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Book part
Publication date: 4 September 2013

Anne M. Hewitt

Recent national policy adoptions of the social determinants of health approach present enormous challenges to practitioners designing health promotion programs aimed at…

Abstract

Purpose

Recent national policy adoptions of the social determinants of health approach present enormous challenges to practitioners designing health promotion programs aimed at eliminating health disparities. This chapter provides a framework for understanding the social determinant rationale embedded in Healthy People 2020 and introduces the concept of place as an important consideration.

Methodology/Approach

This chapter presents a conceptual explanation of social determinant thinking and describes the potential impact for traditional health promotion activities that target the at-risk populations.

Findings

Two major resources, the Health Impact Assessment Toolkit and the HHS Disparities Action Plan, have emerged as frameworks for developing a health in all policies approach that will enable health practitioners to enhance their social determinant interventions.

Research limitations/implications

Current social determinant approaches and models need to be strategically tailored to interventions aiming to reduce health disparities. Additional research focusing on how these approaches are integrated within the existing health promotion program frameworks is required.

Practical implications

Very few health practitioners have had the opportunity to integrate a social determinant approach that emphasizes the concept of place and explores the consequences of using a health in all policies approach. This chapter serves as a practical introduction and outlines the major challenges.

Originality/value of paper

The tipping point for the inclusion of social determinants of health in addressing health disparities occurred with the publication of Healthy People 2020. As this innovation begins to diffuse throughout the country, health practitioners will benefit by reviews and applications of the new rationale and model.

Details

Social Determinants, Health Disparities and Linkages to Health and Health Care
Type: Book
ISBN: 978-1-78190-588-3

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Article
Publication date: 12 August 2014

Juying Zeng

The purpose of this paper is to examine the determinants of average health expenditures for inpatients in China with national data for period 2002-2010 and regional data…

Abstract

Purpose

The purpose of this paper is to examine the determinants of average health expenditures for inpatients in China with national data for period 2002-2010 and regional data during 2005-2010.

Design/methodology/approach

The semi-parametric framework is established to identify the determinants of health expenditures with local-constant least squares (LCLS) and local-linear least squares (LLLS) techniques. The LCLS technique aims to identify correlative determinants among all considered variables, and LLLS technique aims to further distinguish linear decisive and nonlinear control variables among all correlative determinants.

Findings

First, root mean square error tends to decrease with irrelative variables smoothed out in regression model, validating the modelling reasonability of the semi-parametric approach. Second, the determinants of average health expenditures for inpatients exhibit considerable variation among regions despite the fact that governmental health expenditure, GDP per-capita, and urbanization do impact average health expenditures for inpatients to a certain extent. Third, both linear decisive and nonlinear control variables vary greatly with national, provincial, and regional data.

Practical implications

First, the illiteracy rate should be further reduced nationally. Second, urbanization development and the average treatment number of inpatients for each physician per day should be strictly controlled in region A and C, respectively, in order to control average health expenditure for inpatients.

Originality/value

First, the semi-parametric framework with LCLS and LLLS techniques allows for data structure-oriented model in regions rather than a uniform and definite model for underlying structure. Second, the research undertakes for the first time a comprehensive data analysis of the determinants of average health expenditures for inpatients with national and regional data in China.

Details

Management Decision, vol. 52 no. 7
Type: Research Article
ISSN: 0025-1747

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Article
Publication date: 12 March 2018

Lynn A. Stewart, Amanda Nolan, Jennie Thompson and Jenelle Power

International studies indicate that offenders have higher rates of infectious diseases, chronic diseases, and physical disorders relative to the general population…

Abstract

Purpose

International studies indicate that offenders have higher rates of infectious diseases, chronic diseases, and physical disorders relative to the general population. Although social determinants of health have been found to affect the mental health of a population, less information is available regarding the impact of social determinants on physical health, especially among offenders. The purpose of this paper is to examine the relationship between social determinants and the physical health status of federal Canadian offenders.

