Rights and Global Imperatives * Justice and the World * Notes * Name Index * Subject Index
3,834 citations