Search Results (395)

The COVID-19 pandemic has had a diverse impact worldwide, affecting all strata of society. This article examines the relationship between health system adaptation and socioeconomic inequality in countries and the WHO Eastern Mediterranean Region (WHO-EMR), and we suggest that the dynamics among government response, health system preparedness, and epidemic spread are calibrated by the present socioeconomic inequality. With the use of a panel dataset spanning February 2020 to March 2021 and both linear (PARDL) and nonlinear (PNARDL) estimation techniques, we find that more socioeconomically vulnerable regions were disproportionately hit by the efforts of the pandemic, even in the presence of containment measures. From our findings, we find that health system capacity measures, such as hospital bed density and primary healthcare expenditure, are positively related to long-term economic resilience, while antimicrobial drug resistance is strongly negatively related to it. The study emphasizes the need for selective policy interventions to protect the most disadvantaged groups, a finding of relevance for other high-inequality low- and middle-income countries. Full article

Drawing inspiration from Stanley Kubrick’s iconic science fiction masterpiece, this study posits that the future of joint health is not confined to a singular trajectory but is instead shaped by our collective efforts towards pioneering initiatives that transcend present-day boundaries. From its inception to the horizon of 2050, the trajectory of arthroplasty presents a compelling narrative of medical innovation, socioeconomic challenges, and sustainability pursuits. This Perspective addresses the growing osteoarthritis epidemic, emphasizing the urgent need for prevention and early-intervention strategies to reduce disease progression in the context of imminent critical-raw-material scarcity and the transition to a carbon-free economy. This transition, aiming for Net Zero by 2050, may unintentionally lead to financial instabilities and healthcare disruptions—driven by supply-chain fragility and rising costs—and could thereby exacerbate inequities in access to elective joint replacement. The illustrative scenarios and conditional comparative trends presented here highlight potential co-occurring clinical, economic, and material risks under business-as-usual (BAU) assumptions. These multifaceted complexities warrant the development of coordinated strategies. By examining current trends and future challenges, this paper therefore calls for a holistic approach to the green transition that promotes multidisciplinary dialogue and policy alignment to ensure an ethical, equitable, and sustainable future for resilient arthroplasty services amid ongoing decarbonization initiatives. Full article

This study seeks to provide insight into the comprehensive efforts aimed at advancing gender justice, eliminating period poverty, and exposing stigmatizing views toward women’s bodies, specifically in relation to menstrual health. Menstruation is a normal bodily process for all women and girls, but the availability of menstrual products, dignity, and justice during menstruation remains a worrying concern. Menstruators still suffer from adverse circumstances when they menstruate, adding to their sufferings of experiencing pain and distress on a monthly basis. Menstrual hygiene requires the use of standardized menstrual products to maintain cleanliness during menses. However, women experiencing economic hardship and women who are marginalized bear the burden of inadequate hygiene amenities, basic hygiene services, and affordable menstrual products; they are victims of period poverty. The failure to recognize and effectively address menstrual issues perpetuates the idea that menstruation is a burden unique to women. In other words, government inaction on menstrual issues strengthens the perception that menstruation is an individual problem that women must manage independently. This study argues that when menstruation is identified as a bodily problem or a neglected subject, it perpetuates gender inequities and restricts access to well-suited hygiene material, which is known to cause urogenital infections. Given these challenges, the study recommends recognizing menstrual health as a serious health challenge. The absence of robust legal and international norms that specifically address menstrual health perpetuates neglect and the ongoing failure to meet the needs of menstruating women. Full article

