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Social justice issues remain some of the most pressing problems in the United States. One aspect of social justice involves the differential treatment of demographic groups in the criminal justice system. While data consistently show that Blacks and Hispanics are often treated differently than Whites, one understudied aspect of these disparities is how police officers' assessments of suspects' size affects their decisions. Using over 3 million cases from the New York Police Department (NYPD) Stop, Question, and Frisk (SQF) Database, 2006-2013, this study is the first to explore suspects' race, perceived size, and police treatment. Results indicate that tall and heavy black and Hispanic men are at the greatest risk for frisk or search. Tall and heavy suspects are at increased risk for experiencing police force, with black and Hispanic men being more likely to experience force than white men across size categories.

Background Quantitative evidence suggests that Brexit has had a severe and negative impact on European doctors, with many medical staff leaving the UK. This study provides a detailed examination of European doctors’ feelings towards Brexit, their intentions to leave the UK, and factors that may contribute to their potential decisions to migrate. Methods An online questionnaire which included three optional free-text questions explored self-identifying UK-based, European doctors’ views of Brexit. The three questions prompted responses on how Brexit has impacted their personal lives, their professional lives, and their future migration decisions. Fifty-nine doctors participated in the questionnaire with 52 (88.1%) providing one or more responses to the three free-text questions. Twenty-seven doctors provided answers to all three free-text questions (51.9% of included sample). Thematic analysis was used to analyse this qualitative data. Results Brexit was reported by the majority of participants to have a profound impact, although some respondents felt it was too soon to assess the potential consequences. Five themes emerged including: feeling unwelcome in the UK, Brexit as racism, uncertainty on legal ability to work, strain on relationships, and in contrast, a current lack of concern about Brexit. Conclusions To mitigate the adverse personal and professional impact of Brexit, healthcare providers should provide financial and legal support to doctors applying for settlement in the UK, ensure they are addressing issues of racial and ethnic inequality in hiring, promotion, and pay, and work towards making clinical work environments inclusive for all staff and patients.

ObjectivesTo evaluate race-ethnic and gender disparities in National Health Service (NHS) England employment in position, prestige and pay.DesignNational study using data from NHS Digital.SettingTrusts and clinical commissioning groups in England.Participants1 105 390 NHS Hospital and Community Health Service staff.ResultsChinese people (42.9%, 95% CI 41.7% to 44.1%) are the most likely to be employed as doctors, followed by Asians (28.6%, 95% CI 28.3% to 28.8%) and people of mixed race/ethnicity (17.9%, 95% CI 17.3% to 18.4%); while white people (6.8%, 95% CI 6.7% to 6.8%) are less likely to be employed as doctors. However, white doctors are the most likely to be in the highest paid positions: 46.0% (95% CI 45.6% to 46.4%) of white doctors are consultants, whereas only 33.4% (95% CI 31.6% to 35.2%) of Chinese doctors are consultants. Black people are under-represented both among doctors and as consultants: 6.5% (95% CI 6.4% to 6.7%) of black employees are doctors and 30.6% (95% CI 29.2% to 32.0%) of black doctors are consultants. We found similar results for nurses and health visitors, where white people are over-represented in the higher pay bands. However, among support staff for doctors, nurses and midwives, we found that Chinese people were over-represented in the higher pay bands. These race-ethnic differences were similar for women and men. Additionally, we found that men were more likely to be employed in higher pay bands than women, and this gender disparity was apparent across race-ethnic groups.ConclusionsRace-ethnic and gender disparities exist in the NHS in position, prestige and pay. To begin to overcome such disparities, the NHS must collect data using consistent race-ethnic categories in order to examine differences over time.

Background: Although survey data suggest that Brexit has negatively influenced European doctors’ decisions to remain in the United Kingdom, this is the first quantitative study to use multivariate analysis to explore this relationship.Objective: To assess how Brexit relates to doctors’ migration intentions in relation to their feelings that Brexit has impacted their professional life, national identity, and demographic factors.Method: We collected data from 59 self-reported EU/EEA/European identifying doctors working in the UK. We weighted results to the English National Health Service population in terms of gender, professional grade level and ethnicity and ran weighted regression analyses of respondents’ plans (leaving, considering, not considering) and whether they reported Brexit influencing their decision-making. We then examined how stating that Brexit affected their career, national identity, and sex and age related to doctors’ intentions to leave or stay.Findings: The more doctors agreed that Brexit had impacted their professional lives, the more likely they were to state they intended to leave the UK. We found doctors with increased levels of British identity less likely to leave than those with reduced British identity. Interestingly, we found that those with higher levels of European identity were less likely to leave but more sharply likely to consider leaving compared to those with lower levels of European identity.Conclusions: Respondents reported large professional impacts of Brexit. To retain these individuals in the British medical system, the NHS should provide financial and legal assistance for those applying for settled status and financial and other incentives comparable to what doctors could receive in EU health systems.

