Health Information Technology

The number of older adults is steadily increasing in the United States and across the globe. Aging is linked to an increased risk of disability. Disabilities that limit one or more major life activities such as seeing, hearing, walking, and motor skills impact a person’s ability to drive a car. Low utilization of alternative transportation by older adults and people with disabilities may put them at risk for social isolation. Social isolation is associated with a variety of negative health outcomes. While communities are challenged to create available, acceptable, accessible, adaptable and affordable mobility options, there are widely held, inaccurate biases around older adults’ abilities to contribute to the development and improvement of alternative transportation options. Gerontological social workers are well-positioned to address this bias. This paper presents a case study of a large metropolitan county in the Midwest where community-based participatory research (CBPR) strategies were used to engage older residents to support the development of alternative transportation options supporting the tenets of environmental justice.

America, all things not being equal

Health-care inequalities in Italy: challenges for the Government

More than 3 million children 10 million child deaths annually throughout the world [World Health Organization (WHO) 2005]. Some factors of susceptibility, including race, ethnicity, and socioeconomic status, are generally not well understood in the context of risk assessment. For children’s environmental health the focus is almost exclusively on age-related differences and exposure hazards, without much discussion of the myriad additional factors including nutritional status, preexisting health status, multiple exposures, and gender differences that can affect the life course of a child.

BackgroundDigital health interventions have become increasingly common across health care, both before and during the COVID-19 pandemic. Health inequalities, particularly with respect to ethnicity, may not be considered in frameworks that address the implementation of digital health interventions. We considered frameworks to include any models, theories, or taxonomies that describe or predict implementation, uptake, and use of digital health interventions.ObjectiveWe aimed to assess how health inequalities are addressed in frameworks relevant to the implementation, uptake, and use of digital health interventions; health and ethnic inequalities; and interventions for cardiometabolic disease.MethodsSCOPUS, PubMed, EMBASE, Google Scholar, and gray literature were searched to identify papers on frameworks relevant to the implementation, uptake, and use of digital health interventions; ethnically or culturally diverse populations and health inequalities; and interventions for cardiometabolic disease. We assessed the extent to which frameworks address health inequalities, specifically ethnic inequalities; explored how they were addressed; and developed recommendations for good practice.ResultsOf 58 relevant papers, 22 (38%) included frameworks that referred to health inequalities. Inequalities were conceptualized as society-level, system-level, intervention-level, and individual. Only 5 frameworks considered all levels. Three frameworks considered how digital health interventions might interact with or exacerbate existing health inequalities, and 3 considered the process of health technology implementation, uptake, and use and suggested opportunities to improve equity in digital health. When ethnicity was considered, it was often within the broader concepts of social determinants of health. Only 3 frameworks explicitly addressed ethnicity: one focused on culturally tailoring digital health interventions, and 2 were applied to management of cardiometabolic disease.ConclusionsExisting frameworks evaluate implementation, uptake, and use of digital health interventions, but to consider factors related to ethnicity, it is necessary to look across frameworks. We have developed a visual guide of the key constructs across the 4 potential levels of action for digital health inequalities, which can be used to support future research and inform digital health policies.

Background: Evidence-based guidelines for preventive services are developed by expert groups such as the U.S. Preventive Services Task Force (USPSTF) to help Americans stay healthy. Despite the proven value of evidence-based preventive services (e.g., screenings, provider counseling, and preventive medications), implementation by providers and uptake by patients vary, contributing to disparities in disease burden and life expectancy. The NIH convened a workshop with multidisciplinary and multisector participants in June 2019 to assess the available scientific evidence on achieving health equity in the use of clinical preventive services for three leading causes of death: diabetes, heart disease, and cancer. Methods: The workshop was framed around five key questions (KQ) and included a systematic evidence review, speaker presentations, and public discussion. KQ 1-2 considered the effects of barriers on the part of providers and patients to adopting and implementing evidence-based preventive services, and how they contribute to health disparities. KQ 3-5 addressed the effectiveness of health information technology and health care organization interventions to reduce disparities in preventive services use. An unbiased, independent panel of experts considered the scientific evidence in addition to speaker and audience perspectives to develop a report of findings and recommendations for addressing disparities in the use of ten clinical preventive services recommended by the USPSTF. Results: Overall, the need for more research on the effects of barriers was identified. However, compared with heart disease and diabetes, the barriers to adopting preventive services for breast, cervical, and colorectal cancer screening have received greater attention. While patient navigation was shown to be effective in increasing cancer screening rates, strategies for bundling preventive services and implementing health information technologies require more study. The importance of addressing unmet basic needs related to health and enhancing community resources to reduce disparities were recurring themes throughout the workshop. Lastly, there were implications for more research in cancer dissemination and implementation. Conclusion: Chronic diseases, including heart disease, cancer, and diabetes, are responsible for seven of every ten deaths in the U.S. each year. Greater use of proven clinical preventive services could avert the loss of millions of life-years. Achieving health equity in preventive services is feasible, but requires efforts at the patient, provider, healthcare organization, and community levels, and greater attention to addressing social determinants of health. Citation Format: Antoinette Percy-Laurry, Richard Berzon, Jennifer Croswell, Carrie Klabunde, Melissa Green Parker, LeShawndra Price, Pamela Thornton, Kate Winseck, Xinzhi Zhang. Achieving health equity in cancer preventive services: NIH Workshop insights on barriers and the effectiveness of evidence-based interventions and strategies [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-262.

