International Journal for Equity in Health最新文献

{"title":"Geographical inequity in out-of-pocket costs for families of children with congenital heart disease requiring neurodevelopment support: an examination of policy scenarios using economic modelling.","authors":"Steven M McPhail, Benjamin C Auld, Karen J Eagleson, Robert Justo, Susan Pagel, Thomasina Donovan, Pakhi Sharma, Sameera Senanayake, Sanjeewa Kularatna, Bridget Abell","doi":"10.1186/s12939-026-02892-1","DOIUrl":"10.1186/s12939-026-02892-1","url":null,"abstract":"<p><strong>Background: </strong>Out-of-pocket costs represent care-limiting financial burden among families of children with congenital heart disease at risk of adverse neurodevelopmental outcomes. Neurodevelopmental follow-up care is often centred around major paediatric cardiac centres which can contribute to geographic inequity for people who reside in rural, regional or remote areas. This study examined out-of-pocket costs in three potential policy scenarios with neurodevelopment-related care location foci being either: specialist paediatric cardiac centre (Tertiary); nearest paediatric centre (Secondary); nearest community-based services (Primary).</p><p><strong>Methods: </strong>This modelling study used person-level stochastic microsimulations informed by a representative population cohort to estimate out-of-pocket costs under the three policy scenarios. Residence and service provider geographical locations were mapped using geographical information system software. Probabilistic estimates for out-of-pocket costs (direct healthcare, direct non-healthcare, indirect productivity costs) for the first five years of life for four illustrative categories of neurodevelopmental support requirements (surveillance only, mild, moderate and severe neurodevelopmental delays) were generated from 10,000 microsimulations of 1000 families in each scenario.</p><p><strong>Results: </strong>Out-of-pocket costs for families of children who require neurodevelopmental support were substantial across all scenarios and locations of residence, with indirect productivity costs representing the largest burden. Direct travel costs for attending healthcare appointments were also substantial, and differentially affected those who resided in rural, regional or remote areas. With existing healthcare funding support structures, direct healthcare costs were a comparatively smaller contributor to financial burden. Overall, care provision at the nearest paediatric centre (Secondary) scenario was most likely to mitigate financial burden on families. Out-of-pocket costs for families of children with severe delays were approximately 8.7 to 15.4 times higher than for families of children requiring surveillance only. Findings were robust to sensitivity analyses.</p><p><strong>Conclusion: </strong>Out-of-pocket costs for neurodevelopmental support for families of children with congenital heart disease are substantial. These costs differentially affect families of children with more severe developmental delays, as well as those who reside in rural, regional and remote areas. Policy strategies to shift loci of services closer to home have potential to alleviate some out-of-pocket costs for families, with services based at the nearest secondary paediatric centre likely to reduce geographic inequity.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13445653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149485","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 role of health financing system and pluralism in achieving sustainable development goal health outcomes in India: a multilevel analysis.","authors":"Pragyan Monalisa Sahoo, Himanshu Sekhar Rout","doi":"10.1186/s12939-026-02888-x","DOIUrl":"10.1186/s12939-026-02888-x","url":null,"abstract":"<p><strong>Introduction: </strong>The health system in India is pluralistic, with different sources of financing and multiple, overlapping financing systems across states. Existing studies often neglect system-specific factors such as fragmented health insurance schemes and state-level financing mechanisms. This study examines how health insurance pluralism, financing systems, and contextual state factors influence SDG health outcomes, integrating both individual and structural dimensions.</p><p><strong>Methods: </strong>Data from NFHS-5, RBI database (2019-20), and National Health Accounts (2019-2020) were analysed. States were classified by financing systems (public, prepaid, and out-of-pocket) and categorized into low, medium, and high fragmentation groups using a fragmentation index. Multilevel logistic regression accounted for the hierarchical structure of health data, analysing both individual-level characteristics and state-level contextual factors. The descriptive analysis summarized sample characteristics and variable distributions.</p><p><strong>Results: </strong>States demonstrated diverse financing systems, with significant fragmentation in out-of-pocket-dominated systems. Public and pre-paid systems had beneficial effects on child mortality, vaccination rates, and WASH access. While fragmentation occasionally enhanced outcomes, it also increased expenditures. Out-of-pocket expenditures persisted as a key driver of inequity and financial risk.</p><p><strong>Conclusion: </strong>Strengthening India's health system requires reducing fragmentation, promoting equitable financing, and aligning policies with the objectives of universal health coverage and the Sustainable Development Goals.