Using Decomposition Analysis to Identify Modifiable Racial Disparities in the Distribution of Blood Pressure in the United States.

To lower the prevalence of hypertension and racial disparities in hypertension, public health agencies have attempted to reduce modifiable risk factors for high blood pressure, such as excess sodium intake or high body mass index. In the present study, we used decomposition methods to identify how population-level reductions in key risk factors for hypertension could reshape entire population distributions of blood pressure and associated disparities among racial/ethnic groups. We compared blood pressure distributions among non-Hispanic white, non-Hispanic black, and Mexican-American persons using data from the US National Health and Nutrition Examination Survey (2003-2010). When using standard adjusted logistic regression analysis, we found that differences in body mass index were the only significant explanatory correlate to racial disparities in blood pressure. By contrast, our decomposition approach provided more nuanced revelations; we found that disparities in hypertension related to tobacco use might be masked by differences in body mass index that significantly increase the disparities between black and white participants. Analysis of disparities between white and Mexican-American participants also reveal hidden relationships between tobacco use, body mass index, and blood pressure. Decomposition offers an approach to understand how modifying risk factors might alter population-level health disparities in overall outcome distributions that can be obscured by standard regression analyses

Does social policy moderate the impact of unemployment on health? A multilevel analysis of 23 welfare states

BACKGROUND: The magnitude of observable health inequalities between the unemployed and their employed counterparts differs considerably across countries. Few attempts have been made to test theoretical explanations for this cross-national variation. Moreover, existing studies suffer from important theoretical and methodological limitations. This study addresses these limitations and investigates whether differences in the generosity of social protection policies and in public attitudes towards those policies explain why unemployment-related health inequalities are steeper in some societies than in others. METHODS: Multilevel logistic modelling was used to link contextual-level variables on social protection policies and public attitudes in 23 European countries to individual-level data on self-rated health from the 2012 wave of the European Social Survey. RESULTS: The magnitude of inequalities in self-rated health between the unemployed and their employed counterparts varies significantly across countries as a function of cross-national differences in the level of social protection awarded to the unemployed and the level of public support for the welfare state. CONCLUSIONS: The results provide empirical support for the claim that governments can play a more active role in mitigating unemployment-related health inequalities by expanding the generosity and scope of social protection policies. Whether such an expansion of social protection will take place in the current climate of fiscal austerity is a political question whose implications merit the attention of population health scholars

Using Decomposition Analysis to Identify Modifiable Racial Disparities in the Distribution of Blood Pressure in the United States

To lower the prevalence of hypertension and racial disparities in hypertension, public health agencies have attempted to reduce modifiable risk factors for high blood pressure, such as excess sodium intake or high body mass index. In the present study, we used decomposition methods to identify how population-level reductions in key risk factors for hypertension could reshape entire population distributions of blood pressure and associated disparities among racial/ethnic groups. We compared blood pressure distributions among non-Hispanic white, non-Hispanic black, and Mexican-American persons using data from the US National Health and Nutrition Examination Survey (2003–2010). When using standard adjusted logistic regression analysis, we found that differences in body mass index were the only significant explanatory correlate to racial disparities in blood pressure. By contrast, our decomposition approach provided more nuanced revelations; we found that disparities in hypertension related to tobacco use might be masked by differences in body mass index that significantly increase the disparities between black and white participants. Analysis of disparities between white and Mexican-American participants also reveal hidden relationships between tobacco use, body mass index, and blood pressure. Decomposition offers an approach to understand how modifying risk factors might alter population-level health disparities in overall outcome distributions that can be obscured by standard regression analyses

Social-biological interactions in oral disease: A \u27cells to society\u27 view

Oral diseases constitute a major worldwide public health problem, with their burden concentrating in socially disadvantaged and less affluent groups of the population, resulting in significant oral health inequalities. Biomedical and behavioural approaches have proven relatively ineffective in reducing these inequalities, and have potentially increased the health gap between social groups. Some suggest this stems from a lack of understanding of how the social and psychosocial contexts in which behavioural and biological changes occur influence oral disease. To unravel the pathways through which social factors affect oral health outcomes, a better understanding is thus needed of how the social \u27gets under the skin,\u27 or becomes embodied, to alter the biological. In this paper, we present the current knowledge on the interplay between social and biological factors in oral disease. We first provide an overview of the process of embodiment in chronic disease and then evaluate the evidence on embodiment in oral disease by reviewing published studies in this area. Results show that, in periodontal disease, income, education and perceived stress are correlated with elevated levels of stress hormones, disrupted immune biomarkers and increased allostatic load. Similarly, socioeconomic position and increased financial stress are related to increased stress hormones and cariogenic bacterial counts in dental caries. Based on these results, we propose a dynamic model depicting social-biological interactions that illustrates potential interdependencies between social and biological factors that lead to poor oral health. This work and the proposed model may aid in developing a better understanding of the causes of oral health inequalities and implicate the importance of addressing the social determinants of oral health in innovating public health interventions