This Addressing Healthcare Inequities in IDD special issue advances current thinking and research to increase our understanding of health inequities and approaches to improve health care for people with intellectual and developmental disabilities (IDD). In this introduction, we briefly describe health and healthcare inequities for children and adults with IDD, arguing that the quest to improve healthcare quality must include an intentional pursuit of equity. Two articles follow that analyze existing data by factors including diagnosis and other characteristics to explore healthcare disparities. The final three studies explore approaches to advance trainee and clinician competencies to provide quality care to patients with IDD. The inclusion of Dr. Karrie A. Shogren's American Association on Intellectual and Developmental Disabilities (AAIDD) 2022 Presidential Address extends the discussion with a robust reflection on systemic barriers and offers a vision for equity and inclusion that has implications for health care as an aspect of every good life.In 2001, a seminal report published by the Institute of Medicine's Committee on Quality of Healthcare in America Project, "Crossing the Quality Chasm," provided clear evidence of gaps in the quality of healthcare and catalyzed the establishment and growth of quality improvement efforts across the complex systems of healthcare. "The Triple Aim," developed and described by Berwick and colleagues (2008), offered guidance to move towards enhancing patient experience, reducing cost, and optimizing population health. As systems have engaged with this and other quality improvement frameworks, significant disparities based on race, ethnicity, income, and disability status have become increasingly apparent. For example, people with IDD experience inequities in health and health care (Havercamp & Scott, 2015; Krahn & Fox, 2014). People with IDD have high rates of chronic health conditions, yet poorer access to health care compared to people without disabilities (Reichard et al., 2011). They report barriers to accessing health care, high rates of unmet health care needs, and dissatisfaction with the health care they receive compared to people without disabilities (Ali et al., 2013; Doherty et al., 2020; Prokup et al., 2017; World Health Organization [WHO], 2011). Disability-related health inequities are compounded when people with IDD have other marginalized identities, such as those based on race, ethnicity, sexual orientation, gender identity, poverty, or rural place of living (Courtney-Long et al., 2017; Dembo et al., 2022; Magaña et al., 2016). Inequities in health outcomes are understood to result, in part, from differences in social circumstances (e.g., discrimination, poverty) that affect health (Angelelli et al., 2022; Krahn et al., 2006), disparities in healthcare access (Lauer et al., 2021), and inequities in data collection and failure to monitor their health (e.g., Havercamp & Krahn, 2019; Fox et al., 2015; WHO, 2021). The global COVID-19 pandemic dramatically illustrates that the burden of infectious disease falls most heavily on those populations already disadvantaged by systemic discrimination and oppression, including people with IDD (Ruprecht et al., 2021; Turk et al., 2020).The pursuit of healthcare equity for patients with IDD depends on health system research that identifies people with IDD in the data as well as other marginalized identities, where possible. The next two articles in this special issue leverage existing health services data to explore healthcare disparities. Acosta and colleagues used the Nationwide Emergency Data Sample (NEDS) to compare the rates of emergency department visits leading to hospital admission and reasons for hospital admission as a function of intellectual disability (ID) diagnosis, age group, and other characteristics. In