Coupled ethical-epistemic analysis of public health research and practice: categorizing variables to improve population health and equity

The categorization of variables can stigmatize populations, which is ethically problematic and threatens the central purpose of public health: to improve population health and reduce health inequities. How social variables (e.g., behavioral risks for HIV) are categorized can reinforce stigma and cause unintended harms to the populations practitioners and researchers strive to serve.<p></p> Although debates about the validity or ethical consequences of epidemiological variables are familiar for specific variables (e.g., ethnicity), these issues apply more widely.<p></p> We argue that these tensions and debates regarding epidemiological variables should be analyzed simultaneously as ethical and epistemic challenges. We describe a framework derived from the philosophy of science that may be usefully applied to public health, and we illustrate its application.<p></p&gt

Urban-rural inequalities in suicide among elderly people in China: a systematic review and meta-analysis

Background: China has an unusual pattern of suicides, with overall suicide rates in rural areas higher than urban areas. While suicide rates have decreased dramatically, older people increasingly contribute to the overall burden of suicide. However, it is unclear if elderly people within rural areas experience greater suicide risk than those in urban areas. We aimed to systematically review the incidence of suicide in rural and urban China among the elderly (aged over 60 years), with a view to describing the difference in rates between rural and urban areas and trends over time. Methods: Chinese and English language articles were searched for using four databases: EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (EBSCOhost) and CNKI (in Chinese). Articles describing completed suicide among elderly people in both rural and urban areas in mainland China were included. The adapted Newcastle-Ottawa Scale (NOS) was used to assess risk of bias. One reviewer (ML) assessed eligibility, performed data extraction and assessed risk of bias, with areas of uncertainty discussed with the second reviewer (SVK). Random effects meta-analysis was conducted. Suicide methods in different areas were narratively summarised. Results: Out of a total 3065 hits, 24 articles were included and seven contributed data to meta-analysis. The sample size of included studies ranged from 895 to 323.8 million. The suicide rate in the general population of China has decreased in recent decades over previous urban and rural areas. Suicide rates amongst the elderly in rural areas are higher than those in urban areas (OR = 3.35; 95% CI of 2.48 to 4.51; I2 = 99.6%), but the latter have increased in recent years. Insecticide poisoning and hanging are the most common suicide methods in rural and urban areas respectively. Suicide rates for these two methods increase with age, being especially high in elderly people. Conclusions: The pattern of suicide in China has changed in recent years following urbanisation and aging. Differences in suicide rates amongst the elderly exist between rural and urban areas. Addressing the high suicide rate amongst the elderly in rural China requires a policy response, such as considering measures to restrict access to poisons

Determinants of eco-anxiety: cross-national study of 52,219 participants from 25 European countries

No abstract available

Tackling population health challenges as we build back from the pandemic

Gerry McCartney and colleagues argue for a new model of equitable, holistic, and sustainable public health should be central to recovery plan

Analysis Protocol: Constructions of Mental Health and Problematic Alcohol Use Within UK’s Health and Welfare Policy

No abstract available

Development processes for e-cigarette public health recommendations lacked transparency in managing conflicts of interest

Objectives: To investigate how guideline development groups collect and manage conflicts of interest (COI) when producing electronic cigarette (e-cigarette) recommendations. Study Design and Setting: Public health bodies that had produced e-cigarette recommendations were identified from four purposively selected jurisdictions (WHO, UK, Australia, USA). We analysed their COI policies and conducted 15 interviews with guideline methodologists, policymakers and academics in guideline development groups. Results: Only five of ten public health bodies had a publicly available COI policy. Participants discussed the importance of those involved in the development process declaring COI. However, there were differences in who had to report COI, the time period asked about, and what and how declarations are made. COI policies and participants discussed a range of approaches for managing COI, from limiting involvement to disqualification from the recommendation development process. Participants considered the current processes for collecting and managing COI insufficient due to their open interpretation and possibility for partial declarations of interest. Conclusion: The management of COI varies across public health bodies, with little standardisation and lack of transparency. To improve the collection and management of COI, and ultimately increase the trustworthiness of recommendations, guideline development groups should draw upon a comprehensive and accessible COI policy

Inequalities in all-cause and cause-specific mortality across the life course by wealth and income in Sweden: a register-based cohort study

Background: Wealth inequalities are increasing in many countries, but their relationship to health is little studied. We investigated the association between individual wealth and mortality across the adult life course in Sweden. Methods: We studied the Swedish adult population using national registers. The amount of wealth tax paid in 1990 was the main exposure of interest and the cohort was followed up for 18 years. Relative indices of inequality (RII) summarize health inequalities across a population and were calculated for all-cause and cause-specific mortality for six different age groups, stratified by sex, using Poisson regression. Mortality inequalities by wealth were contrasted with those assessed by individual and household income. Attenuation by four other measures of socio-economic position and other covariates was investigated. Results: Large inequalities in mortality by wealth were observed and their association with mortality remained more stable across the adult life course than inequalities by income-based measures. Men experienced greater inequalities across all ages (e.g. the RII for wealth was 2.58 [95% confidence interval (CI) 2.54–2.63) in men aged 55–64 years compared with 2.29 (95% CI 2.24–2.34) for women aged 55–64 years), except among the over 85s. Adjustment for covariates, including four other measures of socio-economic position, led to only modest reductions in the association between wealth and mortality. Conclusions: Wealth is strongly associated with mortality throughout the adult life course, including early adulthood. Income redistribution may be insufficient to narrow health inequalities—addressing the increasingly unequal distribution of wealth in high-income countries should be considered