This study analyzes the relationship between climate change and poverty in Chota Valley’s Afro-Ecuadorian communities. Using a mixed-methods approach—quantitative data from a household survey and qualitative insights from a focus group—the research explores how climate variability affects income, knowledge, and adaptive actions. The findings reveal that while most residents are aware of climate change, their understanding stems from lived agricultural experiences rather than formal education. The Proxy Means Testing (PMT) index shows that higher poverty levels correlate with greater awareness and adaptation efforts. Moreover, climate change has prompted crop substitutions (e.g., to mango), temporarily improving economic conditions. However, the study concludes that sustained resilience requires enhanced education and community-led adaptation strategies. These findings highlight the intersection of environmental vulnerability and social inequality, emphasizing the need for targeted policies and local engagement in climate action. Full article

The phenomenon of white men faculty filing lawsuits alleging that diversity, equity, inclusion, and social justice violate their free speech and academic freedom rights is instructive for how legal strategies are employed. We engaged white legal logic to examine how three white men faculty members narrated their experiences and what legal precedent was used to support their requested legal redress. The two most salient themes are as follows: (1) plaintiffs constructed a dual legal narrative, positioning themselves as both victims and champions of DEI and social justice initiatives by simultaneously mischaracterizing DEI and social justice to align with their ideological perspectives; (2) plaintiffs weaponized academic freedom and free speech legal precedents to frame their purported ideological dissent about DEI initiatives as a constitutionally protected right. In addition to identifying two major themes, we observed a pattern in legal strategies to add to white legal logic: a victimhood legal formula. Ultimately, we illuminate calculated efforts to maintain systemic inequities under the guise of law and demonstrate the enduring struggle over education’s role in a racially diverse society. Full article

Youth violence in Zimbabwe’s high-density suburbs has evolved into a severe public-health emergency, entrenching trauma, fuelling substance abuse, and amplifying structural inequities. Christian churches remain the most pervasive civic institutions in these settings, commanding high moral authority, psychosocial reach, and convening power. However, the mechanisms by which churches mitigate violence, and the constraints they face, continue to be under-researched. Grounded in socio-economic model lens and faith-based social capital theory, this study interrogates the intersections between youth violence and church responses in Zimbabwe’s urban centres. The study adopts a qualitative approach using semi-structured interviews with church leaders. Twenty (20) church leaders from mainline, Pentecostal, and Apostolic traditions were recruited through purposive and snowball sampling to capture denominational diversity and varying levels of programme engagement. Interviews probed leaders’ perceptions of youth-violence drivers, theological framings of non-violence, practical interventions (e.g., trauma-healing liturgies, anti-drug ministries, peer-mentorship schemes), and institutional constraints such as resource scarcity and political pressures. Data was analysed using reflexive thematic analysis. The findings indicate three interconnected mechanisms through which churches mitigate the cycle of violence. Nevertheless, gendered participation gaps, theological ambivalence toward activism, and limited alignment with municipal safety strategies continue to pose challenges to these efforts. By positioning churches within Zimbabwe’s broader violence-prevention ecology, the study offers an empirically grounded blueprint for integrating faith actors into city-level public-health strategies and contributes towards evidence-based, structural solutions to urban youth violence. Full article

Major immunization programs and initiatives have prioritized the advancement of equity in immunization. Over the past decade, the World Health Organization has made contributions to understanding inequalities in immunization, including global analyses of immunization inequality as well as tools for knowledge dissemination and capacity strengthening. This article provides an overview of these contributions, highlighting key findings of scholarly reports and journal articles and identifying areas for further research and development to expand monitoring efforts and enhance their impact. Global analyses have primarily drawn from household survey data to explore inequalities related to economic status, education, gender, and geography. Reports and articles address childhood immunization, COVID-19 vaccine indicators, and maternal tetanus protection. Inequalities were reported across all dimensions, with variation by country and income grouping. Time trends generally suggest persistent, though narrowing, inequalities. Areas for further development include the following: increasing awareness and political support for advancing equity in immunization; expanding the collection, availability, and use of disaggregated immunization data; continuous capacity building of inequality monitoring, especially at national and subnational levels; adapting inequality monitoring practices to changing contexts and priorities; strengthening the links between data/evidence and action/impact; and building on existing partnerships and collaborations. Full article

