International Journal for Equity in Health最新文献

{"title":"More or less equal? Trends in horizontal equity in mental health care utilization in Stockholm county, Sweden (2006-2022). Repeated survey-registry linked studies.","authors":"Joseph Junior Muwonge, Beata Jablonska, Christina Dalman, Bo Burström, Maria Rosaria Galanti, Anna-Clara Hollander","doi":"10.1186/s12939-025-02453-y","DOIUrl":"https://doi.org/10.1186/s12939-025-02453-y","url":null,"abstract":"<p><strong>Background: </strong>Horizontal equity is defined as equal care for equal needs, regardless of socioeconomic factors. This study investigated trends in horizontal equity in mental health care (MHC) utilization in Sweden from 2006 to 2022. Monitoring equity provides valuable information for healthcare system governance (e.g., planning and resource allocation) necessary for ensuring equitable provision of services.</p><p><strong>Methods: </strong>A total of 81,650 Stockholm residents aged 18-64, who participated in the Hälsa Stockholm surveys of 2006, 2010, 2014 or 2021, were analysed. Their subsequent use of MHC (primary, in- and outpatient specialized care, and psychotropic medication) within six months after survey response was collected from registries between 2006 and 2022. Concentration index (CI) and need-standardized CI (Horizontal inequity index, HI), summative measures of inequalities, were used in this study. HI was estimated using self-reported psychological distress (measured with the General health questionnaire 12 in 2006-2014 and Kessler 6 in 2021) as the primary need indicator, with general health status and long-term limiting illness as additional need indicators. Equivalized disposable household income was used as the ranking variable, while education status, migration status, age, and sex were included as non-need variables that we controlled for in the analyses.</p><p><strong>Results: </strong>Lower-income individuals used MHC services more than their higher-income counterparts with comparable levels of psychological distress. These \"pro-poor\" inequities in the probability of MHC use increased from HI = -0.057 [95% Confidence Limits, CL: -0.079, -0.034] in 2006/2007 to HI = -0.130 [95% CL: -0.159, -0.102] in 2014/2015. By 2021/2022, the \"pro-poor\" inequities had decreased (HI = -0.034 [95% CL: -0.06, -0.009]), partly due to an increase in MHC use among higher-income groups but a decrease in the lowest income group. Standardizing for additional need indicators reduced the \"pro-poor\" inequities but maintained the observed trends. Among non-Nordic migrants, \"pro-rich\" inequities fell between 2006/2007 and 2014/2015 but rose in 2021/2022, with significant \"pro-rich\" inequities among non-European migrants in 2021/2022 (HI = 0.100 [95% CL: 0.024, 0.176]). Among patients in outpatient services, \"pro-poor\" inequities in visit frequency decreased over time (2006-2022).</p><p><strong>Conclusion: </strong>We observed increasingly higher probability of MHC use among lower-income individuals than their higher-income peers with similar (measured) needs from 2006 to 2015. However, during the pandemic (2021/2022), potential access problems led to diminishing of \"pro-poor\" inequities in the total sample, and to \"pro-rich\" inequities among non-Nordic migrants. The Covid-19 disruption to the healthcare system-such as restrictions on in-person visits and the rapid transition to digital healthcare services-along with its impact on care-s","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"98"},"PeriodicalIF":4.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare inequities and healthcare providers: we are part of the problem.","authors":"Crystal N Campbell","doi":"10.1186/s12939-025-02464-9","DOIUrl":"10.1186/s12939-025-02464-9","url":null,"abstract":"<p><strong>Background: </strong>The United States (U.S.) spends the highest amount on healthcare globally, at $12,434 per capita, yet experiences poor health outcomes, including lower life expectancy and higher rates of preventable mortality. With a life expectancy of 76.4 years, the U.S. lags behind other high-income countries, which have an average of 81.1 years. Health inequities, especially among marginalized racial and ethnic groups, contribute significantly to these disparities. Implicit bias among healthcare providers plays a critical role in perpetuating these inequities, resulting in misdiagnoses, undertreatment, and patient mistrust.</p><p><strong>Purpose: </strong>This paper examines the role of implicit bias in healthcare disparities, its impact on marginalized populations, and the ethical responsibility of healthcare providers in mitigating bias. It explores the neuroscientific and psychosocial mechanisms of implicit bias and its effects on patient outcomes.</p><p><strong>Methods: </strong>A literature review was conducted using PubMed, APA PsycNet, JSTOR, ProQuest, and Google Scholar. The search included peer-reviewed articles from 2008 to 2025 discussing implicit bias in healthcare, its effects on marginalized groups, and evidence-based mitigation strategies. Exclusion criteria included responses and commentaries.</p><p><strong>Findings: </strong>Quantitative findings on implicit bias mitigation strategies show mixed results. Counter-stereotypic strategies and intention-setting interventions reduced Implicit Association Test (IAT) scores by 0.15 at 4 weeks and 0.17 at 8 weeks. However, some strategies, like stereotype replacement and intergroup contact, consistently showed measurable positive effects. Qualitative findings revealed that simulation-based training and perspective-taking significantly increased self-awareness, empathy, and behavioral changes in healthcare providers. Mindfulness meditation and emotional regulation techniques helped reduce stress and bias in high-pressure settings. These findings suggest that while some strategies are effective in the short term, long-term success requires ongoing training, continuous reflection, and practical application in clinical practice.