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Background Inequalities in obesity pertain in part to differences in dietary intake in different socioeconomic groups. Examining the economic, social, physical and political food environment of low-income groups as a complex adaptive system – i.e. a system of multiple, interconnected factors exerting non-linear influence on an outcome, can enhance the development and assessment of effective policies and interventions by honouring the complexity of lived reality. We aimed to develop and apply novel causal loop diagramming methods in order to construct an evidence-based map of the underlying system of environmental factors that drives dietary intake in low-income groups. Methods A systematic umbrella review was conducted on literature examining determinants of dietary intake and food environments in low-income youths and adults in high/upper-middle income countries. Information on the determinants and associations between determinants was extracted from reviews of quantitative and qualitative studies. Determinants were organised using the Determinants of Nutrition and Eating (DONE) framework. Associations were synthesised into causal loop diagrams that were subsequently used to interpret the dynamics underlying the food environment and dietary intake. The map was reviewed by an expert panel and systems-based analysis identified the system paradigm, structure, feedback loops and goals. Results Findings from forty-three reviews and expert consensus were synthesised in an evidence-based map of the complex adaptive system underlying the food environment influencing dietary intake in low-income groups. The system was interpreted as operating within a supply-and-demand, economic paradigm. Five sub-systems (‘geographical accessibility’, ‘household finances’, ‘household resources’, ‘individual influences’, ‘social and cultural influences’) were presented as causal loop diagrams comprising 60 variables, conveying goals which undermine healthy dietary intake. Conclusions Our findings reveal how poor dietary intake in low-income groups can be presented as an emergent property of a complex adaptive system that sustains a food environment that increases the accessibility, availability, affordability and acceptability of unhealthy foods. In order to reshape system dynamics driving unhealthy food environments, simultaneous, diverse and innovative strategies are needed to facilitate longer-term management of household finances and socially-oriented practices around healthy food production, supply and intake. Ultimately, such strategies must be supported by a system paradigm which prioritises health.

Objective Multi-drug resistance (MDR) has notably increased in community acquired uropathogens causing urinary tract infections (UTIs), predominantly Escherichia coli . Uropathogenic E. coli causes 80% of uncomplicated community acquired UTIs, particularly in pre-menopausal women. Considering this high prevalence and the potential to spread antimicrobial resistant genes, the current study was conducted to investigate the presence of clinically important strains of E. coli in Pakistani women having uncomplicated cystitis and pyelonephritis. Women belonging to low-income groups were exclusively included in the study. Seventy-four isolates from urine samples were processed, phylotyped, and screened for the presence of two Single Nucleotide Polymorphisms (SNPs) particularly associated with a clinically important clonal group A of E. coli (CgA) followed by antibiotic susceptibility testing and genome sequence analysis. Results Phylogroup B2 was most prevalent in patients and 44% of isolates were positive for the presence of CgA specific SNPs in Fumarate hydratase and DNA gyrase subunit B genes. Antibiotic susceptibility testing showed widespread resistance to trimethoprim-sulfamethoxazole and extended-spectrum beta-lactamase production. The infection analysis revealed the phylogroup B2 to be more pathogenic as compared to the other groups. The genome sequence of E. coli strain U17 revealed genes encoding virulence, multidrug resistance, and host colonization mechanisms. Conclusions Our research findings not only validate the significant occurrence of multidrug-resistant clonal group A E. coli (CgA) in premenopausal Pakistani women suffering from cystitis and pyelonephritis but also reveal the presence of genes associated withvirulence, and drug efflux pumps. The detection of highly pathogenic, antimicrobial-resistant phylogroup B2 and CgA E. coli strains is likely to help in understanding the epidemiology of the pathogen and may ultimately help to reduce the impact of these strains on human health. Furthermore, the findings of this study will particularly help to reduce the prevalence of uncomplicated UTIs and the cost associated with their treatment in women belonging to low-income groups.

PurposeThe increasing growth of urbanisation, especially in developing countries, coupled with affordable housing leakages, may thwart achieving Sustainable Development Goal (SDG) 11 (sustainable cities and communities). Studies regarding affordable housing leakages and their aftermath to Goal 11 in one study are scarce in Malaysia. The study investigated Malaysia's low-cost housing (LCH) leakages and their aftermath to Goal 11 and proffered measures to achieving Goal 11 and its targets. The purpose of this paper is to address these issues.Design/methodology/approachThe researchers covered four of Malaysia's major cities via a qualitative approach. The study used 40 participants via semi-structured virtual interviews, and saturation was achieved. The study adopted a thematic approach for the collected data and honed them with secondary sources.FindingsFindings group Malaysia's LCH leakages into government/agencies/departments in housing, housing developers/building contractors and client/building owners' root causes in Malaysia's context. It shows a threat from Malaysia's LCH leakages to achieving Goal 11 and proffered measures to enhance achieving Goal 11. Achieving Goal 11 will strengthen and improve Malaysia's many SDGs accomplishments because of their link.Originality/valueApart from proffering measures to mitigate long-standing issues (leakages) in Malaysia's LCH delivery from achieving Goal 11, findings will stipulate the accomplishment of other SDGs related to housing delivery.

