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Public health and social justice : a Jossey-Bass reader
Praise for Public Health and Social Justice
\"This compilation unifies ostensibly distant corners of our broad discipline under the common pursuit of health as an achievable, non-negotiable human right. It goes beyond analysis to impassioned suggestions for moving closer to the vision of health equity.\"
—Paul Farmer, MD, PhD, Kolokotrones University Professor and chair, Department of Global Health and Social Medicine, Harvard Medical School; co-founder, Partners In Health
\"This superb book is the best work yet concerning the relationships between public health and social justice.\"
—Howard Waitzkin, MD, PhD, Distinguished Professor Emeritus, University of New Mexico
\"This book gives public health professionals, researchers and advocates the essential knowledge they need to capture the energy that social justice brings to our enterprise.\"
—Nicholas Freudenberg, DrPH, Distinguished Professor of Public Health, the City University of New York School of Public Health at Hunter College
\"The breadth of topics selected provides a strong overview of social justice in medicine and public health for readers new to the topic.\"
—William Wiist, DHSc, MPH, MS, senior scientist and head, Office of Health and Society Studies, Interdisciplinary Health Policy Institute, Northern Arizona University
\"This book is a tremendous contribution to the literature of social justice and public health.\"
—Catherine Thomasson, MD, executive director, Physicians for Social Responsibility
\"This book will serve as an essential reference for students, teachers and practitioners in the health and human services who are committed to social responsibility.\"
—Shafik Dharamsi, PhD, faculty of medicine, University of British Columbia
eBook
Cancer mortality and sectors of employment: a cohort study in Italy
Background
Cancer is a multifactorial disease. The large impact of occupational exposure on the burden of cancer continues to be a paramount public health concern that deserves more attention. The study aims to evaluate cancer-specific mortality risk in relation to sectors of employment.
Methods
We used a cohort from the Rome Longitudinal Study (ROL) and linked it with the National Social Insurance Agency (INPS) database to obtain working histories. We considered the longest duration of employment in a sector as a proxy of exposure, and insurance activities as the reference category. A Cox regression adjusted model was used to examine the associations between cancer-specific causes of death and the sector of employment in men and women. A similar analysis was performed considering the length of employment (≤ 10 years versus ≥ 10 years).
Results
The study population comprised 910,559 (52% of the total population of the cohort after linkage with INPS) 30 + yr employees (53% men and 47% women) followed for a total period of approximately 7 million years. The outcomes confirmed some well-known associations (e.g. lung and pleura in construction, pleura in paper and printing, and lung in wood and leather) and suggested possible high-risk sectors that have not yet been thoroughly investigated. In men we observed an increased mortality risk for stomach cancer in the printing and paper industry (HR = 1.69, 95% CI:1.11–2.57) as well as for stomach and lung cancer in cleaning activities (HR = 1.98, 95% CI:1.13–3.49 and HR = 1.55, 95% CI:1.22–1.98, respectively). Among women, there was an elevated mortality risk in the cleaning industry for all malignant cancers (HR = 1.15, 95% CI:1.03–1.29), liver cancer (HR = 1.94, 95% CI:1.08–3.48) and cancer of the lympho-hematopoietic tissue (HR = 1.65, 95% CI:1.09–2.50).
Conclusions
The results showed an increased risk of cancer death in some traditional industrial sectors compared to the reference category of insurance activities such as construction and wood and leather products and limited evidence in sectors like cleaning, accommodation and food services and hairdressing. The adopted method proved to be effective in monitoring occupational risks and activating proper prevention initiatives and further insights.
Journal Article
Receipt of social services intervention in childhood, educational attainment and emergency hospital admissions: longitudinal analyses of national administrative health, social care, and education data in Wales, UK
Background
Research consistently finds poorer health and educational outcomes for children who have experienced out-of-home care relative to the general population. Few studies have explored differences between those in care and those in receipt of intervention from social services but not in care. Children receiving social services interventions often experience Adverse Childhood Experiences (ACEs), and deprivation, which are known to negatively impact outcomes. We aimed to estimate the association of different social services interventions with educational outcomes and hospital admissions, while adjusting for ACEs and deprivation.
Methods
We linked retrospective, routinely collected administrative records from health, education, and social care to create a cohort via the Secure Anonymised Information Linkage (SAIL) databank in Wales, UK. We analysed data for children and household members (
N
= 30,439) across four different groups: (1) no social care intervention; (2) children in need but not in care (CIN); (3) children on the Child Protection Register but not in care (CPR); (4) children in care - i.e. removed from the family home and looked after by the local authority (CLA). Our primary outcome was education outcomes at age 16 years. Secondary outcomes were all cause emergency hospital admissions, and emergency admissions for external causes/injuries.
Results
Children in receipt of social services intervention were more likely to not attain the expected level upon leaving statutory education at age 16 after adjusting for ACEs and other characteristics (for children who had been in out-of-home care (conditional OR: 1·76, (95%CI) 1·25 − 2·48), in need (2·51, 2·00–3·15) and those at risk (i.e., on the child protection register) (4·04, 2·44 − 6·68). For all-cause emergency admissions, all social care groups were at greater risk compared to children in the general population (children in care (conditional HR: 1·31, 1·01–1·68), children in need (1·62, 1·38 − 1·90), and children at risk (1·51, 1·11 − 2·04).
