International Journal for Equity in Health最新文献

{"title":"The DANA disaster: unraveling the political and economic determinants for Valencia's floods devastation.","authors":"Pablo Galvez-Hernandez, Yining Dai, Carles Muntaner","doi":"10.1186/s12939-025-02435-0","DOIUrl":"10.1186/s12939-025-02435-0","url":null,"abstract":"<p><p>On October 29, 2024, the DANA (Depresión Aislada en Niveles Altos) floods devastated the Spanish region of Valencia, resulting in 224 fatalities, extensive infrastructural destruction, and profound physical and mental health impacts. This analysis examines how political neglect, systemic corruption, and historical policy legacies exacerbated the disaster's consequences. Corruption-driven urbanization of flood-prone areas during Spain's real estate boom (1997-2007), coupled with the systematic reduction of critical emergency infrastructure and inadequate emergency response protocols, highlights a political agenda misaligned with public welfare. The political discourse following the disaster has been marked by a lack of accountability, with public outrage culminating in mass protests. As Valencia confronts the aftermath, Spain faces a critical moment to demonstrate whether it can uphold democratic principles, prioritizing public welfare, and addressing the institutional and political-economic deficiencies exposed by the DANA floods.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"64"},"PeriodicalIF":4.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566756","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":"Contextualising the WHO Global Research Agenda on Health, Migration and Displacement in Norway invites to a reflection for decolonising research.","authors":"Esperanza Diaz, Pierina Benavente","doi":"10.1186/s12939-025-02410-9","DOIUrl":"10.1186/s12939-025-02410-9","url":null,"abstract":"<p><p>Migrants and displaced persons are ubiquitously present, yet there is insufficient evidence and strategies to provide sustainable, equitable healthcare to these populations globally. Migration and health research has primarily been led by researchers in the Global North (GN), resulting in selective focus that can pose challenges in prioritizing socially relevant questions, and framing migration as a geographically fragmented problem without globally implementable solutions. This power disbalance has recently been termed \"colonialisation of research\". The WHO, through an equitable process including the GN and Global South (GS), released the \"Global Research Agenda on Health, Migration and Displacement\" (Agenda) in 2023 to strengthen globally fair research and translate priorities into policy and practice. WHO invites all countries to contextualise the Agenda´s core research themes and identify national gaps and priorities. With this purpose, the National Research Network for Migration and Health held a workshop in Bergen, Norway, in April 2024. The Norwegian priorities were compared to those from the WHO Agenda and discussed in light of decolonisation of research. Norwegian research priorities align with the WHO Agenda but differ in focus due to national context. Contextualizing the WHO Agenda to specific countries, such as Norway, highlights the need for local relevance while addressing global inequities in research and can, unintentionally, maintain the unresolved challenge of colonialism in research. Future research should critically examine the epistemological and ideological underpinnings of migration and health research to ensure equitable outcomes.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"62"},"PeriodicalIF":4.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556780","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":"Structural conditions, social networks, and the HIV vulnerability among Indonesian male labour migrants and motorbike taxi drivers.","authors":"Paul Russell Ward, Nelsensius Klau Fauk","doi":"10.1186/s12939-025-02420-7","DOIUrl":"10.1186/s12939-025-02420-7","url":null,"abstract":"<p><strong>Background: </strong>The Indonesian National AIDS report reveals that the percentage of HIV cases in the country is significantly higher in men compared to women, which is contrary to global AIDS data. Using a conceptual model of how social networks impact health, this paper describes how structural conditions, such as poverty, lack of job opportunities, and lack of income shaped the social networks of Indonesian men. It also describes how these social networks created opportunities for various social mechanisms, including social influence, peer pressure, and intimate contact, that facilitated HIV infection through different behavioural pathways, such as unprotected sex with multiple partners and injecting drug use (IDU) practices.</p><p><strong>Methods: </strong>A qualitative design using face-to-face in-depth interviews was employed to collect data from heterosexual male participants (n = 25) in Yogyakarta municipality and Belu district, Indonesia. Participants were former labour migrants and previously or currently (at the time of the study) motorbike taxi (ojek) drivers. They were recruited using the snowball sampling technique, starting from two HIV clinics in the study settings. Data were analysed thematically guided by a qualitative data analysis framework.