Introduction: Despite global improvements in immunization, major gaps persist. By 2024, an estimated 14.3 million infants, predominantly in low- and middle-income countries (LMICs), remained zero-dose (ZD), never having received even the first DTP vaccine. In 2022, 33 million children missed their measles vaccination (22 million missed the first dose, 11 million missed the second dose), highlighting entrenched structural, behavioral, and systemic barriers that continue to exclude marginalized populations. Addressing these inequities requires innovative, context-adapted approaches that strengthen primary health care (PHC) and extend services to the hardest-to-reach populations. Objectives: This study aims to document and synthesize implementation research (IR) projects on immunization programs in LMICs, identifying key enablers and effective strategies that reduce inequities, improve outcomes, and support efforts to reach ZD children. Methods: We conducted a retrospective multiple-case study of 36 IR projects across 13 LMICs, embedded within an evidence review framework and complemented by policy analysis. Data were drawn from systematic document reviews and validation discussions with project leads. A total of 326 strategies were extracted, coded using a structured codebook, and mapped to the WHO–UNICEF PHC Levers for Action. Descriptive analysis synthesized patterns across service delivery and policy outcomes, including coverage gains, improved microplanning, community engagement, and system integration. Results: Of the 326 immunization strategies identified, most (76.1%) aligned with operational PHC levers, particularly monitoring and evaluation (19.3%), workforce development (18.7%), and models of care (12%). Digital technologies (11.7%) were increasingly deployed for real-time tracking and oversight. Core strategic levers comprised 23.9% of strategies, with community engagement (8.9%) and governance frameworks (7.7%) emerging as critical enablers, though sustainable financing (4%) and private-sector engagement (0.9%) were rarely addressed. While the majority of projects focused on routine immunization (n = 32), only a few directly targeted ZD children (n = 3). Interventions yielded improvements in both service delivery and policy outcomes. Improvements in microplanning and data systems (23.5%) reflected the increased uptake of digital dashboards, GIS-enabled tools, and electronic registries. Community engagement (16.2%) emphasized the influence of local leaders and volunteers in building trust, while health system strengthening (15.7%) invested in cold chain, supervision, and workforce capacity. Coverage gains (10.6%) were achieved through delivery innovations, though sustainable financing remained a critical problem (3.4%). Conclusions: Reaching ZD children requires equity-driven strategies that combine digital innovations, community engagement, and resilient system planning. Sustained progress depends on strengthening governance, financing, and research. Embedding IR in immunization programs generates actionable evidence, supports context-specific strategies, and reduces equity gaps, offering practical insights that complement health system research and advance the Immunization Agenda 2030. Full article

This paper examines the evolving trajectory of the Social Determinants of Health (SDOH), tracing their development from early observational studies to contemporary, interdisciplinary frameworks that emphasize structural inequities and relational dynamics. It explores foundational milestones such as the Whitehall studies, the Heckler Report, and the World Health Organization’s conceptual models, which positioned SDOH as key drivers of population health. The paper highlights how upstream determinants—such as governance, policy, and socioeconomic systems—influence downstream health outcomes through mechanisms of social stratification and unequal access to resources. While SDOH are increasingly applied in clinical and educational settings, significant challenges persist, including underinvestment in community systems, fragmented care models, and political rollbacks of equity-centered policies. The paper critiques deterministic and deficit-focused framings of SDOH and underscores a shift toward more relational, context-sensitive, and agency-oriented approaches, reflected in the emerging concept of “social dynamics of health.” It highlights the importance of experiential education, competency-based curricula, and digital innovations in driving systemic transformation. Emphasis is placed on reimagining SDOH pedagogy and expanding interdisciplinary, data-driven research to bridge the gap between knowledge and practice. Amid shifting political landscapes, sustaining health equity efforts requires embracing adaptive, participatory models that acknowledge power, community agency, and structural change. Full article

