Special Issue:
Challenges and Opportunities in Health Equity
Susan Garfield, Shannon Armstrong, Julie Nguyen
Ernst & Young
Christine Hildreth, Bianca Wu, Isabella James, Sylvie Babat, Malu Foley
Abstract
Health technology assessments are evaluation tools used by decision makers and governing bodies to evaluate the relative effectiveness, safety, and cost of new health technologies. Despite the significant access and reimbursement implications of the decisions informed by health technology assessments, health equity is not consistently included in these assessments. This review explores current health technology assessment approaches using global examples, examines how health technology assessments include health equity considerations, reviews how health equity is not optimally included in health technology assessments using a case study example, and discusses emerging practices to include more health equity related metrics using examples from sponsors and health technology assessment agencies. Results show that health technology assessments do not have a consistent, clearly defined measures of health equity impact or methods to include health equity-oriented measures in assessments. Additionally, most do not provide differentiated value assessments for health equity-oriented data or impact. However, innovators and health technology assessment organizations are presenting new approaches to evaluation. Some outside groups are advocating for change and investing in developing health equity checklists and frameworks for incorporation in health technology assessments. Moving forward, more research is needed to understand how to best incorporate heath equity-oriented measures into health technology assessments and how innovators can get more involved to inform both product development and evaluation efforts. If done well, health technology assessments can be developed to reward technologies and research programs that have a significant and measurable impact on delivering more equitable health outcomes.
Leslie Zuniga-Rivas, MPH
Quality Improvement and Equity Project Manager, Center For Sustainable Health Care Quality and Equity, National Minority Quality Forum
Henry Nuss, PhD
Associate Professor, Louisiana State University Health New Orleans
Adewale Lawrence, MD, MS
CEO and Founder, Bioluminux Clinical Research Network, U.S.
Laura Hernandez
Data Quality Analyst, Baywell Health
Nushrat Sultana, MPH
Freelance Public Health Consultant, Center for Sustainable Health Care Quality and Equity, National Minority Quality Forum
Kristen Stevens Hobbs, MPH, CPH
CEO and Founder, The Equity Studio, LLC
DeLorean Ruffin, DrPH, MPH
CEO and Founder, Ruffin Consulting, LLC
Bishop Erik O. Nation
Senior Pastor, Hope Center Church of Oakland, California
Aneesa Choudhry, MPH
Quality Improvement and Equity Intern, Center For Sustainable Health Care Quality and Equity, National Minority Quality Forum
Laura Lee Hal, PhD
President Emeritus, Center for Sustainable Health Care Quality and Equity, National Minority Quality Forum
Abstract
Background: Type 2 Diabetes Mellitus (T2DM) is influenced by various factors, with racial and ethnic minorities experiencing higher prevalence. Existing diabetes management programs focus on primary prevention, often neglecting optimal hemoglobin A1C (HbA1c) management for individuals with prediabetes. Consistent HbA1c monitoring is crucial for comprehensive care. This study highlighted the need for secondary prevention and community collaboration to enhance health equity for individuals with T2DM.
The DRIVE program, conducted by the National Minority Quality Forum’s (NMQF) Center for Sustainable Health Care Quality and Equity (SHC), aimed to improve health outcomes for individuals with Type 2 Diabetes Mellitus (T2DM) in Oakland, CA. Building on prior successes in New Orleans, Los Angeles, and Queens, NY, DRIVE employs a flexible and sustainable approach that integrates quality improvement strategies at clinic sites, focusing on patient and community engagement. The study addressed barriers to medication adherence, provided Diabetes Self-Management Education and Support (DSMES), fostered community partnerships, and utilized culturally appropriate resources. The program’s impact was evaluated through changes in HbA1c levels and community participation.
Methods: A pre-and post-test design was used, targeting patients of Baywell Health, Oakland, CA, aged 18 and older with initial HbA1c levels greater than 9%. The intervention, developed using SHC’s DRIVE program, included components such as food distribution events, workflow enhancements, identification and mitigation of medication adherence barriers, rapid cycle improvement processes, community educational sessions, and the creation of patient resources. This two-year study implemented four Plan-Do-Study-Act (PDSA) cycles, each lasting 2-4 months, following a three-month planning phase. HbA1c levels were measured at baseline, six months after implementation, and again at 18-month follow-up.
