Chapter 2 School food approaches in Peru, Colombia and Ecuador

The purpose of this chapter is to compare approaches to school food in Peru, Ecuador and Colombia from an educational perspective, taking into consideration national policy documents, plans and programs. The focus is on the purported social justice aims of school food initiatives, including their intent to improve learning and educational achievement or the social protection of marginalized communities. The authors explore the versions of health and education that are put forth in official texts, and how these versions are supported by equity-oriented mechanisms that are advanced or affirmed in the same texts. Using thematic analysis, the most salient characteristics of food plans and programs in the three countries are synthesized, and recommendations are formulated considering that school food can be aimed at improving health and wellbeing, but not necessarily only due to its nutritional contents. The messages that are woven around food in educational settings may be equally or more important. Lastly, a brief discussion of school food policies in the context of the COVID-19 pandemic response is included

Understanding health care utilization : a theoretically-based analysis of the Ecuadorian health care system

One in four Ecuadorians do not have access to health services; while more than two-thirds have no health insurance and insufficient resources to pay for the health care services they might require. The following three studies examined utilization of health care services using Andersen’s Health Care Utilization Behavior Theory. Secondary data (in a multilevel multivariate framework) from the 2004 National Demographic and Maternal & Child Health Survey (ENDEMAIN) was the main dataset used. In this context, a better comprehension of people’s perceived needs when it comes to utilizing health care services was crucial in determining equity in the provision of services. For such purpose, the first manuscript focused on analyzing various predisposing, enabling and need factors affecting health care utilization in the Ecuadorian population. Adjusting for various predisposing, enabling, and need factors, economic status and ethnicity were significant predictors of health care utilization. Study 2 analyzed the context in which individual health care utilization behavior occurred, focusing on the provision of services and health outcomes. In addition to the main dataset, province-level data from the Ecuadorian System of Social Indicators (SIISE) and the Institute of Statistics and Census (INEC) were included. Spatial autocorrelation scores revealed no significant spatial clustering of provider measures by province, excepting for public practice health personnel. In multilevel models, public practice health personnel was found to be associated with use of preventive care (positively) and antiparasitic medicines (negatively). The density of public inpatient clinics was positively associated with solution of the second reported health problem. Finally, study 3 assessed the relationship between emigrant remittances and health care utilization in Ecuador. Emigrant predictors were strongly associated with use of antiparasitic medicines, and to a lesser extent to curative visits, even after adjusting for various predisposing, enabling, and need factors. In general, Ecuadorian policymakers need to pay closer attention to inequalities, contextual factors, and the influence of emigrant remittances in advancing health care reform

Is there a link between wealth and cardiovascular disease risk factors among Hispanic/Latinos? Results from the HCHS/SOL Sociocultural Ancillary Study

Objective. To examine the relationship between wealth and cardiovascular disease risk factors among Hispanic/Latinos of diverse backgrounds. Design. This cross-sectional study used data from 4,971 Hispanic/Latinos, 18 to 74 years, who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) baseline exam and the HCHS/SOL Sociocultural Ancillary Study. Three objectively measured cardiovascular disease risk factors (hypertension, hypercholesterolemia, and obesity) were included. Wealth was measured using an adapted version of the Home Affluence Scale, which included questions regarding the ownership of a home, cars, computers, and recent vacations. Results. After adjusting for traditional socioeconomic indicators (income, employment, education), and other covariates, we found that wealth was not associated with hypertension, hypercholesterolemia or obesity. Analyses by sex showed that middle-wealth women were less likely to have hypercholesterolemia or obesity. Analyses by Hispanic/Latino background groups showed that while wealthier Central Americans were less likely to have obesity, wealthier Puerto Ricans were more likely to have obesity. Conclusion. This is the first study to explore the relationship between wealth and health among Hispanic/Latinos of diverse backgrounds, finding only partial evidence of this association. Future studies should utilize more robust measures of wealth, and address mechanisms by which wealth may impact health status among Hispanic/Latinos of diverse backgrounds in longitudinal designs

Prevalence and Correlates of Food Insecurity Among Students Attending a Midsize Rural University in Oregon

Objective: To examine the prevalence and identify correlates of food insecurity among students attending a rural university in Oregon. Methods: Cross-sectional non-probability survey of 354 students attending a midsize rural university in Oregon during May 2011. Main outcome was food insecurity measured using the USDA Household Food Security Survey Module: Six-Item Short Form. Socioeconomic and demographic variables were included in multivariate logistic regression models. Results: Over half of students (59%) were food insecure at some point during the previous year. Having fair/poor health (OR: 2.08, 95%CI: 1.07 – 4.63), being employed (OR: 1.73, 95%CI: 1.04 – 2.88) and with incomes below $15,000 per year (OR: 2.23, 95% CI: 1.07 – 4.63) was associated with food insecurity. In turn, good academic performance (GPA 3.1 or higher) was inversely associated with food insecurity. Conclusions: Food insecurity seems to be a significant issue for college students. It is necessary to expand research on different campus settings, and further strengthen support systems to increase access to nutritious foods for this population

¿Reforma de salud en Ecuador como modelo de éxito? Crítica al número especial de la Revista Panamericana de Salud Pública