The Chinese Dietary Guidelines propose a balanced diet for healthy living, but the affordability of this diet needs to be considered, especially for low-income households. To investigate the affordability of a healthy diet, this study analyzes the daily retail prices of 46 food items in 36 Chinese cities from 2016 to 2021. This study compares expenditure, diet composition, and nutritional status in two scenarios aligned with the guidelines. The results show that the mean minimum cost of a balanced diet exceeds the current per capita food expenditure for at least 182.85 million urban households. This suggests that low-income people would need to increase their expenditure by at least 20–121% to achieve the recommended diets. This study also identifies affordable and nutrient-dense foods such as standard flour, eggs, black beans, and cabbage, which policymakers should focus on when monitoring food prices. The findings recommend a combination of social and food system policies to reduce prices and make healthy diets accessible. This study identifies the gaps in the Chinese Dietary Guidelines for ensuring accessibility for vulnerable groups and provides a template for policymakers and researchers to track diet affordability using available food price data in China, contributing to China’s 2030 Health Plan and the UN’s Sustainable Development Goals.

Modifying the food environment of cities is a promising strategy for improving dietary behaviors, but using traditional empirical methods to test the effectiveness of these strategies remains challenging. We developed an agent-based model to simulate the food environment of Austin, Texas, USA, and to test the impact of different food access policies on vegetable consumption among low-income, predominantly Latino residents. The model was developed and calibrated using empirical data from the FRESH-Austin Study, a natural experiment. We simulated five policy scenarios: (1) business as usual; (2)–(4) expanding geographic and/or economic healthy food access via the Fresh for Less program (i.e., through farm stands, mobile markets, and healthy corner stores); and (5) expanding economic access to vegetables in supermarkets and small grocers. The model predicted that increasing geographic and/or economic access to healthy corner stores will not meaningfully improve vegetable intake, whilst implementing high discounts (>85%) on the cost of vegetables, or jointly increasing geographic and economic access to mobile markets or farm stands, will increase vegetable intake among low-income groups. Implementing discounts at supermarkets and small grocers is also predicted to be an effective policy for increasing vegetable consumption. This work highlights the utility of agent-based modeling for informing food access policies.

Background With the rapid development of population ageing, the international community has been paying more attention to the health problems of older adults and the age-friendly community. But there has not been enough discussion about the internal mechanism of the community-built environment that influences the health of older adults. The aim of our study was to explore the complex relationships among community-built environment, social participation, outdoor exercise, and health of older adults, as well as the differences among older adults in different income groups, particular attention was paid to the situation of low-income group. Methods This study used descriptive statistical analysis and structural equation Modeling (SEM) to make a group comparison among older adults in different income groups. The data of this study came from a sample survey in Shanghai, China. Results The study found that health difference exists among older adults in China: the lower the income, the worse the community-built environment, the worse the health. The community-built environment had an important impact on the health of older adults, especially the low-income older adults. And the community-built environment influenced the health of older adults through the intermediary role of outdoor exercise and social participation. Furthermore, the lower the income level of older adults, the stronger the direct effect of the community-built environment on their health; the higher the income level of older adults, the stronger the mediating effect of outdoor exercise and social participation on the impact of the community-built environment on their health. Conclusion Governments should pay more attention to the health and living conditions of low-income older adults and take proactive steps to help them. Community design and construction should pay more attention to the demands of low-income older adult groups, which will help to improve the health inequality of older adults, consequently enhancing older adults’ overall health.

The crisis directly related to the COVID-19 pandemic has put many states of the European Communities into recession. The measures that were introduced, on the one hand, were factors affecting labor markets, on the other hand, they had a fundamental impact on the quality of life of low-income groups. We found that the corona crisis and the subsequent economic collapse due to anti-pandemic measures led to a reduction in jobs and salaries, which caused an increase in the low-income population in individual EU countries. It analyzes the development of individual macroeconomic indicators: GDP (in 2020, GDP in the EU fell by 5.9% and in the eurozone by 6.4%), unemployment (disproportionate impact of the pandemic on the unemployment of the younger generation), inflation and their impact on low-income groups. The article examines the processes of public administration at home and abroad during the implementation of interventions in the time of COVID-19 and analyzes the process of changes in society. We identify the relationship between public administration interventions in the pandemic period and the quality of life of low-income citizens. This article is a partial output of the project VEGA 1/0595/21 – Public administration interventions at the time of COVID-19 and their impact on the quality of life of citizens of selected communities.