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13435455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148101527","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":"A European collaborative initiative to systematically map cancer risk by migration background: the Cancer RADAR project.","authors":"Catharina Johanna Alberts, Damien Georges, Freddie Bray, Andrea Bordoni, Marià Carulla Aresté, Maria Dolores Chirlaque López, Joanna Didkowska, Jaume Galceran, Koen Van Herck, Enrica Migliore, Laura Ortelli, Lorenzo Richiardi, Antonia Sánchez Gil, Freija Verdoodt, Otto Visser, Urszula Wojciechowska, Andrea Gini, Irene Man, Stefano Rosso, Iacopo Baussano","doi":"10.1186/s12939-026-02899-8","DOIUrl":"10.1186/s12939-026-02899-8","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization (WHO) Action Plan for Refugee and Migrant Health highlights the need for strengthened migration health governance and data-informed policies. A major barrier in Europe has been the lack of systematically collected and comparable cancer data stratified by migration background.</p><p><strong>Methods: </strong>This study assesses the availability of routine data to map and examines differences of cancer risk among those with a migration background in Europe. The cancer types selected (breast, colorectal, cervical, stomach, liver, and lung) are either infection-related or amenable to detection through screening. In collaboration with pilot population-based cancer registries, a framework was developed to collect cancer data stratified by country of birth.</p><p><strong>Results: </strong>Feasibility was high: 48 of 80 registries (60%) are able and willing to share data and eight (10%) intend to retrieve and share data, together from 22 countries. Reasons for data sharing included the prospects of reducing cancer inequalities and enhancing registry visibility, while barriers included time constraints, lack of resources, and the need for ethical and legal approval, particularly for data linkage. A protocol and analysis tool, co-developed with pilot registries, supports data collection of comparable effect measures while ensuring protection through anonymisation and aggregation. The data collection enables analysis of cancer estimates in inequality and trends, including major events such as the war in Ukraine.</p><p><strong>Conclusion: </strong>Cancer RADAR provides a framework for the systematic and comparable collection of cancer data by migration background, collaboratively, across Europe. This work represents a necessary enabling step toward standardised international comparisons and supports data-driven policies to address cancer inequalities.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148143384","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":"Toward equitable digital health: an integrated framework addressing exclusion, ethics, and implementation across healthcare systems.","authors":"Suresh Bangla, Anuva Kapoor, Girish Jeer","doi":"10.1186/s12939-026-02903-1","DOIUrl":"10.1186/s12939-026-02903-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Digital health technologies are fundamentally reshaping healthcare delivery, access, and governance worldwide. While these innovations offer unprecedented opportunities to extend services, particularly in resource-constrained settings, early implementation experiences from large-scale platforms such as India's Co-WIN vaccination system and the Ayushman Bharat Digital Mission (ABDM) reveal that poorly designed digitalization can entrench or even widen existing health inequities. Despite growing recognition of these challenges, there remains an urgent need for a coherent analytical framework to understand how patterns of digital exclusion, ethical challenges, and implementation barriers interact to shape digital health outcomes across diverse healthcare systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This narrative review aims to: (1) synthesize current evidence on patterns and mechanisms of digital health exclusion across socioeconomic, geographic, and demographic dimensions; (2) identify key ethical and governance challenges, including informed consent, data protection, algorithmic fairness, and cybersecurity, in contemporary digital health implementations; (3) analyze implementation experiences from India and comparable low- and middle-income country (LMIC) settings; and (4) propose an integrated equity framework to guide more inclusive digital health strategies that can inform policy, practice, and future research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We undertook a narrative review of peer-reviewed literature, policy documents, and grey literature published between 2015 and 2025 to examine digital health equity, ethical governance, and implementation challenges. Relevant sources were identified through iterative, purposive searches of PubMed/MEDLINE, Scopus, Web of Science, and the WHO Global Health Library, supplemented by targeted grey literature retrieval. These searches identified 312 records; following deduplication and eligibility screening, 22 peer-reviewed and policy sources were included in the synthesis. No AI-assisted screening tools were employed. Literature addressing patterns of digital exclusion, ethical or legal considerations, and real-world implementation experiences in clinical or public health settings was conceptually and thematically synthesized to identify recurrent themes, interconnections, and critical gaps in current digital health practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Analysis revealed that digital health interventions frequently mirror and amplify offline health inequities. Structural barriers related to income, gender, geography, disability, age, and digital literacy shape who owns devices, controls personal health data, and can meaningfully engage with digital health tools. Ethical challenges, including inadequate