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Health Disparities in Low- and Middle-Income Countries

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 12517

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Special Issue Editor

Prof. Dr. Báltica Cabieses

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Guest Editor

1. Social Studies in Health Program, Universidad del Desarrollo, Santiago 7710162, Chile
2. Department of Health Sciences, University of York, York YO10 5DD, UK
Interests: social inequities in health; health of international migrants and participation of patients in decision-making on health coverage

Special Issue Information

Dear Colleagues,

A Special Issue on Health Disparities in Low- and Middle-Income Countries, in the International Journal of Environmental Research and Public Health, is being organized. For detailed information on the journal, I refer you to https://www.mdpi.com/journal/ijerph.

For the current 2021 fiscal year, low-income economies are defined as those with a GNI per capita, calculated using the World Bank Atlas method, of USD 1045 or less in 2020; lower middle-income economies are those with a GNI per capita between USD 1046 and USD 4095; upper middle-income economies are those with a GNI per capita between USD 4096 and USD 12,695. For their part, high-income economies are those with a GNI per capita of USD 12,696 or more. Socioeconomic disparities in health and healthcare across and within LMICs are a major global public health issue, as they reflect structural influences of unequal opportunities between individuals and communities to nurture, grow, and flourish throughout the life course. Such social disparities in health and healthcare are pervasive, difficult to modify, and cause significant premature deaths and DALYs in LMICs. Population health in LMICs needs more investigation and action in relation to health disparities. Current data describes, to some extent, our understanding of this matter in some critical health conditions and social groups. In our globalised and changing world, evidence needs to be pushed forward, questioned, and updated in relation to how and why social inequalities affect population health in LMICs. Moreover, we need to disentangle the role of governments, non-governmental organizations, international organizations, among others, in these influences. As we see the world rapidly adapting to new social and health scenarios during and after the COVID-19 pandemic, we also need to re-establish our theories, methodologies, and analytical tools to better reflect and understand how social disparities influence population health, as well as the role of health care systems in the challenging contexts of LMICs.

This Special Issue is open to the subject area of Health Disparities in Low- and Middle-Income Countries. The keywords listed below provide an outline of some of the possible areas of interest.

Prof. Dr. Báltica Cabieses
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

LMICs
prevention
treatment
health care systems
access to health care
barriers to health care
epidemiology
multi-morbidity
socioeconomic status and population health
socioeconomic inequalities in health
poverty
risk factors
financing
health care settings
experience and perception (patients, carers, and practitioners)
health care contexts
gaps in health and health care
gradients in health and health care
health care planning
international cooperation
non-governmental organizations
universal coverage
community-based interventions
health technology assessment
health care prioritization
climate change and global change
natural disasters
antimicrobial resistance
chronic conditions
infectious diseases
eHealth
COVID-19

Published Papers (6 papers)

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Research

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13 pages, 958 KiB

Open AccessArticle

Socioeconomic Disparities in Individual-Level Quality-Adjusted Life Years throughout Remaining Lifetimes: A National Representative Longitudinal Survey in China

by Xinyi Huang, Xingtong Pei, Weiyan Jian and Mingming Xu

Int. J. Environ. Res. Public Health 2023, 20(5), 4612; https://doi.org/10.3390/ijerph20054612 - 05 Mar 2023

Cited by 1 | Viewed by 1312

Abstract

Socioeconomic disparities in health within and across low- and middle-income countries pose a significant global public health concern. While prior research has demonstrated the importance of socioeconomic status on health outcomes, few studies have employed comprehensive measures of individual-level health such as quality-adjusted life years (QALYs) in exploring the quantitative relationship. In our study, we employed QALYs to measure individual-level health, using health-related quality of life scores based on the Short Form 36 and predicted remaining life years through individual-specific Weibull survival analysis. We then constructed a linear regression model to explore the socioeconomic factors that influence QALYs, providing a predictive model of individual-level QALYs throughout remaining lifetimes. This practical tool can help individuals predict their remaining healthy life years. Using data from the China Health and Retirement Longitudinal Study between 2011 and 2018, we found that education and occupation were the primary factors influencing health outcomes among individuals aged 45 and above, while income appeared to have less of an impact when education and occupation were simultaneously controlled for. To promote the health status of this population, low- and middle-income countries should prioritize the long-term advancement of their population’s education while controlling unemployment rates in the short term. Full article

(This article belongs to the Special Issue Health Disparities in Low- and Middle-Income Countries)

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22 pages, 1068 KiB

Open AccessArticle

Perceptions of Health Needs among Venezuelan Women Crossing the Border in Northern Chile during the COVID-19 Pandemic

by Alice Blukacz, Alejandra Carreño Calderon, Alexandra Obach, Báltica Cabieses, Jeniffer Peroncini and Alejandra Oliva