Background Over recent years there have been several major terror attacks in cities across Europe. These attacks result in deaths, physical injuries, and pose long-term threats to mental health and wellbeing of large populations. Although psychologists have completed important work on mental health responses to disaster exposure including terrorist attacks, the mental health impacts of such attacks have been comparatively less examined in academic literature than the acute health response to physical injuries. This paper reflects on Southwark Council’s pioneering public mental health response to the June 2017 terror attack at London Bridge and Borough Market. It aims to explore perceptions of the mental health impact of the incident by those living and working in the borough. Methods A rapid qualitative evaluation informed by the logic underpinning Southwark Council’s response was conducted. Seven formative interviews were undertaken with individuals involved in the response planning and/or delivery, enabling the evaluation team to establish the response’s theoretical basis. Subsequently, nineteen semi-structured interviews with consenting Council employees, residents, business owners, and workers from the Borough were conducted to understand perceived mental health impacts of the attack and the success of the Council response. Thematic analysis of transcribed interviews was undertaken to evaluate the extent to which the response was implemented successfully. Results Participants reported feeling the attack had a wide-reaching negative impact on the mental health of residents, those working in the borough and visitors who witnessed the attack. Delivering the response was a challenge and response visibility within the community was limited. Participants suggested a comprehensive systematic approach to health needs assessment informed by knowledge and relationships of key Council workers and community stakeholders is imperative when responding to terrorist incidents. Improved communication and working relationships between statutory organisations and community stakeholders would ensure community groups are better supported. Prioritising mental health needs of terror attack responders to mitigate persisting negative impacts was highlighted. Conclusions This article highlights a potential public health approach and need for developing robust practical guidance in the aftermath of terror attacks. This approach has already influenced the response to the Christchurch mosque shooting in 2019.

The Affordable Care Act (ACA) has vastly reduced racial health insurance disparities, but efforts continue to repeal this health care law. It is not clear, however, whether this policy is rejected because of its health care provisions, or if the ACA is interpreted primarily as a social welfare policy aimed at providing resources specifically to non-white Americans. In this paper, we assess whether the racial divide in opposition to the Affordable Care Act is unique to this law or represents a reflection of a longer history of racialized social welfare policies in the U.S. The for this research come from the American National Election Studies (ANES) 2016 Time Series Study which targets United States-based citizens aged 18 and older. We conducted logistic regression to understand how racial attitudes and support for social policies relate to opposition to the ACA. Perceptions of the ACA, especially among white Americans, were related to both support for affirmative action in hiring and education and racial resentment more generally. Attitudes toward the ACA were unrelated to support for policies that have not been explicitly framed as benefitting non-white Americans. As public debates related to whether to amend the ACA or repeal and replace it altogether continue, scholars and public health practitioners should emphasize the role that racism and racial resentment more specifically play in health policy debates.

Purpose : Studies on drug use in transgender populations, particularly those in resource-limited settings, are scarce. Considering that drug use can be a coping mechanism to deal with stigma and traumatic experiences, we examined associations between stigma, trauma, and drug use in a national sample of transgender women from the Dominican Republic. Methods : Bivariate analyses examined differences between drug users and abstainers ( n =287). Multivariate analyses reported odds ratios (OR) with general drug, marijuana, and cocaine use as outcomes ( n =243). Results : A quarter of respondents (24.5%) experienced sexual abuse, 12.1% were tortured, and 20.1% experienced a murder attempt. More than a quarter reported using illegal drugs (26.1%). Drug users had lower socioeconomic status; 30.0% of drug users had a primary level of education or less (18.2% of abstainers) and 17.6% of drug users had higher income, defined as greater than 10,001 pesos (∼$210 United States Dollars, USD) per month (28.1% of abstainers). More than half of drug users experienced some form of trauma (51.4%) compared to 43.5% of abstainers, and 28.4% of drug users, compared to 17.1% of abstainers, experienced a murder attempt on her life. Independent sample t -tests found significant differences between drug users and abstainers. Transgender women who experienced sexual abuse had three times high odds of using cocaine. Drug users were more likely to have experienced sexual abuse and attempted suicide ( p <0.05 for both). Respondents who attempted suicide had higher odds of using drugs generally and using marijuana specifically, compared to respondents who had not attempted suicide (OR=2.665 and 3.168, respectively). Higher scores on the stigma scale were associated with higher odds of any drug use and cocaine use (OR=1.132 and 1.325, respectively). Conclusions : Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are not consistently enforced. Eliminating stigma and stigmatizing policies may reduce rates of drug use as a coping mechanism.