consent pathways, fragmented data protection regimes, persistent algorithmic bias, and escalating cybersecurity risks, remain pervasive across many national programs. Implement","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054274","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":"Intersection of gender and class in the assessment of self-rated health in the Spanish population: a classification tree study.","authors":"Jordi Gumà-Lao, Núria Pedrós Barnils, Daniel La Parra-Casado","doi":"10.1186/s12939-026-02897-w","DOIUrl":"10.1186/s12939-026-02897-w","url":null,"abstract":"<p><strong>Aim: </strong>This study assesses the influence of various specific health conditions as activity limitations and groups of chronic diseases, in estimating poor self-rated health for the Spanish population aged 30-60, stratified by the intersections of gender and social class. Moving beyond unidimensional social gradients, the research utilises decision tree analysis to identify specific configurations of SRH responses that align with the epidemiological profiles of distinct intersectional strata.</p><p><strong>Methods: </strong>Data were drawn from the 2023 Spanish Health Survey (ESdE), focusing on a sample of 10,210 adults aged 30-60. This age bracket was selected to capture health inequality dynamics during the working life-course. Specific machine learning decision trees (J48 algorithm) were employed to assess the pathways for classifying individuals with poor SRH across six distinct intersectional groups.</p><p><strong>Results: </strong>Resulting decision trees differ significantly in composition, shape, and length across strata. A clear trend emerged: less skilled groups exhibited higher tree complexity, reflecting a more rapid accumulation of chronic illnesses at earlier ages.</p><p><strong>Conclusion: </strong>This research contributes to the emerging field of study regarding what truly underlies individuals' general assessment of their health. The resulting decision trees illustrate the social gradient in health in a novel way that enriches the understanding of health inequalities. Instead of simply showing a linear trend across a one-dimensional variable, these trees reveal that as disadvantages accumulate through the intersection between gender and social class, the combination of relevant diseases do not only become more complex, but also distinct, in specific and unique ways for each group, as the intersectional framework predicts.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13449678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054298","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":"Inclusiveness of social participation for health reform: findings from a realist review.","authors":"Shraddha Mishra, Neymat Chadha, María Eugenia Esandi, Camila Serrao, Rodrigo Hernan Acuña, Surya Surendran, Amandeep Saini, Ines Aristegui, Devaki Nambiar","doi":"10.1186/s12939-026-02847-6","DOIUrl":"10.1186/s12939-026-02847-6","url":null,"abstract":"<p><strong>Objective: </strong>In 2024, the 77th World Health Assembly adopted a resolution on social participation for health (SPH), underscoring the importance of inclusive health system decision-making to achieve universal health coverage. Inclusion-oriented SPH is key to achieving health equity, enabling the needs and perspectives of marginalized communities to reflect in decisions, yet many initiatives fall short. A realist review sought to determine the contextual factors influencing the inclusiveness and outcomes of SPH reform initiatives, alongside their mechanisms of influence.</p><p><strong>Methods: </strong>Studies were sourced through a comprehensive search focused on social participation, health reform, and inclusion. Following title-abstract screening, quality and relevance were rated using adapted 0-5 scoring. The sub-analysis presented here mapped SPH reform processes, outcomes, geographic spread, and strategies and resources for inclusive SPH.</p><p><strong>Results: </strong>150 studies were retrieved. Strategies to enhance inclusiveness focused on ensuring access to platforms, tailoring recruitment, and employing culturally safe approaches, and were undergirded by diverse (e.g., financial and technical) resources. 50% of studies reported the nature of diversity in participatory processes, while others addressed qualitative aspects of inclusion/exclusion.</p><p><strong>Conclusions: </strong>While efforts have enhanced inclusiveness of social participation in health systems decision-making, challenges of meaningful engagement and exclusion remain. There may be no single point or threshold at which complete inclusiveness of social participation for health may be achieved, but it is clear that for populations overall as much as for particular \"left behind groups\" there are key entry points that may help overcome limitations and barriers.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054276","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":"Addressing social determinants of health and equity in early childhood: a qualitative document analysis of national policies in Ecuador.","authors":"Grace Navarrete Chávez, Alex García Gutiérrez, Diego Andrade Ortíz, Daniel Kopasker, Ruth Dundas, Srinivasa Vittal Katikireddi","doi":"10.1186/s12939-026-02891-2","DOIUrl":"10.1186/s12939-026-02891-2","url":null,"abstract":"<p><strong>Background: </strong>Early childhood health is a major policy priority in Ecuador, yet systematic analyses of relevant policies are limited. This study analyses how Ecuadorian national-level policies (2000-2024) have addressed social determinants of health (SDH) in early childhood and promoted health equity. We map the development and scope of the past and present national policy documents across sectors to identify gaps, strengths and priorities within the policy landscape.