Statistical Analysis
Univariate analyses described demographic data, while paired sample t-tests assessed changes in HbA1c levels. Independent sample t-tests and ANOVA with pairwise comparisons were used to determine group differences.
Results: Among the 255 participants, 58% identified as female and 42% as male. The majority were Black/African American (64%) and 73% were Non-Hispanic/Latino/a, with a mean age of 55.4 years. HbA1c levels were significantly reduced from an average of 10.3±1.4 to 9.4±2.1 at follow-up. Participants who enrolled the longest showed greater reductions. Community initiatives reached over 600 individuals, demonstrating the program’s effectiveness in building partnerships and sustainability.
Conclusion: SHC’s DRIVE program improved T2DM outcomes through community involvement, quality improvement, and culturally tailored education. This initiative highlighted the importance of addressing health inequities and barriers in diabetes care through culturally sensitive techniques and sustained interventions. DRIVE effectively reduced disparities and promoted sustainable health outcomes among minority groups. Collaborative efforts enhanced trust and demonstrated the advancement of health equity through tailored interventions, with DRIVE providing a flexible and sustainable framework for tailoring interventions to community needs. These findings underscored the need for individualized, culturally competent diabetes care, continuous education, community engagement, and equitable resource access to support communities of color and ethnic minorities in managing T2DM effectively.
Abha Agrawal, MD, FACP, FACHE
Chief Medical Officer, Humboldt Park Health, Chicago IL USA
Abstract
Equitable care has been recognized as one of the six core components of quality for over two decades, yet scant attention has been paid to understand and address healthcare disparities in the US. There is long-standing evidence of substantial health disparities and poor health outcomes along race, ethnicity and income levels in the US. The COVID-19 pandemic both exacerbated and exposed these inequities and catalyzed a national imperative to achieve equitable healthcare. The objective of this article is to provide a case study of a resource-challenged safety net hospital’s journey to advance health equity in Chicago. Humboldt Park Health (HPH) is a 200-bed independent community teaching hospital located on the West side of Chicago serving a multiracial, multilingual and socioeconomically disadvantaged population. Our journey started with the formation of a multidisciplinary health equity committee in 2021, reporting to the Board of Trustees, that was charged with formulating a strategy, developing an evidence-based framework and priorities for action, and implementing the action plan. We addressed four groups of stakeholders: our patients, our people, our organization, and our community. Our actions to advance equity have included (a) collection of patients’ demographic data such as race, ethnicity, language, sexual orientation, and gender identity; (b) assessment of social determinants of health (SDOH) along with connecting patients with social services; (c) the development of health disparities dashboards for various ambulatory preventive measures for stratification of quality data along race, ethnicity and language; (d) focus on LGBTQ+ community’s access to well-informed and sensitivity-trained behavioral health service providers, and (e) organization-wide training to embed the concepts of diversity, equity and inclusivity in the fabric of the organization. Other initiatives include the building of a community wellness center and a 100-unit affordable housing complex in the community. Digital health equity is an important domain that is being addressed by the launch of a patient portal to empower patients by providing them access to their information, and remote patient monitoring solutions. The next phase of our work involves evaluation studies to understand the impact of our interventions on health disparities and outcomes in our community.
Peter John Fos
Minority Health and Health Equity Research Center, Dillard University
Peggy Ann Honore’
Louisiana State University Health Sciences Center, School of Public Health, School of Medicine
Katrina Patchus Kellum
Dillard University, College of Nursing
Abstract
Background: The Centers for Disease Control and Prevention and its affiliate the Agency for Toxic Substances & Disease Registry established an index to identify the social vulnerability for natural disasters and infectious disease outbreaks for communities in the United States. This index, potentially, may be useful in evaluating the impact of social vulnerability on health.
Aim: The objective of the study is to identify the relationship of the Social Vulnerability index with COVID-19, chronic diseases, and life expectancy.
Methods: Social Vulnerability Index values were obtained for counties in Georgia, Louisiana (parishes), Michigan, and Mississippi. Current data on COVID-19, diabetes and obesity prevalence, premature age-adjusted death rates, and life expectancy were obtained from the County Health Ranking and Roadmaps. Pearson’s correlation coefficients were calculated for the relationship of social vulnerability and health outcomes. The relationship of funding formpublic health and social services interventions that target the social determinants of health as a mechanism for reducing community vulnerabilities was also examined.