Int. J. Environ. Res. Public Health 2022, 19(22), 15175; https://doi.org/10.3390/ijerph192215175 - 17 Nov 2022

Cited by 6 | Viewed by 1714

Abstract

In parallel to the COVID-19 pandemic, Chile has experienced a significant influx of international migrants, many of whom are Venezuelan women who have entered the country through unauthorized crossing points. In this context, gender and migration intersect as the social determinants of health, leading to their experiencing a range of adverse events. This poses important challenges in terms of short- and long-term health outcomes, the social determinants of health, and access to healthcare. This study aims at describing Venezuelan women’s perceptions of their health needs as they migrate to Chile via an unauthorized crossing point, with a focus on adverse events throughout the migration cycle, self-reported health needs, and responses. A qualitative case study was carried out with 22 participants in the Antofagasta region of Chile, including Venezuelan migrant women, healthcare professionals, and social workers from the public healthcare system, stakeholders from non-governmental and international organizations, and local government officials. The semi-structured, individual interviews were analyzed thematically. The results show that Venezuelan women face a range of adverse events throughout the migration cycle. The perceived health needs that are reported are sometimes linked to these adverse events or existed prior to migration and were exacerbated throughout the migratory cycle. Addressing these physical and mental health needs is essential for short- and long-term individual and public health; however, despite substantial efforts to ameliorate the situation, persisting gaps in access to care are reported. Full article

(This article belongs to the Special Issue Health Disparities in Low- and Middle-Income Countries)

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13 pages, 897 KiB

Open AccessArticle

The Validity and Reliability of the PHQ-9 and PHQ-2 on Screening for Major Depression in Spanish Speaking Immigrants in Chile: A Cross-Sectional Study

by Antonia Errazuriz, Rodrigo Beltrán, Rafael Torres and Alvaro Passi-Solar

Int. J. Environ. Res. Public Health 2022, 19(21), 13975; https://doi.org/10.3390/ijerph192113975 - 27 Oct 2022

Cited by 6 | Viewed by 2937

Abstract

Background: The study aimed to explore the psychometric properties of two versions of the Patient Health Questionnaires (PHQ-9 and PHQ-2) on screening for Major Depressive Disorder (MDD) among Spanish-speaking Latin American adult immigrants in Santiago, and to explore factors associated with a higher risk of occurrence of MDD among them. Methods: A representative sample of 897 Spanish-speaking immigrants completed the PHQ-9. The Composite International Diagnostic Interview (CIDI) was employed to evaluate MDD. Internal consistency and structural validity were evaluated using Cronbach’s α coefficient and confirmatory factor analysis (CFA). Convergent validity with the 7-item General Anxiety Disorder Scale (GAD-7) was assessed using Spearman’s correlations. Sensitivity, specificity, positive predictive values, and area under the receiver operating characteristic (ROC) curve were calculated for different cut-off points. Logistic regression analysis was used to identify factors associated with the risk of MDD. Results: Cronbach’s α coefficient of the PHQ-9 was 0.90; item-total correlation coefficients ranged from 0.61 to 0.76 and correlation with the GAD-7 was moderate (r = 0.625; p < 0.001). CFA on three alternative models suggests a plausible fit in the overall sample and among two of the subsamples: Peruvians and Venezuelans. Taking the results of CIDI as the gold standard for MDD, the area under the ROC curve was 0.91 (95% confidence interval (CI): 0.83~1.0). When the cut-off score was equal to 5, values of sensitivity, specificity, and Youden’s index were 0.85, 0.90, and 0.75, respectively. Multivariate logistic regression analyses showed that the influence of having three or more children (OR = 3.91, 95% CI: 1.20~12.81; p < 0.05), residency in Chile of up to three years (OR = 1.79, 95% CI: 1.07~3.00; p < 0.05), active debt (OR = 2.74, 95% CI: 1.60~4.70; p < 0.001), a one (OR = 2.01, 95% CI: 1.03~3.94; p < 0.05) and two or more events of adversity during childhood (OR = 5.25, 95% CI: 1.93~14.3; p < 0.01) on the occurrence of MDD was statistically significant. Reliability (α = 0.62), convergent (r = 0.534; p < 0.01) and criterion (AUC = 0.85, 95% CI: 0.67~1.00) validity coefficients of the PHQ-2 were weaker than for the PHQ-9. Conclusions: The PHQ-2 and the PHQ-9 are reliable and valid instruments for use as screeners for MDD among Spanish-speaking populations of Latin America. Full article

(This article belongs to the Special Issue Health Disparities in Low- and Middle-Income Countries)