the third article, McMaughan and colleagues present the results of a cross-sectional analysis of the 2016 Kids' Inpatient Database to discover the most frequent principal diagnoses for inpatient stays among children and youth with autism, the costs associated with these hospitalizations, and the length of hospital stays. Understanding these factors is needed to advocate for and develop appropriate community-based support services to reduce the burden of hospitalizations and to inform the development of value-based care models. Taken together, these articles demonstrate opportunities to use existing health service datasets to identify disparate healthcare utilization patterns and outcomes in people with IDD."The Quadruple Aim" introduced the quality priorities of clinician work-life and experience in 2014 (Bodenheimer & Sinsky, 2014). Healthcare professionals hold negative and ableist attitudes and beliefs about disability and report feeling uncomfortable and unprepared to meet the health needs of patients with disabilities (Desroches et al., 2019; Iezzoni et al., 2021). Without explicit disability training, health care providers are likely to view disability as a negative health outcome and to hold low expectations for the function and quality of life of individuals with disabilities. Training can prepare clinicians to communicate effectively and provide accessible, patient-centered assessment and treatment to patients with disabilities. In 2022, the National Council on Disability released a policy brief, Health Equity Framework for People with Disabilities, calling for comprehensive disability clinical-care curricula and disability competency education in all U.S. medical, nursing, and other healthcare professional schools (National Council on Disability, 2022).The next three articles in this special issue have direct implications for health care delivery for people with IDD, emphasizing the critical role of training and experience of clinicians. Recognizing the relationship between feeling prepared to care for a patient and positive patient experience, the Golub-Victor team explored perceived self-confidence to care for adults with ID among students in interprofessional healthcare training programs. This study explored the influence of several factors on trainee's self-confidence. Program-related characteristics such as the number of years in the program, healthcare discipline, and individual characteristics such as gender identity, and prior experience or training in ID are described. In the fifth article, Sheppard and colleagues describe an innovative school-clinic partnership where medical students spent a day with a special education faculty member observing children with disabilities in school settings. This pilot study explored the feasibility of implementing this experiential learning activity during a pediatric clerkship and, similar to Golub-Victor and colleagues, students' perceived competence. In the sixth article, Berens and colleagues explore the feasibility, acceptability, and impact of a behavioral intervention to reduce the need for sedation, general anesthesia, and restraint in dental care for adults with IDD.In the final article, taken from her 2022 AAIDD Presidential Address, Shogren likens ableism to racism and sexism in the harm it causes people with disabilities and its insidious nature. She calls on us to 1) recognize and name systemic barriers including ableism, and 2) take action to break down these barriers to advance equity.As editors of this special issue, we have learned much from the contributing authors and are appreciative of readers who will use these findings to improve health care for children and adults with IDD. We hope this special issue inspires readers to seek opportunities to identify and dismantle barriers to equity in health and health care for people with IDD.