Results: Correlations were determined between social vulnerability and several health outcomes, both infectious and chronic diseases. Life expectancy was correlated with social vulnerability, overall and by race. Study findings found a positive correlation between social vulnerability and COVID-19 infections and mortality, premature age-adjusted mortality, and the prevalence of diabetes and obesity. There is a negative correlation between social vulnerability and life expectancy. Additionally, life expectancy was greater in non-Hispanic Whites compared to non-Hispanic Blacks.
Conclusion: The study results can be used to guide policies directed to improvements in the social determinants of health that target reductions in community vulnerabilities. Social vulnerability of communities can be reduced with adequate resource allocations in public health and socialservices to mitigate untoward health outcomes associated with natural disasters and disease outbreaks.
Tarsha Jones, PhD, MSN, RN, PHNA-BC
Florida Atlantic University
Karen Wisdom-Chambers, DNP, APRN, FNP-BC, PMHNP-BC
Christine E. Lynn College of Nursing, Florida Atlantic University
Katherine Freeman, Dr.PH.
College of Medicine, Florida Atlantic University
Karethy Edwards, DrPH, APRN, FNP-BC, FAAN
Professor John F. Wymer, Jr. Endowed Distinguished Professor CEO FAU/NCHA Community Health Center. Member, National Advisory Committee, American Nurses Association/Substance Abuse and Mental Health Services Administration Minority Fellowship Program, Florida Atlantic University
Abstract
Background: In the United States (US), Black/African American women suffer disproportionately from breast cancer health disparities with a 40% higher death rate compared to White women. Mammography screening is considered a critical tool in mitigating disparities, yet Black women experience barriers to screening and are more likely to be diagnosed with advanced-stage breast cancer. The purpose of this study was to assess the relative frequency of mammography screening and to examine perceived and actual barriers to screening among women who receive care in our nurse-led community health center.
Methods: We conducted a survey examining frequency of mammography screening and beliefs about breast cancer including perceived susceptibility, perceived benefits, and perceived barriers to mammography screening, guided by the Champion Health Belief Model.
Results: A total of 30 Black/African American women completed the survey. The mean age of the participants was 54.3 years ± 9.17 (SD); 43.3% had a high school education or less; 50% had incomes below $60,000 per year; 26.7% were uninsured; 10% were on Medicaid; and only 50% were working full-time. We found that only half of the participants reported having annual mammograms 16 (53.3%), 1 (3.3%) every 6 months, 8 (26.6%) every 2-3 years, and 5 (16.7%) never had a mammogram in their lifetime. Frequently cited barriers included: ‘getting a mammogram would be inconvenient for me’; ‘getting a mammogram could cause breast cancer’; ‘the treatment I would get for breast cancer would be worse than the cancer itself’; ‘being treated for breast cancer would cause me a lot of problems’; ‘other health problems would keep me from having a mammogram’; concern about pain with having a mammogram would keep me from having one; and not being able to afford a mammogram would keep me from having one’. Having no health insurance was also a barrier.
Conclusion: This study found suboptimal utilization of annual screening mammograms among low-income Black women at a community health center in Florida and women reported several barriers. Given the high mortality rate of breast cancer among Black/African American women, we have integrated a Patient Navigator in our health system to reduce barriers to breast cancer screening, follow-up care, and to facilitate timely access to treatment, thus ultimately reducing breast cancer health disparities and promoting health equity.
Kathryn M. Yount, PhD
Hubert Department of Global Health, Rollins School of Public Health and Department of Sociology, College of Arts and Sciences, Emory University
Alicia Macler
Department of Behavioral, Social, and Health Education Sciences, Emory University
Eun-Ok Im
University of Texas at Austin, School of Nursing
Joanne A. McGriff
Hubert Department of Global Health, Rollins School of Public Health, Emory University
Michael Sacks
Goizueta Business School, Emory University
Abstract
Background: Women are under-represented in global health leadership worldwide. Socio-ecological barriers may diminish women’s institutional belonging, career aspirations, and leadership pathways.
Aims: In this pilot study, we describe and evaluate EMERGE, Empowering Women for Leadership in Global Health, a theory-based, multicomponent leadership development program for diverse women graduate students.
Methods: Emory graduate students who self-identified as women and engaged in global health were eligible to participate in EMERGE. Socio-ecologically grounded program components included: a three-day leadership development workshop; nine-month mentored team-challenge projects; monthly seminars by women leaders; social-media outreach; and project presentations with peers, mentors, and university leadership. We conducted a mixed-methods, single-group pretest-posttest evaluation that included a) four quantitative self-assessments on leadership capabilities over the program period and b) three focus groups with mentored teams that explored fellows’ experiences applying leadership skills, managing team projects, and working with mentors.