</p><p><strong>Conclusion: </strong>Health inequities in the U.S. are a public health crisis, disproportionately affecting marginalized groups. These disparities are preventable, yet persistent due to systemic issues. Healthcare providers must address implicit biases and commit to unbiased, ethical care. Institutions must prioritize health equity through inclusive cultures, comprehensive bias training, and accountability, exemplified by efforts like UW Medicine's bias incident reporting.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"97"},"PeriodicalIF":4.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contentious population policy-making and its consequences: a health policy analysis.","authors":"Hassan Joulaei, Bahar Morshed-Behbahani, Parnian Ghadimi, Sadar Nadimi Parashkouhi, Yasaman Mansoori","doi":"10.1186/s12939-025-02469-4","DOIUrl":"10.1186/s12939-025-02469-4","url":null,"abstract":"<p><strong>Background: </strong>Governments strategically shape their population policies to effectively harness and sustain vital human resources, responding to the evolving dynamics of demographic trends and the intricate interplay of economic, social, and political conditions. Nevertheless, they strive to uphold their populations'health and fundamental rights. Iran's population policies have undergone significant shifts over the past four decades, reflecting changing socio-political dynamics and demographic challenges. This study aims to analyze Iran's population policies, emphasizing their implications for health outcomes and the status of human rights, offering important insights for governance in population policy.</p><p><strong>Methods: </strong>We conducted a qualitative study using Walt Gilson's Policy Analysis Triangle framework. Data were collected through in-depth interviews and national policy documents. Thematic analysis was employed to identify themes across policy context, content, process, and actors.</p><p><strong>Results: </strong>In the realm of population policies that impact the health and rights of individuals, members of parliament and pressure groups wielded the greatest power and influence. The policy-making environment was intricate and turbulent; governance exhibited poor and biased implementation; and, regarding content, an ineffective and inconsistent population policy package existed.</p><p><strong>Conclusion: </strong>Population policies that overlook ethical principles and do not adequately address social needs or adapt to the evolving dynamics of societies pose a risk to individual health and infringe upon fundamental human rights.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"96"},"PeriodicalIF":4.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health conditions, health literacy, access to care, and health care experiences among lesbian, gay, bisexual, transgender and queer adults in Lebanon.","authors":"Wassim Daoud Khatoun, Ali Slim, Jana Makhlouf, Sam S S Lau, Marco C H Cheng, Alissa Chebat, Michel Boustany, Elio Tahan, Carmel Bouclaous","doi":"10.1186/s12939-025-02417-2","DOIUrl":"10.1186/s12939-025-02417-2","url":null,"abstract":"<p><strong>Background: </strong>This study aims to assess the physical health of individuals belonging to the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community, considering health system challenges like access to care and patient experiences and community-specific attributes like health literacy and self-acceptance.</p><p><strong>Methods: </strong>This cross-sectional study was conducted in January-June 2022 using non-probabilistic sampling. The survey collected sociodemographic characteristics, information on access to care and patient experiences, prevalence of chronic conditions, sexually transmitted infections (STIs), and health literacy levels. The inclusion criteria required participants to be of Lebanese nationality, at least 18 years old, and to identify as part of the LGBTQ community. Descriptive statistics summarized the data. Two sample t-tests and chi-square tests were used to examine associations between variables.</p><p><strong>Results: </strong>A total of 496 participants took the survey, with a majority identifying as bisexual (38.5%) or gay (35.1%). Around 41.1% reported at least one chronic condition. Difficulty accessing healthcare was experienced by 37.7%, with 11.1% reporting a negative patient experience. Participants who reported experiencing discrimination were significantly more likely to delay seeking health services (p < 0.001), with transgender-identifying participants experiencing significantly more discrimination that non-transgender-identifying participants. Regarding sexual health, 15.7%, of those who tested, reported at least one STI. Their preferred testing sites were Non-Governmental Organizations (59.3%). Adequate health literacy level was significantly associated with STI testing (t = 3.34, p < 0.01) and chronic disease (t = 3.76, p < 0.01).</p><p><strong>Conclusion: </strong>Our findings underscore the importance of inclusive healthcare policies that address discriminatory experiences in healthcare settings and the need for targeted evidence-based interventions to improve health outcomes among LGBTQ individuals.