En mayo de este año, la Revista Panamericana de Salud Pública dedicó un número especial a promover el proceso más reciente de reforma de salud en Ecuador como un caso exitoso en la región. En el artículo editorial, la directora de la Organización Panamericana de la Salud (OPS), Carissa Etienne, plantea que los “sistemas de salud deben hallar modos innovadores para organizar y financiar los servicios de salud para poder progresivamente extender la cobertura, incrementar el acceso equitativo al cuidado, y proveer protección financiera, especialmente para los grupos poblacionales más vulnerables” (traducción propia). En principio, llama la atención que se presente una visión sesgada del proceso de reforma, donde priman opiniones de funcionarios del gobierno y consultores del Ministerio de Salud Pública (MSP) y la OPS, en detrimento de contribuciones desde la academia y organizaciones de la sociedad civil. Adicionalmente, los autores plantean la atención primaria de salud (Modelo de Atención Integral de Salud, MAIS) como estrategia de reforma..

Psychometric Properties of a Healthcare Discrimination Scale Among Young-Adult Latinos

Objectives A growing body of research has found that healthcare discrimination is a significant barrier in accessing healthcare among Latino patients. Despite evidence of the effects of perceived discrimination among Latinos, psychometric testing of scales used in previous research is limited. The present study explored the psychometric properties of a healthcare discrimination scale (HDS) among young-adult Latinos. Methods We used data from a cross-sectional study of young-adult Latinos, primarily of Mexican heritage, living in rural Oregon. Bilingual, bicultural staff members conducted computer-assisted personal interviews matched by gender with 313 individuals who completed the interview in Spanish (n = 137) or English (n = 176). The interview guide included questions for the HDS and the experiences of discrimination (EOD) and acculturation scales, and satisfaction with healthcare services. Psychometric testing included exploratory factor analysis, internal consistency, split-half reliability, and convergent, discriminant, and predictive validity. Results The HDS scale had high internal consistency (Cronbach’s α = 0.92), was strongly correlated with the EOD scale (r = 0.70, p < 0.001), and weakly correlated with the acculturation scale (r = 0.17, p < 0.01). Discriminant validity was stronger among English speakers (r = − 0.06, p = 0.422). Split-half reliability was 0.87 (p < 0.001). Confirmatory factor analysis yielded a one-factor solution for both Spanish and English language respondents. The HDS was significantly associated with satisfaction with healthcare services, indicative of good predictive validity. Conclusions These results suggest that the healthcare discrimination scale is a valid and reliable tool to use among Spanish and English-speaking young-adult Latinos. Further testing is needed among Latinos of other ages and background groups

Centering Communities of Color in the Modernization of a Public Health Survey System: Lessons from Oregon

Context: Public health survey systems are tools for informing public health programming and policy at the national, state, and local levels. Among the challenges states face with these kinds of surveys include concerns about the representativeness of communities of color and lack of community engagement in survey design, analysis, and interpretation of results or dissemination, which raises questions about their integrity and relevance. Approach: Using a data equity framework (rooted in antiracism and intersectionality), the purpose of this project was to describe a formative participatory assessment approach to address challenges in Oregon Behavioral Risk Factor Surveillance System (BRFSS) and Student Health Survey (SHS) data system by centering community partnership and leadership in (1) understanding and interpreting data; (2) identifying strengths, gaps, and limitations of data and methodologies; (3) facilitating community-led data collection on community-identified gaps in the data; and (4) developing recommendations. Results: Project team members’ concerns, observations, and critiques are organized into six themes. Throughout this engagement process, community partners, including members of the project teams, shared a common concern: that these surveys reproduced the assumptions, norms, and methodologies of the dominant (White, individual centered) scientific approach and, in so doing, created further harm by excluding community knowledges and misrepresenting communities of color. Conclusions: Meaningful community leadership is needed for public health survey systems to provide more actionable pathways toward improving population health outcomes. A data equity approach means centering communities of color throughout survey cycles, which can strengthen the scientific integrity and relevance of these data to inform community health efforts

Improving Parental Engagement for Latino Youths\u27 Educational Success: Lessons from Juntos Oregon

Research has shown that more efforts are needed to increase high school completion and postsecondary enrollment among Latino youths. However, little is known regarding efforts that engage both Latino youths and their parents. To address this gap, we surveyed Juntos Oregon participants to examine the school and community context Latino youths and their families face in the educational journey and identify effects of the Juntos program. Results showed that in a context of persistent discrimination and unfair treatment, Juntos workshops increased the sense of school and community connectedness among Latino parents. Increases in academic planning and motivation occurred as well. Extension may increase its educational impact by strengthening connections and promoting engagement between schools and Latino families

Improving Parental Engagement for Latino Youths' Educational Success: Lessons from Juntos Oregon

Research has shown that more efforts are needed to increase high school completion and postsecondary enrollment among Latino youths. However, little is known regarding efforts that engage both Latino youths and their parents. To address this gap, we surveyed Juntos Oregon participants to examine the school and community context Latino youths and their families face in the educational journey and identify effects of the Juntos program. Results showed that in a context of persistent discrimination and unfair treatment, Juntos workshops increased the sense of school and community connectedness among Latino parents. Increases in academic planning and motivation occurred as well. Extension may increase its educational impact by strengthening connections and promoting engagement between schools and Latino families