Results: All 12 selected fellows self-identified as women from at least one other underrepresented group. Half originated from low- or middle-income countries. At baseline, completing the team project was a common short-term (12-month) aspiration. Managing and leading teams emphasizing equity, mentoring, and participatory problem solving were common longer-term (1-5-year) aspirations. At baseline, fellows were least confident about negotiating their interests and most confident about making ethical decisions. Overall, fellows expressed high satisfaction with instructors (mean 8.8 of 10) and content (mean 8.3 of 10) of the leadership development workshop as well as increased confidence and proficiency in most leadership, team-management, and mentor-related skills at month one. Reported confidence and proficiency in most skills declined by program midline and then increased and peaked at endline.
Conclusion: The EMERGE program supported sustained improvements in fellows’ leadership capabilities. The program’s multi-month and multi-component approach grounded in socio-ecological theory were key elements. EMERGE holds promise to train the next generation of women leaders in global health. Future work is needed to identify opportunities to support leadership pathways for women in global health in diverse work settings.
Cerra C. Antonacci
Department of Behavioral, Social and Health Education Sciences, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
April Hermstad
Department of Behavioral, Social and Health Education Sciences, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
Regine Haardörfer
Department of Behavioral, Social and Health Education Sciences, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
Michelle C. Kegler
Department of Behavioral, Social and Health Education Sciences, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
Abstract
Objective. Assess associations between perceived fresh fruit and vegetable access and obtaining fresh fruit and vegetables from various food sources with meeting national recommendations for fruit and vegetable intakes and BMI, and whether associations differ by food insecurity.
Methods. Secondary data analysis of a cross-sectional survey evaluating a health equity initiative among 1,474 respondents in 6 rural Georgia counties. Logistic regressions assessed associations between perceived fresh fruit and vegetable access and fresh fruit and vegetable sources with meeting/not meeting fruit and vegetable recommendations and BMI, and interactions with food insecurity.
Results. Respondents who obtained fresh fruit and vegetables at small local grocery stores, farmer’s markets, and community/home gardens had twice the odds of meeting national vegetable recommendations. Food secure adults with greater perceived fresh fruit and vegetable access had 1.5 times the odds of meeting national vegetable recommendations.
Conclusions and Implications. Results highlight perceived access inequities for food insecure adults and the importance of food sources for vegetable consumption in the rural South.
Abstract
The effective design, implementation, monitoring, and evaluation of state programs to reduce racial health inequities requires measures of societal resource access (e.g., education, home ownership, voting) and access inequity by race in each state. This paper proposes criteria for the selection of social determinants to assess, and ways to combine data to assess overall access and overall access inequity in states. Access and equity can be compared across geographic regions assessed. Hypotheses regarding the determinants and consequences of access and equity can be examined. Means of validating metrics are proposed. An example of analysis of access and inequity for Blacks and Whites in U.S. states yields surprising results—social determinant access and access equity are generally greatest in southern states. These metrics can be used to target and measure the effects of interventions to advance health equity for racial minority populations. The condition of state access and equity by race indicates the culmination of structural racism.
Erin Kent, PhD, MS
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Health Services Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
Elizabeth Aimone, MS
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
Maija Reblin, PhD
Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, VT
Shakira J. Grant, MBBS, MSCR
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Medicine, Division of Hematology and Division of Geriatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC
Lixin Song, PhD, RN, FAAN
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX
Madeline Sterling, MD, MPH, MS
Department of Medicine, Weill Cornell Medicine, New York, NY
Yiqing Qian, PhD, MPH
8. Center for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, MDDepartment of Psychiatry and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
Eliza M. Park, MD, MSc
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
Abstract
Background: In rural communities around the world, individuals with serious health problems and their family caregivers often experience greater barriers to healthcare access. Identifying unmet support service needs of rural-dwelling caregivers can reveal intervention and policy targets. We examined unmet needs reported by rural caregivers in the U.S.
