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Digital health innovations have been rapidly implemented and scaled to provide solutions to health delivery challenges posed by the coronavirus disease (COVID-19) pandemic. This has provided people with ongoing access to vital health services while minimizing their potential exposure to infection and allowing them to maintain social distancing. However, these solutions may have unintended consequences for health equity. Poverty, lack of access to digital health, poor engagement with digital health for some communities, and barriers to digital health literacy are some factors that can contribute to poor health outcomes. We present the Digital Health Equity Framework, which can be used to consider health equity factors. Along with person-centered care, digital health equity should be incorporated into health provider training and should be championed at the individual, institutional, and social levels. Important future directions will be to develop measurement-based approaches to digital health equity and to use these findings to further validate and refine this model.

\"This project examines how structural and institutional factors contributed and continue to contribute to poor health outcomes for scores of nameless Afro-Brazilian women and men. Despite having the second largest African-descendant population in the world, Brazil failed to develop policies to address health issues that disproportionately affect Afro-Brazilians until the early 21st century. Additionally, Brazil does not have a long tradition of research or policies focusing on racial or ethnic health disparities. While the country has risen to become a world leader in the fight against HIV/AIDS, it continues to face ongoing challenges in ensuring health equity for Afro-Brazilians. This project highlights how Brazil has succeeded and failed at certain challenges in its quest to provide quality healthcare for all its citizens, but particularly to Afro-Brazilian women and men, and examines the development of the feminist health movement and black women's movement, which developed significant policy interventions related to women's health. Kia Caldwell assembles a policy history of Brazilian feminist health movement to analyze how health activists and policy makers have attempted to address gender and racial health inequities from the early 1980s to the present.\"-- Provided by publisher.

The role of the National Health Service (NHS) and relevant national executive agencies in relation to testing capacity, availability of personal protective equipment (PPE), the cancellation and postponement of many aspects of routine care, and decisions around discharge from hospital to care homes should also be critically examined. [...]improve resource management across health and care at national, local, and treatment levels. [...]develop a sustainable, skilled, and fit for purpose health and care workforce to meet changing health and care needs. [...]improve integration between health care, social care, and public health and across different providers, including the third sector (ie, charity and voluntary organisations).

Background The COVID-19 pandemic has given an unprecedented boost to already increased digital health services, which can place many vulnerable groups at risk of digital exclusion. To improve the likelihood of achieving digital health equity, it is necessary to identify and address the elements that may prevent vulnerable groups from benefiting from digital health services. This study examined the challenges experienced by vulnerable groups in using digital health services during the COVID-19 pandemic. Methods Qualitative descriptive design was utilized. Semi-structured interviews were conducted between October 2020 and May 2021. The participants ( N  = 74) were older adults, migrants, mental health service users, high users of health services, and the unemployed. Qualitative content analysis with both inductive and deductive approach was used to analyze the data. Challenges related to the use of digital health services were interpreted through digital determinants of health from the Digital Health Equity Framework. Results For most of the participants the access to digital health services was hampered by insufficient digital, and / or local language skills. The lack of support and training, poor health, as well as the lack of strong e-identification or suitable devices also prevented the access. Digital services were not perceived to be applicable for all situations or capable of replacing face-to-face services due to the poor communication in the digital environment. Fears and the lack of trust regarding digital platforms were expressed as well as concerns related to the security of the services. Contact with a health care professional was also considered less personal and more prone to misunderstandings in the digital environment than in face-to-face services. Finally, digital alternatives were not always available as desired by participants, or participants were unaware of existing digital services and their value. Conclusion Several development needs in the implementation of digital health services were identified that could improve equal access to and benefits gained from digital services in the future. While digital health services are increasing, traditional face-to-face services will still need to be offered alongside the digital ones to ensure equal access to services.

Health risks in the 21st century are beyond the control of any government in any country. In an era of globalisation, promoting public health and equity requires cooperation and coordination both within and among states. Law can be a powerful tool for advancing global health, yet it remains substantially underutilised and poorly understood. Working in partnership, public health lawyers and health professionals can become champions for evidence-based laws to ensure the public’s health and safety. This Lancet Commission articulates the crucial role of law in achieving global health with justice, through legal instruments, legal capacities, and institutional reforms, as well as a firm commitment to the rule of law. The Commission’s aim is to enhance the global health community’s understanding of law, regulation, and the rule of law as effective tools to advance population health and equity.

COVID-19 has affected vulnerable populations disproportionately across China and the world. Solid social and scientific evidence to tackle health inequity in the current COVID-19 pandemic is in urgent need.

Funding for CEDAR from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. [...]together with physical inactivity, dietary risk factors are responsible for 10% of disability-adjusted life years lost globally [2].

Inequalities in medical care are endemic in the USA. The Affordable Care Act (ACA), passed in 2010 and fully implemented in 2014, was intended to expand coverage and bring about a new era of health-care access. In this review, we evaluate the legislation's impact on health-care equity. We consider the law's coverage expansion, insurance market reforms, cost and affordability provisions, and delivery-system reforms. Although the ACA improved coverage and access—particularly for poorer Americans, women, and minorities—its overall impact was modest in comparison with the gaps present before the law's implementation. Today, 29 million people in the USA remain uninsured, and substantial inequalities in access along economic, gender, and racial lines persist. Although most Americans agree that further reform is needed, the proper direction for reform—especially following the 2016 presidential election—is highly contentious. We discuss proposals for change from opposite sides of the political spectrum, together with their potential impact on health equity.

Background The health care sector has a significant role to play in fostering equity in the context of widening global social and health inequities. The purpose of this paper is to illustrate the process and impacts of implementing an organizational-level health equity intervention aimed at enhancing capacity to provide equity-oriented health care. Methods The theoretically-informed and evidence-based intervention known as ‘EQUIP’ included educational components for staff, and the integration of three key dimensions of equity-oriented care: cultural safety, trauma- and violence-informed care, and tailoring to context. The intervention was implemented at four Canadian primary health care clinics committed to serving marginalized populations including people living in poverty, those facing homelessness, and people living with high levels of trauma, including Indigenous peoples, recent immigrants and refugees. A mixed methods design was used to examine the impacts of the intervention on the clinics’ organizational processes and priorities, and on staff. Results Engagement with the EQUIP intervention prompted increased awareness and confidence related to equity-oriented health care among staff. Importantly, the EQUIP intervention surfaced tensions that mirrored those in the wider community, including those related to racism, the impacts of violence and trauma, and substance use issues. Surfacing these tensions was disruptive but led to focused organizational strategies, for example: working to address structural and interpersonal racism; improving waiting room environments; and changing organizational policies and practices to support harm reduction. The impact of the intervention was enhanced by involving staff from all job categories, developing narratives about the socio-historical context of the communities and populations served, and feeding data back to the clinics about key health issues in the patient population (e.g., levels of depression, trauma symptoms, and chronic pain). However, in line with critiques of complex interventions, EQUIP may not have been maximally disruptive. Organizational characteristics (e.g., funding and leadership) and characteristics of intervention delivery (e.g., timeframe and who delivered the intervention components) shaped the process and impact. Conclusions This analysis suggests that organizations should anticipate and plan for various types of disruptions, while maximizing opportunities for ownership of the intervention by those within the organization. Our findings further suggest that equity-oriented interventions be paced for intense delivery over a relatively short time frame, be evaluated, particularly with data that can be made available on an ongoing basis, and explicitly include a harm reduction lens.