Conclusions
All groups receiving social service intervention experience poorer educational and health outcomes than peers in the general population. Children who remain with their home parents or caregivers but are identified as ‘in need’ or ‘at risk’ by social care practitioners require further research. Integrated support is needed from multiple sectors, including health, educational and social care.
Journal Article
Falls in focus: an analysis of the rate of falls in 25 Australian residential aged care facilities from 2019 to 2021, pre- and during COVID-19 lockdowns
Introduction
During 2020–2021 Australia maintained comparatively low rates of COVID-19 in the community and residential aged care facilities (RAC) due to stringent public health measures such as lockdowns. However, the public health measures implemented may have had unintended impacts on critical RAC resident health outcomes, such as falls, due to routine care disruptions and aged care resident isolation. We utilised a longitudinal data to assess the association between COVID-19 lockdowns and the rate of falls in RAC settings.
Methods
A longitudinal cohort study was conduct using routinely collected data from 25 RAC facilities from one non-profit aged care provider in Sydney, Australia. The study included 2,996 long term residents between March 2019 and March 2021. The outcome measures were all falls, injurious falls, and falls assessed as requiring hospitalisation. Generalised estimating equations (GEE) were applied to determine the association between COVID-19 lockdown periods and fall-related outcomes while adjusting for confounders and seasonality.
Results
During the study period 11,658 falls were recorded. Residents frequently experienced at least one fall during the study period (median: 1, interquartile range: 0–4). During Lockdown 1 (March-June 2020) the rate of all falls increased 32% (IRR 1.32, 95% CI 1.19–1.46,
p
< 0.01) and the rate of injurious falls increased by 28% (IRR 1.28, 95% CI 1.12–1.46,
p
< 0.01) compared to pre-pandemic rates. The rate of falls assessed as requiring hospitalisation remained unchanged during Lockdown 1 (IRR 1.07, 95% CI 0.86–1.32,
p
= 0.519). During Lockdown 2 (Dec 2020-Jan 2021) the rate of all falls, injurious falls, and falls assessed as requiring hospitalisation did not change significantly compared to pre-pandemic rates.
Conclusion
These findings suggest that the consequences of stringent COVID-19 restrictions, as seen in Lockdown 1, produced changes in residents’ care which contributed to more falls and associated harm. The subsequent lockdown, which were less restrictive and occurred after staff had gained experience, was associated with no significant increase in falls rate. The nature and extent of lockdowns implemented for infection control in RAC need to balance multiple potential adverse effects. Factors which facilitated resilience during this period require exploration in future research.
Journal Article
The OBS UK Dashboard: an interactive tool for representative trial site selection to facilitate equality and diversity in maternity research
Background
Obstetric Bleeding Study UK (OBS UK) (award ID: 152057) is a National Institute for Health and Care Research (NIHR)-funded stepped wedge cluster randomised controlled trial of a complex intervention for postpartum haemorrhage. This was developed in Wales and evaluated in a feasibility study, with improvements in maternal outcomes observed. Generalisability of the findings is limited by lack of control data and limited ethnic diversity in the Welsh obstetric patient population compared to the United Kingdom (UK): 94% of the Welsh population identifies as White, versus 82% in the UK. Non-White ethnicity and socioeconomic deprivation are linked to increased risk of adverse maternal outcomes. Traditionally, decisions regarding site selection are based on desire to complete trials on target in ‘tried and tested’ research active institutions. To ensure widespread applicability of the results and investigate the impact of ethnicity and social deprivation on trial outcomes, maternity units were recruited that represent the ethnic diversity and social deprivation profiles of the UK.
Method
Using routinely collected, publicly available data, an interactive dashboard was developed that demonstrates the demographics of the population served by each maternity unit in the UK, to inform site recruitment. Data on births per year, ethnic and socioeconomic group of the population for each maternity unit, across the UK, were integrated into the dashboard.
Results
The dashboard demonstrates that OBS UK trial sites reflect the ethnic and socioeconomic diversity of the UK (study vs UK population ethnicity: White 79.2% vs 81.7%, Asian 10.5% vs 9.3%, Black 4.7% vs 4.0%, Mixed 2.5% vs 2.9%, Other 3.0% vs 2.1%) with variation in site demography, size and location. Missing data varied across sites and nations and is presented.
Conclusion
The NIHR equality, diversity and inclusion strategy states studies must widen participation, facilitating individuals from all backgrounds to engage. The development of this novel interactive dashboard demonstrates an innovative way of achieving this. National Health Service (NHS) maternity researchers should consider using this tool to enhance diversity in research, address health disparities and improve generalisability of findings. This approach could be applied to healthcare settings beyond maternity care and across different global populations.
Trial registration
ISRCTN 17679951. Registered on August 30, 2023.
Journal Article