Design/methodology/approach

The study included all men admitted to federal institutions between 1 April 2012 and 30 September 2012 (n=2,273) who consented to the intake health assessment. Logistic regression analyses were used to explore whether age group, Aboriginal ancestry, and each of the individual social determinants significantly predicted a variety of health conditions.

Findings

The majority of men reported having a physical health condition and had experienced social determinants associated with adverse health outcomes, especially men of Aboriginal ancestry. Two social determinants factors in particular were consistently related to the health of offenders, a history of childhood abuse, and the use of social assistance.

Research limitations/implications

The study is limited to the use of self-report data. Additionally, the measures of social determinants of health were indicators taken from assessments that provided only rough estimates of the constructs rather than from established measures.

Originality/value

A better understanding of how these factors affect offenders can inform strategies to address correctional health issues and reduce the impact of chronic conditions through targeted correctional education and intervention programmes.

Details

International Journal of Prisoner Health, vol. 14 no. 1
Type: Research Article
ISSN: 1744-9200

Keywords

Abstract

Purpose

This chapter analyses and discusses local government health promotion in Norway.

Approach/methodology

Institutional theory indicates that political and administrative jurisdictions are path dependent in their policy formation and implementation. By using data from different sources this assumption is analysed and discussed according to health promotion in Norwegian municipalities. The main methodology is cross tabulations, bivariate correlations and regression is carried out to supplement analyses.

Findings

Municipalities are path dependent in their health promotion policies. They acknowledge and prioritize health behaviour independent of experienced socio-economic challenges, municipal capacity as size and income, and local government political profile. Competence devoted to health promotion can create changes in policies.

Limitation/policy implications

The rhetoric on determinants and social determinants in particular is new in Norway. Rhetoric on, and interventions, that highlight the social determinants of health need to be coordinated.

Originality

The chapter presents new knowledge on Norwegian local government health promotion and how this is implemented in relation to the challenges experienced.

Details

Technology, Communication, Disparities and Government Options in Health and Health Care Services
Type: Book
ISBN: 978-1-78350-645-3

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Article
Publication date: 16 December 2019

Juan Smart and Alejandra Letelier

The purpose of this paper is to do a systematic assessment and testing of identified human rights norms alongside social determinant approaches in relation to identified…

Abstract

Purpose

The purpose of this paper is to do a systematic assessment and testing of identified human rights norms alongside social determinant approaches in relation to identified health issues of concern in four Latin American countries (Argentina, Chile, Paraguay and Uruguay) to show how social determinants and human rights frameworks improve population health.

Design/methodology/approach

To do so, in the first part the authors analyze the inequalities both between and within each of the selected countries in terms of health status and health determinants of the population. Then, in the second section, the authors analyze the level of recognition, institutionalisation and accountability of the right to health in each country.

Findings

From the data used in this paper it is possible to conclude that the four analysed countries have improved their results in terms of health status, health care and health behaviours. This improvement coincides with the recognition, institutionalisation and creation of accountability mechanisms of human rights principles and standards in terms of health and that a human rights approach to health and its relation with other social determinants have extended universal health coverage and health systems in the four analysed countries.

Originality/value

Despite of the importance of the relation between human rights and social determinants of health, there are few human right scholars working on the issues of social determinants of health and human rights. Most of the literature of health and human rights has been focussed specific relations between specific rights and the right to health, but less human right scholar working on social determinants of health. On the other hand, just a few epidemiologists and people working on social medicine have actually started to use a universal human rights frame and discourse. In fact, according to Vnkatapuram, Bell and Marmot: “while health and human rights advocates have from the start taken a global perspective, social medicine and social epidemiology have been slower to catch up”.

Details

International Journal of Human Rights in Healthcare, vol. 13 no. 1
Type: Research Article
ISSN: 2056-4902

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Article
Publication date: 31 July 2021

Amjad Mohamadi-Bolbanabad, Farman Zahir Abdullah, Hossein Safari, Satar Rezaei, Abdorrahim Afkhamzadeh, Shina Amirhosseini, Afshin Shadi, Jamal Mahmoudpour and Bakhtiar Piroozi

The purpose of this study was to assess the self-perceived need, seeking and use of dental care and its main determinants in Kurdistan province, Iran.