Methods: We used data from the 2015-2018 U.S. Behavioral Risk Factor Surveillance System that included the optional caregiving module (32 U.S. states, D.C. and Puerto Rico). We identified rural caregivers using metropolitan statistical area (rural) and the item, “During the past 30 days, did you provide regular care or assistance to a friend or family member who has a health problem or disability?” Logistic regression models incorporating sampling weights provided adjusted odds ratios (adjusted ORs) of factors associated with having any unmet support service needs, and specific need types: classes about giving care, help with service access, support groups, individual counseling, respite. Factors included sociodemographic (gender, race/ethnicity, age, education, income, employment, marital status) and caregiving-related (intensity [±20 hours/week and ±2-year duration], caregiver-care recipient relationship, and main health problem) variables.
Results: Of the 8,651 rural caregivers (representing 2.3 million) included, 16% endorsed unmet needs. Help accessing services was the most common need, followed by support groups and individual counseling. Factors associated with higher odds of any unmet need included Black vs. White race (adjusted OR: 1.74 [95%CI: 1.21-2.50]), college vs. high school graduate (adjusted OR: 1.85 [1.37-2.52]), and higher vs. lower intensity caregiving (adjusted OR: 2.18 [1.27-3.73]).
Conclusions: Many U.S. rural caregivers report unmet support service needs. Future interventions to benefit rural caregivers should target individuals and communities with the highest unmet needs.
Elizabeth Kenimer Leibach
HMES
Professor Emerita
Rutgers University
Abstract
Background: Communication gaps in health services delivery significantly compromise quality in clinical decision making. Information generated by diagnostics professionals’ accounts for much of the objective data in the clinical record and therefore is foundational in clinical decision support. This work describes the Diagnostics Consultation Model©, a diagnostics communications portal, which supports communications among interprofessional teams, providers, and institutions.
Aims: Study aims were to develop and validate a workflow prediction index (the complexity index) to assign resolution of consultation requests to diagnostics practitioners with requisite competencies based on an algorithm comprised of characteristics available at the point of consultation initiation. The complexity index functions as the entry into a workflow process directing consultation requests, first, to diagnostics practitioners for investigation and then into communication processes for tracking medical history, patient/consumer clinical information, resolution logic, conclusions, and next step recommendations among all healthcare providers.
Methods: Data to develop the complexity index (N = 325 consultation cases) were collected during daily activities in the clinical diagnostics laboratory and describe consultation characteristics important in clinical decision making and available at the point of consultation initiation. The complexity index was developed and validated by comparison of regression analyses using consultation characteristics, i.e., clinical outcomes, available at the point of consultation initiation (development) and after consultation completion (validation).
Results: Diagnostics Consultation Model© methodology links communication processes among all providers in all care settings, i.e., community, institutional, and referral, involved in the care paths of individual patient/consumers. This methodology also provides the capability to follow individuals’ medical histories longitudinally and, through regular consultations and practice-based clinical research, to address issues of medical effectiveness, cost efficiency, access, equity, timeliness, safety, and compliance.
Conclusion: Implementation of Diagnostics Consultation Model© methods and curriculum in health professions’ daily practice has the potential to change health services delivery by the redistribution of care through interprofessional teams coordinated by standardized communication processes. Employed as a systems approach to individualized patient/consumer care, the Diagnostics Consultation Model© could provide the communications technology and methodology structure for value-based healthcare continuously optimized to address the needs of individuals, populations, and health systems throughout the continuum of care.
Raj Lele
University of Michigan, Ann Arbor, Michigan, USA
Sheryl Haller
Enara Health Inc., San Mateo, California, USA
Kate David
Santa Clara University, Santa Clara, California, USA
Gaby Gutierrez
Santa Clara University, Santa Clara, California, USA
Shurouk Kattan Rahmani
University of Aleppo, Faculty of Medicine, Aleppo, Syria
M Rami Bailony
Enara Health Inc., San Mateo, California, USA
Abstract
This paper examines disparities in obesity treatment and their implications for health equity. A comprehensive literature review was performed using Pubmed, Medline, and Google Scholar to identify studies examining obesity treatment options that reported data on African Americans, Asians, Hispanics, and Caucasians. These studies, published from 2000 to 2022, revealed disparities in behavioral/lifestyle, surgical, and pharmacological interventions for obesity. While a majority of behavioral/lifestyle and surgical treatment studies found disparities in weight loss and clinical outcomes, pharmacological studies found minimal to no evidence of disparities or favorable outcomes for racial and ethnic minorities for weight and cardiometabolic outcomes. All treatment pathways showed disparities in referral rates, access, and engagement/retention. These findings underscore the urgent need to incorporate obesity treatment as a central component in strategies addressing health inequities. By understanding and addressing these disparities, healthcare equity can be improved, ensuring a more inclusive approach to obesity management.