</p><p><strong>Methods: </strong>Following a systematic search, we conducted a qualitative analysis of 29 policy documents using the READ approach (ready the materials, extract data, analyse, and distil findings), with thematic analysis. We combined deductive codes related to governance instruments and six SDH living-conditions domains (healthcare, health services, early education, social protection, childcare, and housing) with inductive codes that emerged during analysis. NVivo software supported data management and theme development, paying attention to contradictory evidence. An advisory board reviewed the interpretation of findings.</p><p><strong>Results: </strong>Early policy documents focused on sector-specific interventions, whereas later policies reflected more holistic approaches. Recent policies strongly promoted intersectoral collaboration but rarely specified clear financing or evaluation mechanisms. All six SDH domains analysed were represented, but attention was unbalanced: healthcare and health services dominated, while housing, early education and childcare were under-represented. Applying a policy typology, most policies were universal or targeted; only one was redistributive, and the use of proportionate universalism was uneven. Commitments to equity became more prominent over time through recognising vulnerable groups and intercultural approaches, yet concrete recommendations on intersectionality, territorial equity and community-based planning remained scarce.</p><p><strong>Conclusion: </strong>Embedding social determinants of health in policy design, underpinned by robust governance, effective intersectoral collaboration, sustainable financing, and locally responsive strategies, is essential, particularly for children facing intersecting disadvantages and those living in underserved territories. Stronger evidence on governance structures, implementation processes, and equity-oriented evaluations using lower-level territorial health indicators is crucial not only for Ecuador but also for other low-and middle-income countries seeking to advance equity in the earliest years and across future generations.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054225","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":"COVID-19 morbidity and mortality in young people in selected countries of the Americas.","authors":"Sonja Caffe, Emmanuel Gonzalez Bautista, Oscar San Roman-Orozco, Antonio Sanhueza","doi":"10.1186/s12939-026-02831-0","DOIUrl":"10.1186/s12939-026-02831-0","url":null,"abstract":"<p><strong>Background: </strong>While COVID-19 primarily affected adults, the epidemiology among adolescents and young adults has been less explored. This study describes the burden, outcomes, and correlates of COVID-19 among people aged 10-24 years in selected countries in the Americas during the acute pandemic phase (2020-mid-2022).</p><p><strong>Methods: </strong>We analyzed case-based surveillance data reported by 32 countries and territories to the Pan American Health Organization between January 2020 and July 2022. Confirmed and probable SARS-CoV-2 infections were included following WHO definitions. We described age, sex, and temporal distributions, estimated cumulative incidence, and assessed associations between recovery status, comorbidities, and treatment modalities using logistic regression models adjusted for age and sex.</p><p><strong>Results: </strong>A total of 17,031,217 COVID-19 cases were reported among young people (72% aged 10-19; 28% aged 20-24). Females accounted for 53% of cases. The pooled cumulative incidence was 7.7 per 100 population aged 10-24, ranging from 0.1 in Cuba to 52.0 in Bonaire, Sint Eustatius, and Saba. Recovery was documented in 88.9% of adolescents and 87.0% of young adults. The odds of recovery were lower among those aged 20-24 years (aOR 0.84, 95% CI 0.83-0.84), those with ≥ 1 comorbidity (aOR 0.17, 95% CI 0.16-0.18), and those requiring ventilatory support (aOR 0.28, 95% CI 0.25-0.31). Females and hospitalized patients had slightly higher recovery odds. Cardiovascular, kidney, and diabetic comorbidities were significantly associated with increased mortality.</p><p><strong>Conclusions: </strong>Young people in the Americas represented a substantial proportion of COVID-19 cases, though with low overall mortality. However, chronic conditions markedly increased the risk of poor outcomes. Strengthening surveillance, ensuring continuity of care for young people with chronic diseases, and tailoring risk communication are essential components of future pandemic preparedness and life-course health strategies.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"25 1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054242","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":"Language barriers, mobility, and health equity: clinical risks, economic burden, and policy options for universal language access.","authors":"Carmen Pena-Díaz","doi":"10.1186/s12939-026-02895-y","DOIUrl":"10.1186/s12939-026-02895-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;International mobility has intensified routine contact between health systems and patients who do not speak the dominant language of care. In these encounters, language discordance is not a minor inconvenience but a mechanism through which existing social inequalities may be translated into delayed access, unsafe care, weaker informed consent, lower trust, and inefficient use of resources. Despite a substantial literature showing that professional interpreters improve communication and patient experience, interpreter provision remains uneven, especially in urgent care, off-hours care, and encounters involving less common languages.