Still time to submit your article: Equity in Primary Health Care Provision – More than 50 years of the Inverse Care Law

Dr Liz Sturgiss and I are guest editing a special issue of the Australian Journal of Primary Health on Equity in Primary Health Care Provision – More than 50 years of the Inverse Care Law.

There’s still time to submit your EOI for inclusion in the special issue, in the form of abstracts are due by 30 March 2022. Full submissions are due by 15th July 2022.

Key areas

We welcome submissions of primary research as well as commentary and review papers from anywhere in the world. We particularly seek submissions based on:

  • Comprehensive primary health care for specific populations, including
    – prison populations
    – Aboriginal and Torres Strait Islander health and First Nations
    – culturally and linguistically diverse communities
    – people living in poverty
    – populations experiencing homelessness and unhoused people
    – rural and remote health
  • Models of care and health services research
  • Team based care and exploration of scope of practice
  • Policy innovations and funding models
  • Community-based responses to the needs of marginalised and oppressed groups

More information on the Australian Journal for Primary Health website.

Conceptualising how emerging infectious diseases exacerbate inequalities

There’s a really interesting commentary piece by Prof Clare Bambra in the International Journal for Equity in Health about Pandemic inequalities: emerging infectious diseases and health equity. It discusses how unequal exposure, susceptibility, transmission and treatment all exacerbate and compound health inequalities associated with infectious diseases.

We can see this in the earlier COVID waves in Australia (omicron is playing out differently, at least partly because it’s so transmissible), where cases clustered in regions and communities and often transmitted through workplaces and social networks unequally.

References

Bambra, C. (2022). Pandemic inequalities: emerging infectious diseases and health equity. International Journal for Equity in Health, 21(1), 6. https://doi.org/10.1186/s12939-021-01611-2

“The availability of good medical care tends to vary inversely with the need of the population served” – Submit your article to our special issue marking fifty years of the inverse care law

Dr Liz Sturgiss and I are guest editing a special issue of the Australian Journal of Primary Health on “Equity in Primary Health Care Provision: More than 50 years of the Inverse Care Law”.

Tudor Hart, J. (1971). The inverse care law. The Lancet297(7696), 405–412.

The special issue will cover a range of topics, including:

  • Comprehensive primary health care for specific populations, including
    – prison populations
    – Aboriginal and Torres Strait Islanders, and First Nations
    – culturally and linguistically diverse communities
    – people living in poverty
    – populations experiencing homelessness and unhoused people
    – rural and remote health.
  • Models of care and health services research.
  • Team based care and exploration of scope of practice.
  • Policy innovations and funding models.
  • Community-based responses to the needs of marginalised and oppressed groups.

There’s more information on the special issue and the Australian Journal of Primary Health herehttps://www.publish.csiro.au/py/content/CallforPapers#1. Final submissions are due by 15 July 2022 but we’re asking that people submit EOIs in the form of an abstract by 30 March 2022.

Promoting the Get Healthy information and coaching service in Australian-Chinese communities: facilitators and barriers

My colleagues Dr Cathy O’Callaghan, An Tran, Nancy Tam, A/Prof Li Ming Wen and I published an article on a pilot telephone health coaching program for Chinese Mandarin and Cantonese-speaking communities, which uses bilingual coaches and translated materials. The study found that:

The bilingual program was culturally and linguistically appropriate and addressed risk factors for chronic conditions. Participants formed positive relationships with bilingual coaches who they preferred to interpreters. They felt the program promoted healthy eating, weight and physical activity. Although Chinese stakeholders had concerns about participants’ ability to goal set, participants said they met their health goals and were committed to the GHS program. Strategies to enhance the program included promoting the bilingual GHS to the communities and stakeholders. Factors to consider beyond language in adapting the program to the Australian Chinese communities include meeting the heterogenous needs of the older population, ensuring community engagement and addressing cultural beliefs and practices.

The aspects of the study that I found interesting were that:

  • translation alone definitely isn’t enough to make a program culturally appropriate and relevant (which we knew but was good to have confirmed)
  • there were a broad range of health beliefs, priorities and attitudes amongst participants, highlighting that even within a relatively narrowly defined population such as this pilot, there is considerable diversity
  • bilingual staff were clearly preferred to interpreters. 

These points are all relevant to other bilingual and culturally targeted health programs. If you have any trouble accessing the article please let me know.

References

When an evidence-based approach entrenches inequalities

The curfew and further COVID control measures that were announced today have had me thinking about how a narrow approach to what constitutes evidence can exacerbate health inequalities.

As Prof Catherine Bennett points out, reducing the reproduction rate of the Delta variant to 1.2-1.3 has itself been a major achievement.

However, because COVID spreads based on inequalities – insecure work, where people live, housing conditions, inability to isolate – a targeted approach based on epidemiological data alone can lead to interventions that reinforce inequities. Interventions like curfews, limiting people to one hour outside the home, and increased policing are unlikely to have an influence on COVID transmission. If anything, they’re only likely to lead to increased criminal justice engagement and charges. They’re also not based on public health evidence.

Because these measures are only being imposed in the poorer parts of Sydney where COVID is circulating most, they’re entrenching determinants of health inequity.

Eighteen months ago, when I was still trying to figure what COVID was all about, I wrote:

There is likely to be a social gradient in transmission, i.e. the poor are more likely to get COVID-19, at least at first. This is a concern that some have already flagged in the U.S.

If there is a social gradient in the disease, there needs to be a social gradient in our response. The most affected locations and communities should be the focus of the health system’s initial response (we can’t just assume this will be the case). If antiviral therapies are found to be effective, or if a vaccine is eventually developed, consideration should be given to deploying them to poorer areas first.

“The first wave hits the poor, the second wave hits the rich”: Lessons from the 1918 pandemic

Now is the time for that social gradient in the response to finally start.

US Office of Climate Change and Health Equity

If I reflect back on when I started in public health, most people were actively hostile to the concept of health equity and global heating was regarded as a fringe issue of marginal significance. How much things have changed when the US DHHS sets up an Office of Climate Change and Health Equity. Even if it’s a small, under-resourced unit, its very existence has meaning.

“The Secretary of Health and Human Services shall … establish an Office of Climate Change and Health Equity to address the impact of climate change on the health of the American people,” – Source

Culture is Key: Towards cultural determinants-driven health policy

Important report from the Lowitja Institute , which outlines a call to action on the cultural determinants of health for Aboriginal and Torres Strait Islander people. It includes the comprehensive framework below.

Framework

References

Williamson, L., Dent, P., & Bowman, N. (2021). Culture is Key: Towards cultural determinants-driven health policy. Lowitja Institute. https://www.lowitja.org.au/page/services/resources/Cultural-and-social-determinants/culture-for-health-and-wellbeing/culture-is-key-towards-cultural-determinants-driven-health-policy

Covid-19: The painful price of ignoring health inequities – The BMJ

Unfortunately, we are quick to respond when there is an urgent risk to our own safety or those we care about; and quick to forget when the crisis has passed and the only perceivable danger is to ‘others.’  Our tendency to distance ourselves from those we view as alien or intrinsically different from us puts everyone in danger. It is a fundamental misunderstanding of a risk that is always there and that can be mitigated only through effective contingency planning, requiring trust and a common denominator of commitment to our shared humanity. 
— Read on blogs.bmj.com/bmj/2020/03/18/covid-19-the-painful-price-of-ignoring-health-inequities/