Policy Approaches to Advancing Health Equity

Hall, Mary Ann Kirkconnell; Graffunder, Corinne; Metzler, Marilyn

doi:10.1097/phh.0000000000000365

Cited by 39 publications

(28 citation statements)

References 29 publications

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“…Our qualitative inquiry with PPOSBC practitioners suggests that more patient education about covered services would be helpful, particularly if it were provided in a clear and culturally sensitive fashion. Such policies would have a health equity orientation to affect these communities in significant ways and at multiple levels (Hall, Graffunder, & Metzler, 2016). …”

Section: Discussionmentioning

confidence: 99%

A Narrative Engagement Framework to Understand HPV Vaccination Among Latina and Vietnamese Women in a Planned Parenthood Setting

et al. 2017

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Disparities in cervical cancer and human papillomavirus (HPV) vaccination persist among Vietnamese and Latina women. Through a partnership with Planned Parenthood of Orange and San Bernardino Counties (PPOSBC) in Southern California, we conducted in-depth interviews with young adult Latina (n = 24) and Vietnamese (n = 24) women, and PPOSBC staff (n = 2). We purposively sampled vaccinated women to elicit HPV vaccine decision narratives to uncover rich data on motivators, cultural values, and implicit vaccine attitudes. Unvaccinated women were interviewed to identify barriers. Women were also asked to discuss their observations of men’s HPV vaccine attitudes. Narrative engagement theory guided the study privileging the meaning women ascribed to their experiences and conversations related to vaccine decision making. Vaccine decision narratives included (a) mother–daughter narratives, (b) practitioner recommendation of HPV vaccination, (c) independence narratives among Vietnamese women, (d) HPV (un)awareness narratives, and (d) school exposure to HPV knowledge. Barriers to vaccinating included trust in partner HPV status, and family silence and stigma about sexual health. Participants conveyed the importance of including messages aimed at reaching men. Practitioners described insurance barriers to offering same day vaccination at PPOSBC health center visits. Narrative communication theory and methodology address health equity by privileging how Vietnamese and Latina women ascribe meaning to their lived experiences and conversations about HPV vaccination. Identifying authentic and relatable vaccine decision narratives will be necessary to effectively engage Vietnamese and Latina women. These findings will guide the process of adapting an existing National Cancer Institute research-tested HPV vaccine intervention.

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Section: Discussionmentioning

confidence: 99%

A Narrative Engagement Framework to Understand HPV Vaccination Among Latina and Vietnamese Women in a Planned Parenthood Setting

et al. 2017

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“…An important rationale for structural change approaches is that, in theory, they promote health behavior change across the community and thus work to reduce health disparities common between privileged and underserved populations. Yet if underserved communities are less equipped to implement those changes due to limited resources or other factors (e.g., creating a new walking path without addressing neighborhood safety), there is potential for exacerbation of health disparities, where already underserved groups are less likely to experience the positive impacts of the changed environments (Golden et al, 2015; Hall, Graffunder, & Metzler, 2016; Lieberman, Golden, et al, 2013). A thorough understanding of the intersection between health inequities and structural changes is therefore necessary in order to make successful and sustainable changes.…”

Section: The Importance Of Structural Change Approaches To Health Promentioning

confidence: 99%

Evaluating Structural Change Approaches to Health Promotion: An Exploratory Scoping Review of a Decade of U.S. Progress

et al. 2017

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Structural change approaches-also known as policy and environmental changes-are becoming increasingly common in health promotion, yet our understanding of how to evaluate them is still limited. An exploratory scoping review of the literature was conducted to understand approaches and methods used to evaluate structural change interventions in health promotion and public health literature. Two analysts-along with health sciences librarian consultation-searched PubMed, Web of Science, and EMBASE for peer-reviewed U.S.-based, English language studies published between 2005 and 2016. Data were extracted on the use of evaluation frameworks, study designs, duration of evaluations, measurement levels, and measurement types. Forty-five articles were included for the review. Notably, the majority (73%) of studies did not report application of a specific evaluation framework. Studies used a wide range of designs, including process evaluations, quasi- or nonexperimental designs, and purely descriptive approaches. In addition, 15.6% of studies only measured outcomes at the individual level. Last, 60% of studies combined more than one measurement type (e.g., site observation + focus groups) to evaluate interventions. Future directions for evaluating structural change approaches to health promotion include more widespread use and reporting of evaluation frameworks, developing validated tools that measure structural change, and shifting the focus to health-directed approaches, including an expanded consideration for evaluation designs that address health inequities.

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“…When associated to the pursuance of UHC, studies from lowand middle-income countries generally explore the equity impact of UHC based on disaggregated data by geographical area, socio-economic status and gender; but another key area in which inequity may arise across both developing and developed contexts is disparities in the quality of care and access to specialised clinical services [9]. Other types of disparities in health services relate to race/ethnicity, culture, education, or other social advantages [17][18][19][20][21]. The measurement of health inequalities remains challenging and is an evolving concept [9,12,[22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

How is equity approached in universal health coverage? An analysis of global and country policy documents in Benin and Senegal

Paul

Deville

Bodson

et al. 2019

Int J Equity Health

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Background: Equity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it. We explore how the multidimensional concept of equity has been approached in key global UHC policy documents, as well as in country-level UHC policies. Methods: We analysed a purposeful sample of UHC reports and policy documents both at global level and in two Western African countries (Benin and Senegal). We manually searched each document for its use and discussion of equity and related terms. The content was summarised and thematically analysed, in order to comprehend how these concepts were understood in the documents. We distinguished between the level at which inequity takes place and the origin or types of inequities. Results: Most of the documents analysed do not define equity in the first place, and speak about "health inequities" in the broad sense, without mentioning the dimension or type of inequity considered. Some dimensions of equity are ambiguousespecially coverage and financing. Many documents assimilate equity to an overall objective or guiding principle closely associated to UHC. The concept of equity is also often linked to other concepts and values (social justice, inclusion, solidarity, human rightsbut also to efficiency and sustainability). Regarding the levels of equity most often considered, access (availability, coverage, provision) is the most often quoted dimension, followed by financial protection. Regarding the types of equity considered, those most referred to are socioeconomic , geographic, and gender-based disparities. In Benin and Senegal, geographic inequities are mostly pinpointed by UHC policy documents, but concrete interventions mostly target the poor. Overall, the UHC policy of both countries are quite similar in terms of their approach to equity. Conclusions: While equity is widely referred to in global and country-specific UHC policy documents, its multiple dimensions results in a rather rhetorical utilisation of the concept. Whereas equity covers various levels and types, many global UHC documents fail to define it properly and to comprehend the breadth of the concept. Consequently, perhaps, country-specific policy documents also use equity as a rhetoric principle, without sufficient consideration for concrete ways for implementation.

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Policy Approaches to Advancing Health Equity

Cited by 39 publications

References 29 publications

A Narrative Engagement Framework to Understand HPV Vaccination Among Latina and Vietnamese Women in a Planned Parenthood Setting

A Narrative Engagement Framework to Understand HPV Vaccination Among Latina and Vietnamese Women in a Planned Parenthood Setting

Evaluating Structural Change Approaches to Health Promotion: An Exploratory Scoping Review of a Decade of U.S. Progress

How is equity approached in universal health coverage? An analysis of global and country policy documents in Benin and Senegal

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