Objectives To assess the extent to which persistent racism shapes perspectives on public health policies aimed at improving health equity in the United States. Specifically we evaluate the relationship between implicit and explicit anti-black attitudes and support for the ACA at the beginning of the Trump administration. Methods We use bivariate statistics to examine views toward the ACA, anti-black attitudes, and demographic variables. Using logistic regression, we examine how anti-black attitudes and demographic variables relate to participants stating that the ACA has worsened the quality of health care services in the United States. Survey Population Data for this study come from the American National Election Studies 2016 Time Series Study, which targets US citizens age 18 and older currently living in the United States ( N = 3245). Results Implicit anti-black attitudes, particularly among whites, are strongly associated with negative feelings toward the ACA. A measure of explicit racial prejudice has the opposite relationship among whites. These results suggest that whites are most critical of the ACA when they hold positive attitudes toward blacks but hold negative stereotypes about blacks’ work ethic and reject policies to eliminate racial inequalities. Conclusions Anti-black racial attitudes are a critical barrier to enacting health policies that stand to improve health equity in the United States. Public health practitioners and policymakers should consider racism as an essential barrier to overcome in the push for greater health equity in the United States.

IntroductionGender inequality has been associated with child mortality; however, sex-specific mortalities have yet to be explored. The aim of this study is to assess the associations between gender inequality and the child mortality sex ratio at country level, worldwide and to infer on possible mechanisms.MethodsData on sex-specific under-five mortality rates (U5MR) and the corresponding sex ratio (U5MSR) for the year 2015, by country, were retrieved from the Unicef database. Excess under-five female mortality was derived from previous published work. Gender inequality was measured using the Gender Inequality Index (GII). Additional biological and social variables have been included to explore potential mechanistic pathways.ResultsA total of 195 countries were included in the analysis. In adjusted models, GII was significantly negatively associated with the U5MSR (β=−0.29 (95% CI −0.42 to –0.16), p<0.001) and borderline significantly positively associated with excess under-five female mortality (β = 3.25 (95% CI −0.28 to 6.67, p=0.071). The association between GII and U5MSR was strong and statistically significant only in low-income and middle-income countries and in the Western Pacific area.ConclusionThe more gender unequal a society is, the more girls are penalised in terms of their survival chances, in particular in low-income and middle-income countries. In order to decrease child mortality and excess girl mortality, global policy should focus on reducing gender inequality surrounding measures of reproductive health, women’s political empowerment, educational attainment and participation in the workforce.

ObjectivesWe aimed to explore the experiences of people who initiated rapid antiretroviral therapy (ART) within 7 days of HIV diagnosis, as part of routine care in London.MethodsUsing purposive sampling, 18 in-depth, semistructured interviews were conducted between December 2020 and September 2021 with people who started rapid ART at Barts Health NHS Trust. Participants aged 22–69 years included 15 cisgender men and three cisgender women. Five identified as heterosexual and 13 as gay and bisexual and other men who have sex with men. Ethnic identities: six White Non-UK, five White UK, three Black Caribbean, two South Asian and two East Asian. Interviews explored feelings about the new HIV diagnosis, attitudes to rapid ART including barriers to and facilitators of starting. Thematic analysis of transcribed interviews was undertaken.ResultsFour themes were identified: (1) being offered rapid ART is acceptable; (2) it is a way of taking control of their health; (3) the need for information and support and (4) an individualised approach to care. Reasons for starting included getting well, staying well and reducing the likelihood of passing on HIV. Facilitators included being given comprehensive information about treatment and managing potential side-effects and a supportive clinical team. Support specified included a non-judgemental attitude, approachability, reassurance, encouragement and information about peer support. Most participants expressed they could not understand why people would not begin treatment, but suggested needing more time to decide and denial of diagnosis as possible barriers.ConclusionsTo our knowledge, this is the first qualitative study exploring the experiences of people initiating rapid ART in the UK. It was deemed acceptable to an ethnically diverse, predominantly male sample of people newly diagnosed with HIV. Future research should include strategies to recruit a more gender diverse sample and those who declined or stopped rapid ART.