Luca Brunelli
Division of Neonatology, Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah
Kee Chan
American College of Medical Genetics and Genomics
James Tabery
University of Utah, Department of Philosophy;
Warren Binford
University of Colorado, School of Medicine, CU Law School;
Amy Brower
American College of Medical Genetics and Genomics; Munroe-Meyer Institute, University of Nebraska Medical Center, Creighton University School of Medicine;
Abstract
The year 2023 marked the 60th anniversary of screening newborns in the United States for diseases that benefit from early identification and intervention. All around the world, the goal of NBS is to facilitate timely diagnosis and management to improve individual health outcomes in all newborns regardless of their place of birth, economic circumstances, ability to pay for treatment, and access to healthcare. Advances in technology to screen and treat disease have led to a rapid increase in the number of screened conditions, and innovations in genomics are expected to exponentially expand this number further. A system where all newborns are screened, coupled with rapid technological innovation, provides a unique opportunity to improve pediatric health outcomes and advance children’s rights, including the unique rights of sick and disabled children. This is especially timely as we approach the 100th anniversary of the 1924 Geneva Declaration of the Rights of the Child, which includes children’s right to healthcare, and the 1989 United Nations Convention on the Rights of the Child that expanded upon this aspect and affirmed each child’s right to the highest attainable standard of health. In this manuscript, we provide background on the evolving recognition of the rights of children and the foundational rights to healthcare and non-discrimination, provide two examples that highlight issues to access and equity in newborn screening that may limit a child’s right to healthcare and best possible outcomes, detail ways the current approach to newborn screening advances the rights of the child, and finally, propose that the incorporation of genomics into newborn screening presents a useful case study to recognize and uphold the rights of every child.
Juliet Anne Virginia Waterkeyn
Africa AHEAD
Abstract
Whilst the concept of Social Capital is well known in Western literature as a measure of a functional community, the indigenous African ethical code known as Ubuntu is seldom referred to in community development programmes. We undertook exploratory research to better understand the extent to which values of Ubuntu are still recognised today and if such values could be co-opted into Community Health Club programs to address the many common diseases that could be prevented by group action.
Method: A questionnaire was developed to identify key aspects of Ubuntu as lived experience in modern-day Zimbabwe and how this ethic may manifest in the ordinary lives of Zimbabweans. The survey consisted of 40 questions with a mixture of quantifiable multiple-choice questions using a Lickert scale and qualitative open-ended questions. 100+ respondents were purposely selected representing a proportionate distribution of demographics. The quantitative data was cleaned and analyzed in Excel with frequencies and percentages. The qualitative data was analysed using ‘Applied Thematic Analysis’. A Focus Group Discussion with Shona and Ndebele community development officers was held to ensure a deeper cultural interpretation of findings.
Results: The ethical code of Ubuntu was understood by 95% of the 102 final respondents, who reported they had been brought up with such values. However, socialisation of children in norms and values of Ubuntu had dropped to 75% in the current generation of parents. Social networks in both rural and urban areas were high with all but 11% belonging to a regular group, and 45% having 21 or more friends within walking distance.
For the rural areas, 64% of respondents considered ‘Ubuntu’ to be high, 68% thought ‘honesty’ is high; ‘child safety’ in rural areas is considered moderate by 50% and high by 48% but only 9% would leave the door unlocked when going out. Only 4% could cite examples of non-Ubuntu behavior in rural areas which included disrespect to elders, child disobedience, alcohol abuse, witchcraft, and gender-based violence.
In urban areas, the inverse was found: only 16% thought there was any Ubuntu at all, and 81% thought there was a high level of non-Ubuntu behaviour, with a low level of ‘honesty’, no ‘personal security’ and low ‘child safety’. 81% cited examples of erosion of Ubuntu values, such as lack of trust and reciprocity, substance abuse, little social support and immorality in sexual behaviour.
People who are guided by values of Ubuntu invest highly in community which may generate high social networks and reciprocity, although levels of trust still remain low. Unlike Ubuntu, ‘Social Capital’ is not an ethical code but is the ‘common good’ that may be the outcome if Ubuntu is practiced sufficiently by a large enough group.