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"95"},"PeriodicalIF":4.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The design and implementation of culturally-safe dementia risk reduction strategies for immigrant women: a theoretical review.","authors":"Sharon Iziduh, Bora Umutoni, Saleema Allana, Oluwakemi Amodu, Carmela Tartaglia, Anna R Gagliardi","doi":"10.1186/s12939-025-02466-7","DOIUrl":"10.1186/s12939-025-02466-7","url":null,"abstract":"<p><strong>Background: </strong>Raising awareness about dementia risk reduction is particularly important for ethno-culturally diverse or immigrant women, who have greater risk of dementia compared with men due to multiple interacting factors. We aimed to synthesize prior research on culturally-safe strategies to raise diverse women's awareness of dementia risk reduction.</p><p><strong>Methods: </strong>We conducted a theoretical review. We searched for studies published up to April 2023 included in a prior review and multiple databases. We screened studies and extracted data in triplicate, informed by existing and compiled theoretical frameworks (WIDER, RE-AIM, cultural safety approaches) and used summary statistics, tables and text to report study characteristics, and strategy design, cultural tailoring, implementation and impact.</p><p><strong>Results: </strong>We included 17 studies published from 2006 to 2021. Most were conducted in the United States (15, 88%), before-after cohorts (7, 41%), and included African, Caribbean or Latin Americans (82%). No studies focused solely on women (median women 72%, range 50% to 95%). All strategies consisted of in-person didactic lectures, supplemented with interactive discussion, role-playing, videos and/or reinforcing material. Strategies varied widely in terms of format, delivery, personnel, and length, frequency and duration. Details about tailoring for cultural safety were brief and varied across studies. Ten approaches were used to tailor strategies, most often, use of target participants' first language. Assessment of implementation was limited to reach and effectiveness, offering little insight on how to promote adoption, fidelity of implementation and longer-term maintenance of strategies. Strategies increased knowledge of dementia and decreased misconceptions, but did not prompt participants to seek dementia screening in the single study that assessed behaviour.</p><p><strong>Conclusions: </strong>While this review revealed a paucity of research, it offers insight on how to design culturally-safe dementia risk reduction strategies that may be suitable for ethno-culturally diverse or immigrant women. Healthcare professionals can use these findings to inform policy, clinical guidelines and public health programs. Future research is needed to establish the ideal number, length and duration of sessions, and confirm strategy effectiveness for diverse women.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"94"},"PeriodicalIF":4.5,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health conspiracy theories: a scoping review of drivers, impacts, and countermeasures.","authors":"Adnan Kisa, Sezer Kisa","doi":"10.1186/s12939-025-02451-0","DOIUrl":"10.1186/s12939-025-02451-0","url":null,"abstract":"<p><strong>Background: </strong>Health-related conspiracy theories undermine trust in healthcare, exacerbate health inequities, and contribute to harmful health behaviors such as vaccine hesitancy and reliance on unproven treatments. These theories disproportionately impact marginalized populations, further widening health disparities. Their rapid spread, amplified by social media algorithms and digital misinformation networks, exacerbates public health challenges, highlighting the urgency of understanding their prevalence, key drivers, and mitigation strategies.</p><p><strong>Methods: </strong>This scoping review synthesizes research on health-related conspiracy theories, focusing on their prevalence, impacts on health behaviors and outcomes, contributing factors, and counter-measures. Using Arksey and O'Malley's framework and the Joanna Briggs Institute guidelines, a systematic search of six databases (PubMed, Embase, Web of Science, CINAHL, PsycINFO, and Scopus) was conducted. Studies were screened using predefined inclusion and exclusion criteria, with thematic synthesis categorizing findings across diverse health contexts.</p><p><strong>Results: </strong>The review revealed pervasive conspiracy beliefs surrounding HIV/AIDS, vaccines, pharmaceutical companies, and COVID-19, linked to reduced vaccine uptake, increased mistrust in health authorities, and negative mental health outcomes such as anxiety and depression. Key drivers included sociopolitical distrust, cognitive biases, low scientific literacy, and the unchecked proliferation of misinformation on digital platforms. Promising countermeasures included inoculation messaging, media literacy interventions, and two-sided refutational techniques. However, their long-term effectiveness remains uncertain, as few studies assess their sustained impact across diverse sociopolitical contexts.</p><p><strong>Conclusion: </strong>Health-related conspiracy theories present a growing public health challenge that undermines global health equity. While several interventions show potential, further research is needed to evaluate their effectiveness across diverse populations and contexts. Targeted efforts to rebuild trust in healthcare systems and strengthen critical health literacy are essential to mitigate the harmful effects of these conspiracy beliefs.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"93"},"PeriodicalIF":4.