Background: Pancreatic cancer is a challenging malignancy with an aggressive biology and limited treatment options, contributing to low survival rates. Supportive and palliative care play a key role in improving the quality of life and psychological distress for patients and their families. However, appropriate delivery and effectiveness of these interventions may be influenced by social determinants of health (SDOH). These factors create significant barriers for patients, influencing their access to care and ability to make informed decisions. This review explores the role of SDOH in supportive and palliative care of pancreatic cancer patients and identifies areas for improvement to enhance this type of care for vulnerable populations. Methods: A thorough narrative review was carried out to evaluate the influence of social determinants of health on supportive and palliative care in the management of pancreatic cancer, focusing on symptom management, psychosocial support, nutritional support, advance care planning, rehabilitation, functional support, and care coordination. Results: This review demonstrates that disparities exist. Black and Asian patients receive less pain medications; those with lower level of education struggle to access psychological support; Hispanic and Black patients often do not receive needed nutritional care; and end-of-life planning is less common among non-White and less-educated patients. Conclusions: SDOH significantly affects the experience and delivery of supportive and palliative care in pancreatic cancer patients, exacerbating inequities across multiple domains of care. Addressing these disparities requires coordinated efforts at clinical, organizational, and policy levels to ensure equitable access to care for all patients in their final phase of life. Integrating attention to SODH into care delivery models can improve outcomes and enhance quality of life for these patients. Full article

This theoretical article examines how belongingness, defined as the sense that one’s participation is legitimate and valued, interacts with cultural value orientations to help explain persistent disparities in U.S. technology engagement, including emerging technologies, across racial and ethnic groups. While structural barriers (e.g., racism, poverty, linguistic bias, etc.) remain essential to understanding such inequity, we argue that engagement patterns in technology also reflect how different cultural communities may define and experience belongingness in relation to digital domains. Drawing on Triandis and Gelfand’s framework, and focusing specifically on educational contexts, we propose the Belongingness through Cultural Value Alignment (BCVA) model, whereby belongingness serves as a catalyst between cultural value orientations and technology engagement, with vertical collectivism deriving belongingness primarily through structured skill development and validation while horizontal collectivism focusing instead on belonging based on community integration. When technological environments value practices that are consistent with vertical collectivist norms, individuals from horizontal collectivist cultures may experience cultural misalignment not from disinterest in technology or exclusionary efforts but, instead, because dominant engagement modes conflict with their familiar frameworks for fostering a sense of belonging. By examining how cultural value orientations mediate the sense of belonging in contexts involving modern technologies, the proposed perspective offers a novel framework for understanding why access alone may have proven insufficient to address technological participation gaps, and suggests directions for creating technology spaces where individuals from a wider range of communities can experience the authentic sense of belonging. Full article

The Sustainable Development Goals have galvanized efforts to improve access to higher education globally. While higher education has expanded over the last decade, access inequities endure, with economic deprivation, gender, and other dimensions of marginalization shaping individual opportunities to engage with higher education. Regional differences have also emerged, with some higher education systems growing at a rapid pace, driven by a variety of policy initiatives. This paper explores higher education access inequities in the Southeast Asian context, where a period of rapid higher education expansion has recently given way to complex patterns of access, against diverging national directions for higher education development. Using large-scale nationally representative data from the Demographic and Health Survey (DHS) and the Multiple Indicator Cluster Survey (MICS), this paper traces patterns of inequitable higher education access in eight Southeast Asian countries over time. This paper then discusses country-specific policy initiatives, and the levers they deploy in trying to lower higher education inequities. It explores how these country-specific policy initiatives aiming at equality or equity in higher education access sit alongside periods of sector expansion and wealth-based gaps in higher education access, to conclude about potential policy shifts which may support work towards more equitable systems. Full article