Underlying Equity Discourses of the World Health Organization

Background: Globally, increasing attention has been paid to the concept of equity in the context of health, largely stemming from the work of the World Health Organization (WHO) beginning in the late 1970s with the Declaration of Alma-Ata (WHO, 1978) and more recently following the Commission on the Social Determinants of Health (CSDH, 2008) and their final report in 2008. Despite increasing attention to this issue, there is global ambiguity on the true definition of “health inequity”, “health inequalities”, or “health disparities” (Braveman, 2006, p. 167; Braveman & Gruskin, 2003). Methods/Design: This original scoping review clarifies how the WHO conceptualizes equity. It also identifies the theoretical underpinnings guiding the WHO’s approach to equity and its broader implications. This protocol followed the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018), with details discussed in the full protocol. Discussion: To date, much of the research on health equity globally has been restricted to chronological discussions over time or specific research fields (Borde & Hernández, 2018, p. 3). Therefore, researching the WHO’s approach to equity in terms of alignment with theory and broader normative standpoint(s) becomes increasingly important in addressing a gap in the literature. In addition, because the definition of equity in the context of health has practical implications for its operationalization (Guerra, Borde, & Salgado De Snyder, 2016), this work seeks to clarify in the concept of equity used by the WHO in hopes of moving towards a shared understanding to bridge action [e.g. in measurement and accountability (Braveman & Gruskin, 2003)]

How does the social “get under the gums”? The role of socio-economic position in the oral-systemic health link

OBJECTIVES: To evaluate the extent of association between systemic inflammation and periodontal disease in American adults, and to assess whether socio-economic position mediated this relationship. METHODS: We used data from the National Health and Nutrition Examination Survey (NHANES IV) (2001-2010). Systemic inflammation was defined by individual and aggregate (cumulative inflammatory load) biomarkers (C-reactive protein, white blood cell counts, neutrophil counts, and neutrophil: lymphocyte ratio). Loss of attachment and bleeding on probing were used to define periodontal disease. Poverty:income ratio and education were indicators of socio-economic position. Covariates included age, sex, ethnicity, smoking, alcohol, and attendance for dental treatment. Univariate and multivariable logistic regressions were constructed to assess the relationships of interest. RESULTS: In a total of 2296 respondents, biomarkers of systemic inflammation and cumulative inflammatory load were significantly associated with periodontal disease after adjusting for age, sex, and behavioural factors. Socio-economic position attenuated the association between markers of systemic inflammation and periodontal disease in the fully adjusted model. CONCLUSION: Socio-economic position partly explains how systemic inflammation and periodontal disease are coupled, and may thus have a significant role in the mechanisms linking oral and non-oral health conditions. It is of critical importance that the social and living conditions are taken into account when considering prevention and treatment strategies for inflammatory diseases, given what appears to be their impactful effect on disease processes

Probing key informants’ views of health equity within the World Health Organization’s Urban HEART initiative

To date, no studies have assessed how those involved in the World Health Organization’s (WHO) work understand the concept of health equity. To fill the gap, this research poses the question, “how do Urban Health Equity Assessment and Response Tool (Urban HEART) key informants understand the concept of health equity?”, with Urban HEART being selected given the focus on health equity. To answer this question, this study undertakes synchronous electronic interviews with key informants to assess how they understand health equity within the context of Urban HEART. Key findings demonstrate that: (i) equity is seen as a core value and inequities were understood to be avoidable, systematic, unnecessary, and unfair; (ii) there was a questionable acceptance of need to act, given that political sensitivity arose around acknowledging inequities as “unnecessary”; (iii) despite this broader understanding of the key aspects of health inequity, the concept of health equity was seen as vague; (iv) the recognized vagueness inherent in the concept of health equity may be due to various factors including country differences; (v) how the terms “health inequity” and “health inequality” were used varied drastically; and (vi) when speaking about equity, a wide range of aspects emerged. Moving forward, it would be important to establish a shared understanding across key terms and seek clarification, prior to any global health initiatives, whether explicitly focused on health equity or not.publishedVersio

Large-scale automated analysis of news media: A novel computational method for obesity policy research: Novel Media Analysis of Obesity Framing

Analyzing news media allows obesity policy researchers to understand popular conceptions about obesity, which is important for targeting health education and policies. A persistent dilemma is that investigators have to read and manually classify thousands of individual news articles to identify how obesity and obesity-related policy proposals may be described to the public in the media. We demonstrate a novel method called “automated content analysis” that permits researchers to train computers to “read” and classify massive volumes of documents