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manifestation, causes and approach to mental distress among the population of migrant and refugee women in Ecuador and Panama: a qualitative study with key informants.","authors":"Zeus Aranda, Annie Bonz, Andrea Armijos, Alejandra Angulo, M Claire Greene","doi":"10.1186/s12939-025-02455-w","DOIUrl":"10.1186/s12939-025-02455-w","url":null,"abstract":"<p><strong>Introduction: </strong>Human mobility in the Latin American and Caribbean (LAC) region has increased in the last decade, as well as the proportion of women within this population. The difficulties they experience in the country of origin, in their journey and in the receiving country have a negative impact on their mental well-being. In order to gain knowledge about the manifestations of mental distress in the population of migrant women in the region, the causes of such discomfort, the mental health support available to them and proposals for interventions that promote their mental health, we carried out this exploratory qualitative study. The study focused on the towns of Guayaquil and Tulcán in Ecuador and Panama City.</p><p><strong>Methods: </strong>We employed phenomenological qualitative design. Semi-structured interviews were conducted with 37 key informants residing in the three study locations. These were conducted in Spanish in February and March 2021 and recorded in audio. The transcripts of the interviews were analyzed using the thematic analysis methodology.</p><p><strong>Results: </strong>We identified 5 themes and 18 sub-themes from the data. All participants had perceived manifestations of mental distress in migrant women in their communities, citing migratory grief, unmet expectations, uncertainty, violence and discrimination as some of its main causes. Participants cited the family, community, government institutions, international agencies, and civil society organizations as sources of psychoemotional support in the population of study. Several informants agreed on the importance of creating specific care spaces for the migrant women's population, implementing peer support groups, providing educational and informative sessions that promote mental well-being, and providing comprehensive responses to the needs of migrant women, including mental and physical health, but also their causes.</p><p><strong>Conclusions: </strong>This study represents a first step to improve current strategies for the prevention and care of mental distress in the population of migrant women in LAC. Evidence-based interventions such as the one in our study can contribute to reducing inequities based on gender and migration status in mental health and access to mental health services in the region.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"92"},"PeriodicalIF":4.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health in Kerala: exploring achievements and remaining challenges of health systems reform using an equity lens.","authors":"Hari Sankar D, Anish Thekkumakara Surendran, Rakhal Gaitonde, Devaki Nambiar","doi":"10.1186/s12939-025-02414-5","DOIUrl":"10.1186/s12939-025-02414-5","url":null,"abstract":"<p><strong>Background: </strong>The southern Indian state of Kerala is often regarded as a global model for its impressive health outcomes at a low cost. While the state consistently invests in healthcare and showcases remarkable health indicators, disparities persist, particularly among underserved populations who experience poorer health outcomes. This special issue focuses on research work that examines health equity in the region.</p><p><strong>Methods: </strong>Following an open call for the collection featuring research studies focusing on health equity in Kerala in 2022, we received 29 submissions; four editors handled the submissions, and after peer review, nine articles were finally published as part of the special issue.</p><p><strong>Results: </strong>The final collection has nine articles which include studies describing health system efforts and user experiences about the control of tuberculosis, two evaluations of Universal Health Coverage (UHC) reforms in the state, a commentary on challenges faced by transgender persons in accessing gender-affirming medical care, two qualitative studies that span the UHC reform process and policies through the lens of a marginalized section of society, a case study on rabies death and a cross-sectional analysis characterizing the impact of COVID 19 pandemic in the mental health of school children.</p><p><strong>Conclusion: </strong>The special issue contributes to the growing body of literature around health equity in Kerala and India and documents key challenges that plague the state health system like persisting access issues to seek necessary care, lack of acknowledgment of important social determinants in policies, absence of targeted interventions for underserved communities, and shortcomings in engaging with the private sector - that continue to plague the journey of moving towards Universal Health Coverage (UHC). The findings suggest that custom made policies are required to address the specific health needs of underserved population rather than a doing \"more of same\" approach.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"89"},"PeriodicalIF":4.