Abstract

Purpose

The purpose of this study was to assess the self-perceived need, seeking and use of dental care and its main determinants in Kurdistan province, Iran.

Design/methodology/approach

A total of 1,056 adults in Kurdistan province were included in this cross-sectional study. Multistage sampling approach was used to select the samples. Data on sociodemographic characteristics, economic status, self-perceived need, seeking and use of dental care were collected using a self-administrated questionnaire. Multivariate logistic regression model was used to assess factors affecting the use of dental care. In addition, socioeconomic inequality relating to dental care needs and use of dental care were examined using concentration curve and concentration index.

Findings

In this study, unmet dental care need was 62.7%. There was a perceived need for dental care among 13.7% (n = 145) of the participants in the past month, with only 39.3% (n = 57) seeking the care. The most important reasons for unmet dental care need were “Could not afford the cost” and “Insurance did not cover the costs.” Multivariate logistic regression showed that supplementary insurance status and household economic status were identified as main determinants affecting dental care-seeking behavior. The result of concentration index revealed that seeking dental care was more concentrated among the rich, whereas the perceived dental care need is more prevalent among the poor.

Originality/value

This study demonstrated that the prevalence of unmet dental care needs is high in the study setting. Also, financial barrier was identified as the main determinant of unmet dental care needs.

Details

International Journal of Human Rights in Healthcare, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2056-4902

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Book part
Publication date: 30 December 2004

Nancy Blythe and Cecilia Benoit

Late nephrology referral, a problem currently identified across many high income countries, has been associated with reduced opportunities for delaying or halting the…

Abstract

Late nephrology referral, a problem currently identified across many high income countries, has been associated with reduced opportunities for delaying or halting the progression of chronic kidney disease (CKD), delayed dialysis initiation, reduced choice in treatment modality, increased morbidity and hospitalization, and premature death. Despite a recent finding that the progression of CKD nearly always presents warning signs, and despite the fact that all Canadians are entitled to receive medically necessary health care free at the point of patient entry, each year in the province of British Columbia (BC) a substantial number of people with CKD experience late or no referral to nephrology care prior to requiring renal replacement therapy. A subset of these CKD patients experience no referral and “crash” onto dialysis (experience an acute or emergent start). Existing research has not fully explored the range of potential health determinants that may affect the timing of nephrology referral. This paper adopts a “determinants of health” framework and assesses the impact of a variety of indicators on patients’ physical health, demographics, socioeconomic status, social support, geographic and health system characteristics. Using a late referral definition of <3 months and data on BC patients who began dialysis between April 2000 and March 2003, multiple regression analysis indicates that the following determinants have an independent effect on the timing of referral: cause of end-stage renal disease (p=<0.0001); age (p=<0.0001); race/ethnicity (p=0.0019); English ability (p=0.0158); marital status (p=0.0202); proximity to care (p=0.0118); and, “age by first language” (p=0.0244).

Details

Chronic Care, Health Care Systems and Services Integration
Type: Book
ISBN: 978-1-84950-300-6

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Article
Publication date: 22 July 2021

Elisabeth Nöhammer

Workplace health promotion (WHP) is an investment in human capital that can lead to substantial organizational and individual benefit. However, this depends on high…

Abstract

Purpose

Workplace health promotion (WHP) is an investment in human capital that can lead to substantial organizational and individual benefit. However, this depends on high participation rates, which are rarely reached. The aim of this article thus is to examine necessary conditions for WHP success by analyzing employee perceived determinants of participation.

Design/methodology/approach

Based on a qualitative study, a questionnaire was designed. The determinants of participation were assessed regarding underlying categories and importance via factor analysis.

Findings

Personal benefit, social aspects, information, uncomplicated use, security and autonomy plus time and participation in offer design emerged as relevant factors. For the population studied, uncomplicated use, personal benefit and information were rated as most important.