Background: Immunization coverage has increased substantially in the Western Pacific Region, saving millions of lives and supporting disease elimination efforts. However, gaps in coverage and inequitable vaccine access persist, leaving millions unvaccinated. Wealth-based inequalities remain a critical barrier to achieving equitable immunization coverage and maximizing the health benefits of vaccination programs. Methods: We analyzed full immunization coverage among 1-year-olds in 10 middle-income countries of the Western Pacific Region using data from the WHO Health Inequalities Data Repository. National and wealth quintile-specific coverage rates and within-country inequalities were assessed using absolute and relative measures (difference, ratio, slope index of inequality, and relative index of inequality). Trends over time were examined in countries with longitudinal data (n = 5), identifying pro-rich or pro-poor changes based on shifts in quintile-specific coverage. We also calculated the population attributable risk (PAR) and fraction (PAF) to estimate the potential increase in national coverage if wealth-based inequalities were eliminated. Findings: Substantial gaps in immunization coverage persist across all countries studied (n = 10), but with substantial between- and within-country disparities. Coverage was higher among the richest quintiles in half of the countries, with the rest showing no significant disparities. Trends in inequalities were mixed: Cambodia, Mongolia, and Viet Nam experienced pro-poor improvements over time; the Philippines saw widening pro-rich inequalities; and Lao PDR showed little change. Population attributable risks (PAR) showed that eliminating wealth-based inequalities could increase national coverage significantly in five countries (Fiji, Lao PDR, Papua New Guinea, Samoa, and Tonga), with relative gains that could increase national coverage by up to 50% while achieving equity gains. Conclusions: Addressing wealth-based inequalities in immunization could drive substantial gains in national coverage across the Western Pacific Region. Sustained, equity-oriented approaches are essential to achieving universal vaccine access and ensuring no population is left behind. Inequality patterns can guide equity-focused policies to reach underserved and disadvantaged populations. Full article

(1) Background: The COVID-19 pandemic exacerbated existing health inequities for Native American communities, intensifying the challenges faced in accessing addiction and recovery services. As part of a tribal-university collaborative effort in Arizona, our team explored the impacts of the COVID-19 pandemic on mental well-being and resilience among the Indigenous substance use recovery community. (2) Methods: We conducted qualitative analysis of transcribed individual interviews (n = 19) to understand the factors of resilience and mental well-being for providers of Western addiction treatment services and Indigenous community members who were in addiction recovery or engaged in addiction treatment during the pandemic. (3) Results: Four major themes that impacted mental well-being among the Indigenous recovery group during the pandemic were identified: (1) healthcare barriers; (2) culture in recovery; (3) the impact of colonization/historical trauma; and (4) the importance of relationships. (4) Conclusions: This work provides insight into the disproportionate impact of the COVID-19 pandemic on Indigenous communities and vulnerable populations such as the recovery community. Findings from this study highlight the need for Indigenous-grounded and culturally informed recovery interventions. Full article

The year 2025 marks the fifth anniversary of the COVID-19 pandemic, a crisis that profoundly disrupted secondary schools in England and intensified existing inequalities, including those experienced by LGBTQ+ students. Through an analysis of teacher interviews and the lens of intimate citizenship, this article explores how pandemic-driven changes, such as remote learning, school closures, and ‘social bubbles’, exposed the precariousness of LGBTQ+ inclusion and embodiment within educational institutions. The research highlights how cisheteronormativity was sustained through symbolic institutional compliance and cisheteronormative fragility, as LGBTQ+ inclusion was deprioritised through the erasure of safe spaces and restrictions on self-expression. While previous research has primarily focused on students’ well-being, this article centres the perspectives of teachers to consider what can be learned from their experiences to better support students in future crises. The pandemic revealed critical gaps in inclusion efforts, underscoring the urgent need for proactive strategies that extend beyond individual teacher initiatives or informal, hidden curriculum practices. The findings emphasise that LGBTQ+ visibility and inclusion must be structurally embedded within curricula, school policies, and teacher training and that the emotional and relational labour of inclusion must be institutionally recognised rather than left to individual educators. Full article