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Priorities and expectations of researchers, funders, patients and the public regarding equity in medical research and funding: results from the PERSPECT qualitative study.","authors":"Raksha Ramkumar, William R Betzner, Nora Cristall, Bogna A Drozdowska, Joachim Fladt, Tanaporn Jaroenngarmsamer, Rosalie McDonough, Mayank Goyal, Aravind Ganesh","doi":"10.1186/s12939-025-02458-7","DOIUrl":"10.1186/s12939-025-02458-7","url":null,"abstract":"<p><strong>Background: </strong>Considerations of equity in funding and conduct of medical research are receiving greater attention. However, perspectives of diverse stakeholder groups on this topic are poorly characterized. Our study aimed to further understand broad stakeholder perspectives and priorities regarding inequities in medical research and funding, including implications for international collaborations with low-and middle-income countries (LMICs).</p><p><strong>Methods: </strong>Participants were recruited through purposive and snowball sampling. We employed a qualitative descriptive methodology embedded in an interpretive grounded theory framework. This approach involved in-depth, semi-structured interviews with researchers, funders, patients, and members of the public. Participants were asked to discuss their perspectives on the current state of equity in medical research and funding. Collected data were analyzed using constant comparison, open-coding, and theme identification to generate a substantive theory.</p><p><strong>Results: </strong>We conducted 41 interviews involving 11 researchers, 10 funders, 10 patients, and 10 members of the public. Participants perceived several inequities within research participation, funding opportunities, topic prioritization, and lack of international collaborations inclusive of LMICs. Potential strategies to address these inequities were also identified. Through participants' perspectives, we developed a central theory that addressing inequities in medical research and funding can promote collaborative spaces and produce greater research impact for society, regardless of demographics, socioeconomic status, and geographical residence. While we gained diverse perspectives from four distinct stakeholder groups, our primary limitation was that participants in our study were predominantly from Canada and the United States.</p><p><strong>Conclusions: </strong>Participants perceived various inequities in the funding and conduct of medical research. Our findings were primarily captured from participants living in Canada and the United States. However, we were able to gain insights of challenges and potential solutions through their diverse perspectives, and we are optimistic that sustaining efforts to mitigate medical research and funding inequities will help accelerate and broaden the societal impact of medical research within and across countries, including in LMICs.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"90"},"PeriodicalIF":4.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The inclusion of LGBTQ + people within UK health policy: a critical discourse analysis.","authors":"Debbie Braybrook, William E Rosa, Charlotte Norman, Richard Harding, Katherine Bristowe","doi":"10.1186/s12939-025-02446-x","DOIUrl":"10.1186/s12939-025-02446-x","url":null,"abstract":"<p><strong>Background: </strong>Health policymakers can leverage change to improve equity in access to care, patient experiences and clinical outcomes. Despite legal progress to reduce health inequalities, social and systemic injustices persist and lesbian, gay, bisexual, trans and queer (LGBTQ+) people have increased risk of some health conditions and poorer health outcomes linked to the discrimination they experience. In 2022, 42 regional integrated care systems were created across England to reduce health inequalities and improve the wellbeing of their local population.</p><p><strong>Methods: </strong>This study aimed to examine the inclusion of UK Equality Act (2010) protected characteristics within the 42 publicly available integrated care system strategies, and to consider specifically how LGBTQ + communities and their needs, experiences and outcomes are framed within these strategies. A Critical Discourse Analysis was conducted positioned within a social constructivist paradigm.</p><p><strong>Results: </strong>Almost all strategies talked about the needs of their populations in terms of age (42/42), disability (42/42), gender (41/42), ethnicity (39/42) and maternity or pregnancy (39/32). 27/42 strategies mentioned religion. There were no references to marital status. 22/42 strategies referred to LGBTQ + people, but only around 25% of those references provided context about the specific needs of LGBTQ + people, the health inequities they face, or services for LGBTQ + people. Regarding gender minorities, there were eight mentions of trans people and no mentions of intersex people, despite some policies using the acronym LGBQTI. While there were two mentions of inequities in care delivery for trans people, the specific health or social care needs of trans people were not described in any strategies, and there were a small number of examples where trans people were presented in a problematizing frame; with no discussion of trans inclusive care, only problems associated with being trans. Across all 42 strategies there were only four references to systemic forces (e.g. homophobia, transphobia, discrimination) affecting LGBTQ + people.</p><p><strong>Conclusions: </strong>While the needs of some minoritized groups are well recognized within health policies, LGBTQ + people remain marginalized. Further work is needed to educate and enable policy makers to advocate for LGBTQ + people and communities, and to ensure equitable and respectful inclusion of all minoritised groups.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"88"},"PeriodicalIF":4.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}