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This article presents an expanded narrative review of evidence published between 2000 and 2025 on language barriers, professional interpreting, migrant-sensitive care, and safety-related outcomes in health services. The synthesis was organised around political accountability, economic stewardship, and system-level implementation, with attention to rights, legal entitlements, avoidable waste, measurement, and governance. In addition to the literature review, the article uses conceptual cost reasoning based on publicly available tariffs from the region of Madrid (Comunidad Autónoma de Madrid) and develops illustrative vignettes to show how a hybrid model of on-demand remote and in-person interpreting may operate across primary care, emergency care, maternity care, and mental health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The reviewed literature indicates that language barriers are associated with more serious adverse events, interpretation errors, longer lengths of stay, weaker discharge communication, and underuse or patchy use of professional language support. Professional interpreters are associated with better comprehension, higher patient and provider satisfaction, better-quality discharge communication, and, in some settings, lower risk of communication-sensitive harm. The synthesis also suggests that the problem is not only linguistic. It is patterned by structural vulnerability, administrative precarity, unstable housing, work conditions, and variable institutional willingness to document and respond to language need. A hybrid service model, combining immediate telephone or video interpreting with reserved in-person support for high-risk and high-nuance encounters, is presented as a pragmatic and equity-oriented design for contemporary health systems.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Universal language access should be understood as core health-system infrastructure rather than as a discretionary support service. Reframing language access in this way can strengthen informed consent, patient safety, operational efficiency, and equity. The article proposes an integrated policy package covering statutory or stable funding, mandatory language documentation, electronic health record integration, workforce training and standards, and explicit governance for di","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13412124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148054239","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":"Gender-related perceptions among healthcare providers and mothers in a pregnancy and early childhood obesity prevention intervention in Shanghai, China.","authors":"Kyla Christianson, Hong Jiang, Fanyu Zeng, Anxin Yin, Xingying Li, Jianxia Fan, Jean-Patrice Baillargeon, Louise C Mâsse, Olivia De-Jongh González, Nadia Abdelouahab, William Fraser, Hefeng Huang, Catherine M Herba, Andraea Van Hulst","doi":"10.1186/s12939-026-02878-z","DOIUrl":"10.1186/s12939-026-02878-z","url":null,"abstract":"<p><strong>Background: </strong>Gendered perceptions can shape parental beliefs, behaviours and practices relevant to childhood obesity prevention during the critical early life period from pregnancy to infancy. We explored how pregnant women, mothers and healthcare providers in maternal child health in Shanghai, China, perceive the influences of gender within an overweight and obesity prevention context.</p><p><strong>Methods: </strong>We conducted a qualitative descriptive study integrated into the intervention arm of an ongoing early childhood obesity prevention trial. Individual interviews and focus group discussions with pregnant women and mothers participating in the intervention and healthcare providers involved in the delivery of the intervention were conducted (n = 59). We documented perceptions on gender in relation to parental beliefs, behaviours and practices in the context of overweight and obesity prevention. Interviews were audio recorded, transcribed and analyzed using thematic analysis.</p><p><strong>Results: </strong>Three main themes were identified. First, participants shared expectations for children's bodies, emphasizing that health was a priority for both boys and girls, but that expectations regarding body figure were generally stricter for girls than for boys. Second, regarding parenting expectations and health behaviours, few gender differences were reported other than boys being expected to engage in more physical activity compared to girls. Third, participants shared their views on gender roles and involvement in parenting, highlighting mothers' central role in overweight and obesity prevention during pregnancy and early childhood, alongside a desire for greater paternal involvement in parenting and in modelling healthy lifestyle behaviours.</p><p><strong>Conclusions: </strong>Findings underscore the importance of integrating gender‑related perceptions into early childhood overweight and obesity prevention efforts, beginning prenatally and extending through early childhood. Increasing awareness of these perceptions early in the life course could contribute to more gender-sensitive care and support childhood obesity prevention from the earliest stages of life.</p><p><strong>Trial registration: </strong>The SCHeLTI protocol was registered on the Chinese registry ChiCTR1800017773 on 2018-08-13 ( https://www.chictr.org.cn/hvshowproject.html?id=93827%26v=1.3 ).</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029460","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}