Review Article: Freedom to Lead a Life We Have Reason to Value? A Spotlight on Health Inequity in the Asia Pacific Region

Friel, Sharon; Chiang, Tung Liang; Cho, Youngtae; Guo, Yan; Hashimoto, Hideki; Jayasinghe, Saroj; Loring, Belinda; Matheson, Don; Nguyen, Huong Thanh; Rao, M. R.

doi:10.1177/1010539511402053

Cited by 22 publications

(21 citation statements)

References 35 publications

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“…Infrastructural improvements and the growth of the middle class are driving the expansion and improvement of the health system and reducing geographical and economic barriers to health care, particularly for urban and non-poor rural residents. 28,29 Nonetheless, our findings show that some vulnerable groups are being left behind and that the equity gap is widening. Conditions in Viet Nam differ from those that exist in nearby countries.…”

Section: Discussionmentioning

confidence: 62%

“…The causes and determinants of these inequities are manifold and diverse, as has been shown in several studies. 29,34,35 Informal payments and a growing private sector, together with weak public health insurance, generate inequities because people's ability to pay for services parallels the increasing income divide in society. 34 Additionally, modernization has generated greater social complexity, with fewer opportunities for the less educated in society.…”

Section: Discussionmentioning

confidence: 99%

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Maternal health care utilization in Viet Nam: increasing ethnic inequity

Målqvist

Lincetto²,

Du³

et al. 2013

Bull. World Health Organ.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Maternal health care utilization in Viet Nam: increasing ethnic inequity

Målqvist

Lincetto²,

Du³

et al. 2013

Bull. World Health Organ.

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“…In a broad literature review on health inequity in Asia, Friel et al [22] stressed that the health of people in Asia is shaped by both socioe-conomic and environmental conditions, as well as persistent health inequities. They found that a lack of clean drinking water was a strong indicator of health inequity in Asia.…”

Section: Resultsmentioning

confidence: 99%

Non-communicable diseases in Indian slums: re-framing the Social Determinants of Health

Lumagbas

Coleman

Bunders

et al. 2018

Global Health Action

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Background: The epidemic of non-communicable diseases (NCDs) in slums has pushed its residents to heightened vulnerability. The Social Determinants of Health (SDH) framework has been used to understand the social dynamics and impact of NCDs, especially in poorly resourced communities. Whilst the SDH has helped to discredit the characterisation of NCDs as diseases of affluence, its impact on policy has been less definite. Given the multitude of factors that interact in the presentation of NCDs, operationalising the SDH for policies and programmes that account for the contextual complexity of slums has stalled. Objective: To organise the complex networks of relations between SDH in slums so as to identify options for Indian municipal policy that are feasible to implement in the short term. Methods: The study reviews the literature describing SDH in Indian slums, specifically those that establish causal relations between SDH and NCDs. Root cause analysis was then used to organise the identified relations of SDH and NCDs. Results: Although poverty remains the largest structural determinant of health in slums, the multi-dimensional relations between SDH and NCDs are structured around four themes that describe the dynamics of slums, namely scarce clean water, low education, physical (in)activity and transportation. From the reviewed literature, four logic trees visualising the relations between SDH in slums and NCDs were constructed. The logic trees separate symptomatic problems from their more distal causes, and recommendations were formulated based on features of these relationships that are amenable to policy intervention. Conclusion: Root cause analysis provides a means to focus the lens of examination of SDH, as evidenced here for Indian slums. It provides a guide for the development of policies that are grounded in the actual health concerns of people in slums, and takes account of the complex pathways through which diseases are socially constituted.

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“…In order to reduce inequities, it is vital that high quality, locally derived, and disaggregated data become available to inform the development, implementation, and evaluation of SDH policies and interventions and that local research cadres are available to provide this data. Research on the socio-economic drivers of health inequity is an emerging field worldwide [12–14], and there was a needed for better training possibilities for SDH research, particularly in LMICs [2, 15]. In response to this need the INTREC (INDEPTH Training & Research Centres of Excellence) collaboration developed and piloted a training programme on SDH research for health- and demographic researchers in LMIC’s in Africa and Asia.…”

Section: Introductionmentioning

confidence: 99%

Strengthening capacity to research the social determinants of health in low- and middle-income countries: lessons from the INTREC programme

et al. 2017

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BackgroundThe INDEPTH Training & Research Centres of Excellence (INTREC) collaboration developed a training programme to strengthen social determinants of health (SDH) research in low- and middle-income countries (LMICs). It was piloted among health- and demographic researchers from 9 countries in Africa and Asia. The programme followed a blended learning approach and was split into three consecutive teaching blocks over a 12-month period: 1) an online course of 7 video lectures and assignments on the theory of SDH research; 2) a 2-week qualitative and quantitative methods workshop; and 3) a 1-week data analysis workshop. This report aims to summarise the student evaluations of the pilot and to suggest key lessons for future approaches to strengthen SDH research capacity in LMICs.MethodsSemi-structured interviews and questionnaires with 24 students from 9 countries in Africa and Asia were used to evaluate each teaching block. Information was collected about the students’ motivation and interest in studying SDH, any challenges they faced during the consecutive teaching blocks, and suggestions they had for future courses on SDH.ResultsOf the 24 students who began the programme, 13 (54%) completed all training activities. The students recognised the need for such a course and its potential to improve their skills as health researchers. The main challenges with the online course were time management, prior knowledge and skills required to participate in the course, and the need to get feedback from teaching staff throughout the learning process. All students found the face-to-face workshops to be of high quality and value for their work, because they offered an opportunity to clarify SDH concepts taught during the online course and to gain practical research skills. After the final teaching block, students felt they had improved their data analysis skills and were better able to develop research proposals, scientific manuscripts, and policy briefs.ConclusionsThe INTREC programme has trained a promising cadre of health researchers who live and work in LMICs, which is an essential component of efforts to identify and reduce national and local level health inequities. Time management and technological issues were the greatest challenges, which can inform future attempts to strengthen research capacity on SDH.

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Review Article: Freedom to Lead a Life We Have Reason to Value? A Spotlight on Health Inequity in the Asia Pacific Region

Cited by 22 publications

References 35 publications

Maternal health care utilization in Viet Nam: increasing ethnic inequity

Maternal health care utilization in Viet Nam: increasing ethnic inequity

Non-communicable diseases in Indian slums: re-framing the Social Determinants of Health

Strengthening capacity to research the social determinants of health in low- and middle-income countries: lessons from the INTREC programme

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