</p><p><strong>Results: </strong>The findings highlight the significance of structural conditions, such as poverty, poor family conditions, precarious employment, and lack of income, which contributed to shaping the men's social networks through their occupations as labour migrants and ojekdrivers. Involvement in these occupations allowed them to become acquainted with fellow labour migrants and ojek drivers, leading to cohabitation in the same shelters or areas and daily interactions, which fostered the development of social networks among them. These social networks then provided opportunities for various social mechanisms, including social influence through peer pressure and person-to-person contact. The influence and pressure experienced by the participants were reflected in their behaviours related to sex, condom use, and IDU, ultimately contributing to the transmission of HIV among them.</p><p><strong>Conclusions: </strong>The findings underscore the importance of social network peer interventions that consider the dynamics of these networks. Such interventions have been shown to be effective in reducing HIV-risk behaviours and transmission, as well as in promoting HIV prevention and treatment among diverse population groups.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"61"},"PeriodicalIF":4.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541975","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":"Variability of COVID-19 mortality in Honduras: influence of sociodemographic factors.","authors":"Vilma Cristina Escoto Rodríguez, Manuela Expósito Ruiz","doi":"10.1186/s12939-025-02407-4","DOIUrl":"10.1186/s12939-025-02407-4","url":null,"abstract":"<p><strong>Background: </strong>In Central America, Honduras experienced a significant increase in SARS-CoV-2 infections between March 11, 2020, and January 26, 2022. Although limited research has been conducted on the impact of the COVID-19 pandemic on populations in Central American countries, this study seeks to contribute to the existing body of knowledge in the region. The objective of this study was to investigate the variability of COVID-19 mortality in Honduras and the impact of sociodemographic factors.</p><p><strong>Methods: </strong>A cross-sectional and ecological study, using data from cases collected by the National Risk Management System (SINAGER) and recorded by the Demographic Observatory of the National Autonomous University of Honduras (ODU) between March 11, 2020, and January 26, 2022. Sociodemographic variables were obtained from the 2013 XVII Population and VI Housing Census by the National Institute of Statistics (INE). Age-adjusted case and COVID-19 mortality rates by sex were calculated. To explain the potential causes of variability, multilevel logistic regression models were constructed, considering individual and contextual variables.</p><p><strong>Results: </strong>A total of 513,416 COVID-19 cases were included, of which 98 <math><mo>%</mo></math> (503,176) survived and 2 <math><mo>%</mo></math> (10,240) died. The results showed differences in COVID-19 mortality rates between municipalities and departments. The multilevel model revealed that age (OR: 1.0737; 95 <math><mo>%</mo></math> CI: [1.0726; 1.0749]) and sex (OR: 0.7434; 95 <math><mo>%</mo></math> CI: [0.7027; 0.7841]) were significantly associated with COVID-19 mortality, with men being more likely to die. Among departments, the significant contextual factors were the illiteracy rate and the percentage of the rural population, both of which were associated with higher COVID-19 mortality (OR: 1.0850; 95 <math><mo>%</mo></math> CI: [1.0511; 1.1189] and OR: 1.0234; 95 <math><mo>%</mo></math> CI: [1.0146; 1.0323]), while the percentage of the active population (working age people) was associated with a decrease in COVID-19 mortality (OR: 0.9768; 95 <math><mo>%</mo></math> CI: [0.9591; 0.9944]). The intraclass correlation coefficient (ICC) showed a reduction in variability attributable to the variation between departments, with a final ICC of 0.68 <math><mo>%</mo></math> .</p><p><strong>Conclusions: </strong>Differences in COVID-19 mortality were found between the different departments, partly explained by sociodemographic factors. The results of this study show that, in addition to individual characteristics, population-level socioeconomic and educational factors influence COVID-19 mortality. Multilevel analysis is highly useful for providing evidence to improve approaches in future pandemics.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"60"},"PeriodicalIF":4.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537099","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 impact of interprofessional collaboration between pharmacists and community health workers on medication adherence: a systematic review.","authors":"Carole Bandiera, Ricki Ng, Sabuj Kanti Mistry, Elizabeth Harris, Mark F Harris, Parisa Aslani","doi":"10.1186/s12939-025-02415-4","DOIUrl":"10.1186/s12939-025-02415-4","url":null,"abstract":"<p><strong>Background: </strong>There is increasing evidence to support the effectiveness of interventions involving community health workers (CHWs) in improving patient health outcomes, which reinforces their growing integration in healthcare teams. However, little is known about the interprofessional collaboration between pharmacists and CHWs. This systematic review aimed to explore the impact of interprofessional interventions involving pharmacists and CHWs on patient medication adherence.