This study aims to examine the effect of low-income group (LIncG) women’s financial well-being (FWB) on their quality of life (QoL) and to assess the moderating effect of capability on the relationship between their FWB and QoL. A survey of 320 LIncG women was conducted in Malaysia. QoL constructs examined were overall QoL in general, QoL in terms of overall health, and four domains of QoL: physical health, psychological, social relationship, and environment. The results indicated that FWB had a significant positive effect on the LIncG women’s overall QoL in general and the three QoL domains of physical health, social relationship and environment. However, FWB had no significant effect on LIncG women’s QoL in terms of the overall health and psychological domain. Additionally, the results demonstrated that capability had a significant positive moderating effect only on the relationship between the FWB and QoL (in terms of psychological domain) of LIncG women. Nonetheless, capability was found to have no moderating effects on the relationship between FWB and the other QoL constructs (overall QoL in general, overall health, physical health, social relationship and environment). The findings of this study offer useful empirical evidence regarding the QoL of women in the LIncG in Malaysia. Strategies should be formulated to improve the FWB of LIncG women which will ultimately enhance their QoL.

The current issue of BMC Public Health presents work by the Consortium of Low Income Population Research (CB40R), highlighting a comprehensive aspect of health, i.e., physical health, mental health, health behaviour and health financing; and also nutrition involving all stages of lifespan of the socioeconomic deprived group in Malaysia. Consortium of B40 Research (CB40R) reposited and harmonised shared, non-identifiable data from epidemiological studies involving low income population (B40) in Malaysia. CB40R also performed joint or mega-analyses using combined, harmonised data sets that yield collated results with enhanced statistical power, more variabilities (study population, geographical regions, ethnicities and sociocultural groups) to better understand the needs, characteristics and issues of B40 groups in Malaysia. It also aimed to develope a system/framework of minimum/standard variables to be collected in research involving B40 in future. For this special issues, members of the consortium have been invited to contribute an original article involving analysis of the health aspects, access to health and nutritional issues of the B40 samples. All the papers in this special issue have successfully highlighted the health and nutritional issues (i.e., non-communicable disease (NCD), inflammatory bowel disease (IBD), knowledge towards sexually transmitted disease (STD), low birth weight, Motoric Cognitive Risk (MCR) syndrome, urinary incontinence), mental health, oral health and inequalities among the low-income group in Malaysia, including the rural population and also the urban poor. The low-income population in Malaysia is also at risk of both under- and over nutrition, of which specific cost effective strategies are indeed needed to improve their quality of life. The low income population in Malaysia is facing various health challenges, particularly related to NCD and poor mental health, nutritional and physical function. There is a need for a sustainable intervention model to tackle the issues. It is also important to highlight that reducing SES disparities in health will require policy initiatives addressing the components of socioeconomic status (income, education, and occupation) as well as the pathways by which these affect health.

Background Motoric cognitive risk (MCR) syndrome is characterized by slow gait and memory complaints that could be used to predict an increased risk of dementia. This study aims to determine the MCR syndrome and its risk factors among low-income (B40) older adults in Malaysia. Methods Data from TUA cohort study involving 1366 older adults (aged 60 years and above) categorized as low-income were analysed, for risk of MCR syndrome based on defined criteria. Chi-square analysis and independent t test were employed to examine differences in socioeconomic, demographic, chronic diseases and lifestyle factors between MCR and non-MCR groups. Risk factors of MCR syndrome were determined using hierarchical logistic regression. Results A total of 3.4% of participants fulfilled the criteria of MCR syndrome. Majority of them were female (74.5%, p  = 0.001), single/widow/widower/divorced (55.3%, p  = 0.002), living in rural area (72.3%, p  = 0.011), older age (72.74 ± 7.08 year old, p  <  0.001) and had lower years of education (3.26 ± 2.91 years, p  = 0.001) than non-MCR group. After adjustment for age, gender and years of education, participants living in rural area (Adjusted OR = 2.19, 95% CI = 1.10–4.35, p  = 0.026), with obesity (Adjusted OR = 3.82, 95% CI = 1.70–8.57, p  = 0.001), diabetes (Adjusted OR = 2.04, 95% CI = 1.01–4.11, p  = 0.046), heart disease (Adjusted OR = 2.50, 95% CI = 1.00–6.20, p  = 0.049) and cancer (Adjusted OR = 6.57, 95% CI = 1.18–36.65, p  = 0.032) were associated with increased risk of MCR syndrome. Conclusion Only 3.4% of older adults from low-income group were identified as having MCR syndrome. Women, those living in rural areas, had obesity, diabetes, heart disease and cancer were more likely to have MCR syndrome. Further investigation on MCR as a predementia syndrome will help in development of preventive strategies and interventions to reduce the growing burden of dementia, especially among individuals with low socioeconomic status.