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19 pages, 415 KiB

Open AccessArticle

Latin American Youths’ Migration Journeys and Settlement in the Tarapacá Region in Chile: Implications for Sexual and Reproductive Health

by Alexandra Obach, Alejandra Carreño and Michelle Sadler

Int. J. Environ. Res. Public Health 2022, 19(20), 13583; https://doi.org/10.3390/ijerph192013583 - 20 Oct 2022

Cited by 2 | Viewed by 1592

Abstract

The sexual and reproductive health of young migrants has not been sufficiently addressed in mobility studies. In this article, we dwell on some aspects of this issue in the migration process of Latin American youth. We conducted a qualitative study in the region of Tarapacá, Chile, carrying out in-depth interviews with key informants, health staff and young migrants between 18 and 25 years old. The results show some motivations to migrate related to sexual and reproductive health: young pregnant women, LGBTQI+ and HIV-positive people seeking access to health care and social contexts of reduced gender discrimination. During the migration process, young people are exposed to various kinds of sexual violence, and in their settlement in Chile, to situations of racism, stigma and discrimination in society as a whole and in access to and during sexual and reproductive health care. Health care for young migrants is mainly focused on maternal care and reproductive issues, while sexual health as a whole is disregarded. We argue that sexual health must be addressed as a central dimension of the lived experiences of young migrants, and that the social, cultural and structural factors that undermine their sexual and reproductive health must be addressed in order to provide culturally competent health services. Full article

(This article belongs to the Special Issue Health Disparities in Low- and Middle-Income Countries)

22 pages, 1723 KiB

Open AccessArticle

The Effect of the “Triple-Layer Medical Security” Policy on the Vulnerability as Expected Poverty of Rural Households: Evidence from Yunnan Province, China

by Jingjing Zhou, Yaoyu Zhang, Yong Sha, Jianfang Zhou, Hang Ren, Xin Shen and Hui Xu

Int. J. Environ. Res. Public Health 2022, 19(19), 12936; https://doi.org/10.3390/ijerph191912936 - 10 Oct 2022

Cited by 3 | Viewed by 1593

Abstract

China launched the “critical battle against poverty” nationwide in 2012. As its main battlefield, Yunnan province promulgated the “triple medical security” (TMS) policy in 2017. This study, based on the pooled cross-section database of 2015–2020 of registered poor households in Yunnan province, employed the logit model to examine the effect of TMS on the vulnerability as expected poverty (VEP) of these households. It found that increasing the reimbursement rates for overall medical expenses and inpatient expenses and decreasing the proportion of out-of-pocket medical payment to income reduced the VEP; increases in the number of sick people in the family increased its VEP, and although the increase in the reimbursement rate for overall medical expenses or for inpatient expenses partially offset the VEP caused by the increase in the number of chronically ill people in the family, the VEP caused by the increase in the number of critically ill people would increase in the short term with the increase in the reimbursement rate for overall medical expenses or for inpatient expenses. The findings help improve policies concerning the medical security and health of the rural poor population, providing theoretical reference and practical guidance for future research. Full article

(This article belongs to the Special Issue Health Disparities in Low- and Middle-Income Countries)

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Review

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18 pages, 850 KiB

Open AccessReview

Health in Chile’s Recent Constitutional Process: A Qualitative Thematic Analysis of Civil Proposals

by Baltica Cabieses, Sophie Esnouf, Alice Blukacz, Manuel A. Espinoza, Edward Mezones-Holguin and René Leyva

Int. J. Environ. Res. Public Health 2022, 19(24), 16903; https://doi.org/10.3390/ijerph192416903 - 16 Dec 2022

Cited by 1 | Viewed by 1610

Abstract

(1) Background: In response to the recent political crisis in Chile, the “Agreement for Social Peace and the New Constitution’’ was approved. We aimed to analyze the health-related civil proposals uploaded to the official website for popular participation in the new constitution in Chile. (2) Methods: We carried out a qualitative thematic analysis of 126 health-related valid proposals. Moreover, we analyzed their link to the Health Goals 2030, established by the Ministry of Health of Chile and to the Sustainable Development Goals (SDGs). (3) Results: Sixteen main categories were reached. In all, they were organized into four main areas: (i) the right to health and the establishment of a universal health system; (ii) effective access to selected healthcare services; (iii) improving health outcomes for all and for the relevant subgroups; and (iv) the social determinants of health, health in all the policies, and community health. We found that these four areas were strongly linked to the Health Goals 2030 for Chile and to the SDGs. (4) Conclusions: Despite the fact that the new constitutional proposal was rejected in September 2022, the civil health-related proposals and the areas of health and healthcare were of interest to the citizens as the request showed a strong demand from the population for participation in matters of health, healthcare, and public health. Full article

(This article belongs to the Special Issue Health Disparities in Low- and Middle-Income Countries)

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