Humanitarian emergencies require a range of planned and coordinated actions: security, healthcare, and, as this article highlights, health equity responses. Health equity is an evidence-based science that aims to address unfair and unjust health inequality outcomes. New approaches are using health equity to guide the development of community programs, equity methods are being used to identify disadvantaged groups that may face health inequities in a humanitarian emergency, and equity is being used to prevent unintended harms and consequences in interventions. Limitations to health equity approaches include acquiring sufficient data to make equity interpretations, integrating disadvantage populations in to the equity approach, and ensuring buy-in from decision-makers. This article uses examples from World Health Organization, Refugee Health Guidelines and Health Impact Assessment to demonstrate the emerging role for health equity in humanitarian emergencies. It is based on a presentation at the Evidence Aid Symposium, on 20 September 2014, at Hyderabad, India.

The importance for tuberculosis of mitigating economic crises

Considered by many as the main priority of health systems, health inequities are a growing public health concern.1,2 Given the complexity underlying their production, it is possible that the scientific tradition of public health alone, largely influenced by biomedicine and epidemiology, cannot provide all the answers and public health should expand its interests by integrating not only social science theories, but also disciplines that aim at intervening in fields other than health.3-5 indeed, evidence- based data, appropriate when elaborating individual interventions where the results of research using experimental or quasi-experimental designs can be used,6 are not as useful to develop interventions that will reduce social inequalities in health. in fact, there is very little evidence on how to intervene to reduce such health inequities,7 although intersectoral and participatory strategies are recognized as relevant.8As social inequalities are transformed into health inequities under the influence of living conditions, it is therefore relevant to work with specialized professionals in transforming individual problems into collective actions.9 present since the 1970s in Quebec's local community services centres, which were later transformed into local health and social services centres, community organizers have the mandate to support the transformation processes specific to community action. they differ from other health and social services professionals by advocating collective action as a strategy for changing living conditions. several authors consider them as key players in improving the health and wellbeing of people in Quebec.10,11We should inform readers that previously, community organizing in local community services centres was primarily a form of community action that used animation strategies to protest against abject living conditions.12 With time, and major government reforms and organizational changes, community organizing practices appeared in a new light. professionalization of the practice has led it to become a form of professional intervention that now acts upon community action instead of acting directly in the community. thus, community organizers now offer more support, from the standpoint of their expertise and knowledge of communities, various processes of collective action (start-up projects, development of resources, support community groups, animation, evaluation, etc.) instead of endorsing social and political claims. Furthermore, local community services centres, born of citizen initiatives to take control over the health and wellbeing of residents, were also originally structured according to the needs identified by the population and focused primarily on popular demands. However, ministerial guidelines and forms of bureaucratic management put in place during the 1980s and 1990s relegated the role of social change of these institutions to mere service providers.13 nonetheless, most local health and social service centres retained community organizers in their ranks.recognition of living conditions and contextual factors - usually called social determinants of health - in the implementation of public health interventions is an important issue. Although our knowledge needs to be perfected, we suggest that a consensus now exists in the world of public health on the importance of reducing health inequities through action on the social determinants of health.14 in order to act accordingly, public health institutions in the province of Quebec, Canada, have integrated an innovative strategy in its provincial, regional and local public health plans. the 'support the development of communities' strategy that aims at improving population health can be seen as a health equity exercise. Considered as a cross-cutting strategy that encompasses all other public health activities, it draws together issues faced by social and health professionals. there is therefore an opportunity to rally forces around the reduction of social inequalities in health and promote health equity. …

Color lines: Disparities in pharmacy treatment, education, and practice

Sweden faces challenges in improving average health and reducing health inequalities simultaneously. Traditional research methods often measure these aspects separately, posing a dilemma for policymakers. Thus, the Population Health Performance Index (PHPI) has been proposed as a summary measure that integrates both aspects. This study aimed to determine the PHPI for self-rated health (SRH) by income and education in Sweden across its 21 regions. Data were obtained from the 2021 Health on Equal Terms survey, a population-based cross-sectional study from Sweden. This survey included 17 538 participants aged 16–84 years. The outcome was poor SRH, stratified by the highest and lowest education and income groups. The PHPI was calculated as a weighted average of the mean and inequality index according to a neutral inequality aversion weight of 0.5. The prevalence of poor SRH was 28.7%, with pronounced disparities between high- and low-income/education groups. Overall, the PHPI by income and educational inequality was closer to zero across regions, albeit small relative differences were observed among the regions compared. The index also revealed substantial spatial disparities between Sweden’s northern and southern regions. The PHPI can be a complementary tool for policymakers to monitor social inequalities in health. The findings call for targeted interventions to address socioeconomic and regional disparities to achieve equity in health in Sweden.