</p><p><strong>Methods: </strong>The English language scientific literature published in Embase, MEDLINE, Web of Science, CINAHL, Scopus, plus the grey literature were searched in October 2024. Using the software Covidence, two authors screened article titles and abstracts and assessed full-text articles for eligibility. Studies were included if (i) the intervention was delivered by pharmacists and CHWs and (ii) reported on medication adherence outcomes. Data were extracted using a customized template using Excel and synthetized narratively. The Effective Public Health Practice Project quality assessment tool was used to assess the studies' methodological quality.</p><p><strong>Results: </strong>Eight studies met the inclusion criteria, including a total of 1577 participants. Seven studies were conducted in the United States, and six were published since 2020. The interventions consisted of medication therapy management, medication reconciliation, and repeated education sessions. The CHW shared clinical and non-clinical patient information and ensured a culturally safe environment while the pharmacist delivered the clinical intervention. In five studies, medication adherence was evaluated solely through patient self-reported measures. One study used an objective measure (i.e., pharmacy refill records) to evaluate medication adherence. Only two studies assessed medication adherence using both self-reported and objective measures (i.e., pill count and proportion of days covered). A significant improvement in medication adherence was observed in three of the eight studies. Half of the studies were of weak quality and half of moderate quality.</p><p><strong>Conclusions: </strong>There was a small number of studies identified which focused on the impact of interprofessional collaboration between pharmacists and CHWs on medication adherence. The impact of the interprofessional interventions on medication adherence was limited. Further studies of higher quality are needed to better evaluate the impact of such collaboration on patient health outcomes.</p><p><strong>Registration: </strong>PROSPERO, ID CRD42024526969.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"58"},"PeriodicalIF":4.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11869407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531472","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":"Effect of universal health insurance implementation on beneficiaries' evaluation of public health facilities in Egypt - a cross-sectional study.","authors":"Ahmed S Hammad, Ahmed Yehia Khalifa, Gasser Gad ELKarim, Awad Mataria, Ahmed Mahmoud Fouad","doi":"10.1186/s12939-025-02402-9","DOIUrl":"10.1186/s12939-025-02402-9","url":null,"abstract":"<p><strong>Background: </strong>Universal health coverage (UHC) is a key health policy priority to guarantee access to high-quality healthcare without causing undue financial hardship. After many attempts for health reform, Egypt has adopted the Universal Health Insurance (UHI) system in 2018. The aim of the study was to assess the effect of UHI implementation on beneficiaries' perspectives of public healthcare facilities during the early stages of implementation.</p><p><strong>Methods: </strong>A cross-sectional study was conducted from 2021 to 2022 in Egypt, with 785 participants interviewed at UHI and non-UHI areas. All participants were interviewed using a questionnaire for sociodemographic characteristics, perceived health status, insurance plan, and Patient Evaluation Scale -Short form (PES-SF). Besides, participants were asked to report their general evaluation of overall quality, accessibility, and satisfaction with the healthcare services.</p><p><strong>Results: </strong>Out of 785 participants, 326 participants were UHI beneficiaries, while 459 were non-UHI enrollees. UHI was associated with a 4.71-point increase in the mean total PES-SF score compared to non-UHC (95% CI: 3.12-6.30, p < 0.001). UHI was associated with an 80% and 56% increase in the likelihood of reporting a good or more overall accessibility and general satisfaction with health facilities, compared to non-UHI, respectively (OR: 1.80, 95% CI: 1.17-2.77, p = 0.008; OR: 1.56, 95% CI: 1.00-2.43, p = 0.048, respectively). However, perceived overall quality was not significantly associated with UHI status (OR: 1.13, 95% CI: 0.74-1.71, p = 0.578).</p><p><strong>Conclusions: </strong>The study finding shows that UHI beneficiaries perceived a higher level of overall satisfaction and accessibility than non-UHI beneficiaries. However, no significant difference exists regarding the perceived overall quality of care. These findings provide valuable insights into the effect of UHI in Egypt and can inform evidence-based policymaking to strengthen the healthcare system and advance universal health coverage objectives.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"59"},"PeriodicalIF":4.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531468","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":"Rare disease challenges and potential actions in the Middle East.","authors":"Ahmad Nader Fasseeh, Nada Korra, Ahmed Aljedai, Ahmed Seyam, Hajer Almudaiheem, Hana A Al-Abdulkarim, Marwan Janahi, Mary Gamal, Sahar Fahmy, Sara Aldallal, Sherif Abaza, Zoltán Kaló","doi":"10.1186/s12939-025-02388-4","DOIUrl":"10.1186/s12939-025-02388-4","url":null,"abstract":"<p><strong>Background: </strong>Rare diseases, defined variably by global regions, collectively impact approximately 300 million individuals despite affecting small population segments individually. Historically there were no treatments developed for these conditions, leading to significant care challenges. Public interventions have incentivized treatment development, yet up to this day, many rare disease patients are deprived of timely diagnosis and treatment in comparison to patients with more common diseases. This study evaluates the challenges that rare disease patients and healthcare systems face in the Middle East and North Africa (MENA), seeking strategies to enhance treatment accessibility.