Originality/value

The study is based on determinants voiced by the workforce only, not expert-rated aspects. Moreover, it was carried out in small and medium-sized organizations, which are understudied regarding WHP. By reducing data using factor analysis, a basis for further research is created. Also, a basic questionnaire is suggested via the items employed that can help organizations to investigate the WHP-related wishes and needs that matter most to the workforce.

Details

Employee Relations: The International Journal, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0142-5455

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Article
Publication date: 15 June 2021

Bakhtiar Piroozi, Farman Zahir Abdullah, Amjad Mohamadi-Bolbanabad, Hossein Safari, Mohammad Amerzadeh, Satar Rezaei, Ghobad Moradi, Masoumeh Ansari, Abdorrahim Afkhamzadeh and Jamshid Gholami

The purpose of this study is to investigate the status of perceived need, seeking behavior and utilization of health services in the elderly population of Sanandaj (west of Iran).

Abstract

Purpose

The purpose of this study is to investigate the status of perceived need, seeking behavior and utilization of health services in the elderly population of Sanandaj (west of Iran).

Design/methodology/approach

This is a cross-sectional study conducted on 800 elderly people in Sanandaj. Subjects were selected using multistage sampling and data were collected using self-report questionnaires. A multivariate logistic model with odds ratios (ORs) was used to determine the relationship of independent variables with seeking perceived need. Also, the concentration index was used to measure the inequality in using health services.

Findings

The perceived need for outpatient (during the last 30 days) and inpatient health-care services (during the past 12 months) was 69.7% and 29.7%, respectively. Among them, the unmet need for outpatient and inpatient health-care services was 46.6% and 17%, respectively. Having health insurance (adjusted OR 12.08; 95% confidence interval [CI] 1.04–140.11), middle economic status (adjusted OR 5.18; 95% CI 1.30–20.51) and being in an age group of 65–70 years (adjusted OR 7.60; CI 1.42–40.61) increased the chance of seeking inpatient care. Also, being in an age group of 60–65 years (adjusted OR 0.41; 95% CI 0.18–0.95) reduced the chance of seeking outpatient care. There was also a pro-rich inequality in using outpatient health services.

Originality/value

The elderly population suffers from unmet health-care needs, especially in outpatient services. The most important reason for not seeking outpatient and inpatient services was financial barriers and self-medication, respectively. So, designing targeted policies and interventions to address barriers in the conversion of need to demand in the elderly population is essential.

Details

International Journal of Human Rights in Healthcare, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2056-4902

Keywords

Content available
Book part
Publication date: 6 May 2019

Kinga Zdunek, Mitch Blair and Denise Alexander

The Models of Child Health Appraised (MOCHA) project recognises that child health policy is determined to a great extent by national culture; thus, exploring and…

Abstract

The Models of Child Health Appraised (MOCHA) project recognises that child health policy is determined to a great extent by national culture; thus, exploring and understanding the cultural influences on national policies are essential to fully appraise the models of primary care. Cultures are created by the population who adopt national rituals, beliefs and code systems and are unique to each country. To understand the effects of culture on public policy, and the resulting primary care services, we explored the socio-cultural background of four components of policy-making: content, actors, contexts and processes. Responses from the MOCHA Country Agents about recent key national concerns and debates about child health and policy were analysed to identify the key factors as determinants of policy. These included awareness, contextual change, freedom, history, lifestyle, religion, societal activation and tolerance. To understand the influence of these factors on policy, we identified important internal and external structural determinants, which we grouped into those identified within the structure of health care policy (internal), and those which are only indirectly correlated with the policy environment (external). An important child-focused cultural determinant of policy is the national attitude to child abuse. We focused on the role of primary care in preventing and identifying abuse of children and young people, and treating its consequences, which can last a lifetime.

Details

Issues and Opportunities in Primary Health Care for Children in Europe
Type: Book
ISBN: 978-1-78973-354-9

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