Oral health is a multidimensional concept, shaped by biological, behavioral, social, and structural factors, and represents a fundamental element of overall health and wellbeing 1 . Even though dental caries remains one of the most prevalent oral diseases worldwide, it reflects only one aspect of broader inequalities in oral health. These are influenced by unequal distribution of resources, opportunities, and health awareness 2 . Amongst these factors, parental education level and socioeconomic status stand out as key factors that significantly influence the course of oral health in children 3 . Families with low levels of education or limited socioeconomic resources often face cumulative obstacles, including low levels of oral health awareness, limited access to preventive dental services, and increased exposure to unhealthy environments 4,5 . These social factors not only shape oral hygiene behaviors and dietary habits, but also determine the family's ability to cope with health systems and adopt preventive practices, thus perpetuating intergenerational inequalities 2,6 .Despite strong evidence linking parental education, socioeconomic status and oral health outcomes, the mechanisms by which these factors operate are still not adequately covered in the global public health discourse 3 . The differences between countries highlight the structural nature of these inequalities, underscoring the need for comprehensive, system-wide strategies to promote health equity 7,8 . This editorial brings together emerging evidence from diverse settings to illustrate how parental education and socioeconomic status act as overarching determinants of children's oral health. Rather than summarizing individual contributions in isolation, the editorial critically analyzes common themes, identifies persistent knowledge gaps, and considers their implications for public health policy, preventive dentistry, and health equity initiatives.Across all the included studies, a consistent pattern emerges linking parental knowledge, social support structures, socioeconomic conditions, broader social determinants, and children's oral health outcomes. Taken together, the evidence reinforces the central role of families and contextual factors, as described in conceptual models of oral health inequalities, in shaping caries experience, hygiene behaviors, service utilization, and developmental conditions affecting teeth. health status and related behaviors. Higher health literacy and family socioeconomic status were strongly associated with better oral health outcomes, while gender-based differences reflected variations in societal expectations and health communication.These findings reinforce the influence of cultural and educational determinants on adolescent oral health and are consistent with global evidence highlighting the interaction between social context and health behaviors.The studies included in this research topic reveal several interconnected themes, reinforcing the interrelated nature of the determinants of children's oral health. First, parental education and health literacy consistently emerge as key factors influencing children's daily oral hygiene practices, dietary choices, and engagement with preventive dental services. Whether it is social support, knowledge of how to access services, or awareness of appropriate feeding and hygiene behaviors, parental capabilities strongly predict children's oral health outcomes. Second, socioeconomic disadvantage exacerbates barriers to preventive care and healthy behaviors. As low socioeconomic status is associated with higher prevalence of dental caries, suboptimal nutritional practices, reduced access to services, and increased risk of developmental conditions such as MIH. These patterns reflect global evidence showing that inequalities in oral health follow clear social gradients across different countries and health systems. Third, studies highlight the importance of integrated policies and public health interventions, particularly those delivered through schools and family centered programs.Interventions that combine oral health education, nutritional counseling, and structured parental support show promising effectiveness in mitigating inequalities when integrated within broader social and health frameworks.These findings collectively confirm that oral health is shaped by multi-level interactions involving individual behaviors, family dynamics, community resources, and national policy environments. They also underscore that improving children's oral health requires addressing both structural and behavioral factors simultaneously.The body of evidence underscores the need to align oral health promotion with parentcentered educational strategies, particularly during early childhood when health habits This research topic clearly demonstrates that improving children's oral health cannot be achieved through clinical services alone. Sustainable progress requires addressing the educational, behavioral, and socioeconomic foundations that shape oral health from a young age. By integrating parental education, addressing social inequalities, and incorporating preventive strategies into community and school systems, health professionals and policymakers can contribute to reducing disparities and promoting lifelong oral health.

China’s 2009 expansion of universal health insurance has received global interest, but little empirical investigation. This epidemiological study was a first attempt to assess potential impacts on population health and health equity. Multilevel negative binomial regression was used to analyse all-cause and non-communicable disease (NCD) mortality between 2006 and 2012 from a representative sample including all 31 provinces. The age-standardised ratios (per 100,000) in 2006 were 860.4 and 732.9 for mortality from all-causes and NCDs respectively. These ratios decreased over time to 737.5 (all-causes) and 642.9 (NCD) by 2012. Modelling indicated these trajectories were curvilinear, dipping more rapidly from 2009 onwards. Compared to the east, all-cause mortality was higher in other regions (e.g. northwest RR: 1.34, 95% CI: 1.20, 1.48). Compared to more affluent urban areas, rate ratios for all-cause mortality were 1.23 (95% CI: 0.97, 1.54) in the least affluent urban areas, 1.22 (95% CI: 1.02, 1.46) in affluent rural areas and 1.64 (95% CI: 1.51, 1.79) in the least affluent rural areas. These health inequities were largely repeated for NCD mortality and did not vary spatiotemporally. Overall, universal health insurance in China may have accelerated reductions in all-cause and NCD mortality, but potential impacts on health inequity may take longer to manifest.

Health inequalities exist and persist due to the quality and distribution of the social determinants of health, i.e., the day to day circumstances people live in. These circumstances are determined by governing policies and practices which are influenced by the State’s political ideology and its socio-economic structures. Using a political economy approach, this paper takes a critical review of the literature on health equity in the Canadian context and clarifies key concepts pertaining to health equity and human rights. Findings of this review show that Canada has been performing poorly in addressing growing health inequalities, in part because of Canada’s increasingly neo-liberal stance on public health over the last decade. This paper will argue that a human rights framework can offer a concrete tool for restructuring public policies and for taking action against these inequalities. By placing health equity on the policy agenda, Canada can help reduce social and income inequalities and optimize the health of its populations.