</p><p><strong>Methods: </strong>We followed a three-step approach for the study. First, we searched scientific publications and grey literature for the global challenges faced by rare disease patients. Our search also collected information on orphan drug regulations implemented in different countries. Subsequently, we used the findings to conduct a survey to pharmaceutical company representatives across three countries in the region (The Kingdom of Saudi Arabia, Egypt, and the United Arab Emirates). The survey assessed the challenges facing rare disease patients in the MENA region and the policies that have been implemented to overcome these challenges. The survey was then followed by governmental expert interviews to validate the survey responses and provide recommendations to mitigate the challenges.</p><p><strong>Results: </strong>The literature and survey results revealed several challenges facing rare diseases, including lack of awareness, difficulty in acquiring marketing authorization and reimbursing orphan drugs. Validation meetings provided recommendations to mitigate such challenges in the selected countries. For instance, the collaboration between the Ministry of Health and pharmaceutical companies was recommended to improve rare diseases care. A separate registration process for orphan drugs with clear criteria and timelines was suggested. A differential cost-effectiveness threshold for orphan drugs was recommended. It was also recommended to establish a definition for rare diseases and to increase the utilization of managed entry agreements for orphan drugs.</p><p><strong>Conclusions: </strong>Rare diseases present challenges in the MENA region and globally, requiring focused attention and innovative solutions. By implementing comprehensive strategies that consider both economic efficiency and fairness, healthcare systems can better serve rare disease patients and improve their quality of life.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"56"},"PeriodicalIF":4.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515614","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":"Evaluating and addressing demographic disparities in medical large language models: a systematic review.","authors":"Mahmud Omar, Vera Sorin, Reem Agbareia, Donald U Apakama, Ali Soroush, Ankit Sakhuja, Robert Freeman, Carol R Horowitz, Lynne D Richardson, Girish N Nadkarni, Eyal Klang","doi":"10.1186/s12939-025-02419-0","DOIUrl":"10.1186/s12939-025-02419-0","url":null,"abstract":"<p><strong>Background: </strong>Large language models are increasingly evaluated for use in healthcare. However, concerns about their impact on disparities persist. This study reviews current research on demographic biases in large language models to identify prevalent bias types, assess measurement methods, and evaluate mitigation strategies.</p><p><strong>Methods: </strong>We conducted a systematic review, searching publications from January 2018 to July 2024 across five databases. We included peer-reviewed studies evaluating demographic biases in large language models, focusing on gender, race, ethnicity, age, and other factors. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools.</p><p><strong>Results: </strong>Our review included 24 studies. Of these, 22 (91.7%) identified biases. Gender bias was the most prevalent, reported in 15 of 16 studies (93.7%). Racial or ethnic biases were observed in 10 of 11 studies (90.9%). Only two studies found minimal or no bias in certain contexts. Mitigation strategies mainly included prompt engineering, with varying effectiveness. However, these findings are tempered by a potential publication bias, as studies with negative results are less frequently published.</p><p><strong>Conclusion: </strong>Biases are observed in large language models across various medical domains. While bias detection is improving, effective mitigation strategies are still developing. As LLMs increasingly influence critical decisions, addressing these biases and their resultant disparities is essential for ensuring fair artificial intelligence systems. Future research should focus on a wider range of demographic factors, intersectional analyses, and non-Western cultural contexts.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"57"},"PeriodicalIF":4.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515613","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":"\"I would be very proud to be part of an initiative that didn't exclude people because it was hard\": mapping and contextualising health equity responsibilities and decision-making tensions in the implementation of a multi-level system reform initiative.","authors":"Tristan Bouckley, David Peiris, Devaki Nambiar, Samuel Prince, Sallie-Anne Pearson, Gill Schierhout","doi":"10.1186/s12939-025-02405-6","DOIUrl":"10.1186/s12939-025-02405-6","url":null,"abstract":"<p><strong>Background: </strong>Health systems face competing demands when implementing health sector reforms. While health equity principles are generally promoted during reform discussions, they are often deprioritised during implementation. This qualitative study aimed to (1) identify how implementers and designers expected health equity to be included in the implementation of a place-based health system reform initiative, and (2) identify factors that influenced prioritisation of health equity during early implementation.