Conclusion: Ubuntu is a living and valuable attribute of traditional Zimbabwean culture and could be resuscitated particularly in areas, where society is in transition from rural to urban lifestyle, to provide a secular code of ethics to promote gender equity and equality, through consensus building and preventing disease within Community Health Clubs, thereby addressing many ills of modern African society.
Marco Villanueva Reza
Infectious Disease Physician, Instituto Nacional Enfermedades Respiratorias
Sebastián Rodríguez-Llamazares
Division of Respirology and Sleep Medicine, Queen’s University Department of Medicine
Alvaro López Iñiguez
HIV and Infectious Disease Physician, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Santiago Montiel Romero
Infectious Disease Physician, Centro Medico ABC (American British Cowdray Hospital)
Arturo Galindo Fraga
Deputy Director of Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Abstract
In Latin America, the COVID-19 pandemic, which initially surged and is now a constant presence, has brought about significant health challenges due to disparities and differences in regional responses. Vaccination is not only a necessity but also a responsibility as the primary tool for prevention. However, its implementation has not been consistent across countries, leading to various challenges such as global demand, initial high costs, infrastructure limitations for distribution, public hesitance, and misinformation. Other issues, like vaccine efficacy in immunocompromised patients and the use of different vaccines, were initially questioned but are now regarded as strategies to protect patients. This region, with its unique traditions, also faces several risk factors including vaccine supply shortages, lack of vaccine manufacturing, overcrowded cities, and an increasing migrant population that adds to the vulnerability of the people, challenging countries to strive for equity in prevention strategies. It is important to address individual strategies in communities to increase vaccine uptake as part of public health policy, and collaboration between countries should be encouraged to reach more people. This review will provide information about the COVID-19 vaccines available in the region, their characteristics and composition, their use across countries, and the reported effectiveness in the general population and among those with weakened immune systems.
Christabel K. Cheung, PhD, MSW
Assistant Professor, University of Maryland School of Social Work
Laundette Jones, PhD, MPH
Associate Professor, University of Maryland School of Medicine
Haelim Lee, MSW
Doctoral Research Assistant, University of Maryland School of Social Work
Jordan N. Bridges, BSc
Graduate Research Assistant, University of Maryland School of Social Work
Reginald Tucker-Seeley, MA, ScM, ScD
Principal Owner, Health Equity Strategies and Solutions
Melissa Ana Liriano Vyfhuis, MD, PhD
Adjunct Assistant Professor in Radiation Oncology, Baltimore Washington Medical Center
Maria C. Gianelle, BS
Doctoral Research Assistant, University of Maryland School of Medicine
Bria N. Thomas, MBS
Doctoral Research Assistant, Temple University School of Podiatric Medicine
Gail Betz, MLIS
Research and Education Librarian, Health Sciences & Human Services Library
Laurie Waldo, MSW, LCSW-C
Social Worker, University of Maryland Medical Center
Alan S. Hirsch, LCSW-C
Oncology Social Work Team Lead, University of Maryland Medical Center
Shana O. Ntiri, MD, MPH
Associate Professor, Department of Family and Community Medicine, University of Maryland School of Medicine
Abstract
Background: Healthcare providers have an influential role in the experience of financial toxicity among their cancer patients, yet patients commonly report unmet needs and dissatisfaction regarding communication with their providers about financial concerns.
Aims: The purpose of this study is to develop a novel financial navigation pathway that leverages existing patient financial services and resources with corresponding patient-centered, community-informed strategies, via study participants, that may be utilized in routine care to reduce financial hardship among cancer patients.
Methods: We conducted in-depth interviews (n=50) with 34 cancer patients and 16 cancer care professionals at a National Cancer Institute designated comprehensive cancer center located in a dense urban area of the US between December 2022 to June 2023.
Results: Content analyses resulted in emergent themes and representative quotations on experiences of financial hardship within the material, behavioral, and psychosocial domains. Investigators used emergent themes to develop financial strategies and construct a financial navigation pathway to screen patients for and intervene upon the financial toxicity of cancer in routine care.
Conclusion: This study followed an innovative approach by constructing a financial navigation pathway tool that follows the oncological workflow at a National Cancer Institute designated comprehensive cancer center. Future research is needed to test the tool’s impact on financial toxicity, cancer outcomes, and other health-related outcomes, and to better understand how much patient navigation is needed to bring about meaningful change.