</p><p><strong>Method: </strong>We conducted eighteen semi-structured interviews in 2022 and 2023 with a purposive sample of senior policy executives, programme managers and clinicians involved in the design and early implementation of a place-based health system reform initiative in New South Wales, Australia. Informed by a grounded approach, data were analysed inductively drawing on a constant comparative approach. Emerging health equity definitions and expectations informed the development of a Theory of Change (ToC) articulating participants' expectations about how health equity was intended to be embedded in the programme. We also identified opportunities and challenges to prioritise action to address health equity throughout implementation, which informed critical appraisal of the ToC.</p><p><strong>Results: </strong>We identified diffuse actions and responsibilities to address health equity in this state-wide, place-based health reform, articulating these actions and responsibilities in a ToC. This showed diffuse responsibilities for health equity across system levels. We also identified six critical decision-making tensions that influenced health equity prioritisation during early implementation, reflecting participants' perceptions that health equity prioritisation was in conflict with attention to other priorities. These were equity-efficiency; localisation-capacity for health equity; diffuse responsibilities-enforceability; invisible-vocal sub-populations; and health equity-sustainable business models for private providers.</p><p><strong>Conclusion: </strong>The distribution of heath equity responsibilities, as we demonstrated through a ToC of a decentralised, place-based reform, present risk to health equity prioritisation. Risks were particularly present when local resourcing and capacity were stretched, and limited policy guardrails were in place to counteract decision-making tensions, such as clear health equity accountabilities, responsibilities, and actions.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"54"},"PeriodicalIF":4.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500954","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":"An analytical approach towards attaining leave no one behind using patterns and distributions of inequalities in antenatal and facility delivery coverage in Uttar Pradesh, India.","authors":"Vasanthakumar Namasivayam, Ravi Prakash, Bidyadhar Dehury, Shajy Isac, Fernando C Wehrmeister, Marissa Becker, James Blanchard, Ties Boerma","doi":"10.1186/s12939-025-02411-8","DOIUrl":"10.1186/s12939-025-02411-8","url":null,"abstract":"<p><strong>Background: </strong>Leave No One Behind (LNOB) is a central, transformative promise of the 2030 Agenda for Sustainable Development Goals. To attain LNOB, systematic analysis of patterns and distributions of inequalities in coverage of health outcomes on a continuous basis at different program delivery layers is required to design tailored health interventions. We analysed the patterns of change and geographic distribution of inequalities in coverage of antenatal care and facility-based delivery in Uttar Pradesh (UP), India and developed a framework to guide health programmers to understand inequalities better, to accelerate progress by reaching those left behind.</p><p><strong>Methods: </strong>Data from five-rounds of National Family Health Survey (1992-2021) and two-rounds of Community Behaviour Tracking Survey (2014-2018) is used. Education and wealth have been used as stratifiers. Three measures of inequality- mean difference from mean, slope index of inequality, and inequality pattern index are used to depict the state, district and sub-district level inequalities.</p><p><strong>Results: </strong>UP observed a substantial reduction in the education-related inequality in ANC and facility-delivery during 1992-2021. The slope index of inequality declined from 65.3 [95%CI:60.0-70.6] to 9.3 [95%CI:7.8-10.8] for ANC and from 44.7 [95%CI:38.5-50.9] to 29.9 [95%CI:27.8-32.0] for facility-delivery during 1992-2021. The inequality pattern index showed that, with improved reach of interventions, many districts moved towards bottom inequality from top inequality for any ANC while fewer districts for facility-delivery. Even in districts with high coverage and low inequality, sub-district level(blocks) inequality persisted. Similarly, in blocks with high coverage and low inequality, Accredited Social Health Activist (ASHA) level inequality persisted. Interestingly, for the same ASHA area, the patterns of inequality differed for any ANC and facility delivery; in some districts, inequality direction changed based on the stratifier chosen.</p><p><strong>Conclusions: </strong>The proposed health equity framework suggests that to achieve LNOB status, understanding inequality with the coverage status is important. If coverage is high and inequality persists, identify the program layer at which maximum inequality persists to identify the left behinds. Whereas, if coverage is poor, programs are required to improve coverage first. Findings also call for a systematic way of collecting and organizing granular data to understand inequality and identify the left-behinds.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"55"},"PeriodicalIF":4.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500984","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}