Many of today’s public health issues – diabetes, cancer, obesity, cardiovascular disease – are strongly associated with social inequalities. Literature from across the world shows that gaps in income, employment, education and access to acute and preventative health care worsen health outcomes for disadvantaged populations. When the inequalities are avoidable and based on unjust distributions of resources, for example, it then becomes an issue of health inequity.
This means that public health professionals must address the factors that people are born into – where they grow, live and work – at a population level to alleviate health inequities. The World Health Organization points out that these conditions are “shaped by the distribution of money, power and resources at global, national and local levels.”
Research in action
Increasingly, researchers are looking at ways to implement and measure programs to reduce health inequities. This is the goal of what the WHO calls the “third wave” of health inequity research. To understand health inequities, first we need to know what they are. Around the world, public health agencies monitor health inequality trends, provide the basis of understanding which inequalities are equity issues, and create evidence for policy approaches to improve health for entire communities.
The U.S. Centers for Disease Control and Prevention (CDC) integrates public health and census data and it publishes a yearly health inequality report. Year after year, they’ve found that many social determinants are associated with poor health outcomes, and are thus equity issues.
Race is a factor as well. The 2013 CDC report shows many adverse health outcomes related to the social determinants of health were associated with race. For example, deaths by stroke and coronary heart disease, drug-induced deaths and HIV incidence were more likely in non-Hispanic blacks, American Indian/Alaskan Natives and non-Asian racial/ethnic minorities, respectively, than in whites. But, there are not yet any sure-fire solutions to help reduce these inequities.
In the UK, health inequality data is integrated into Public Health England’s tool called “Public Health Profiles”. The interactive tool allows users to view several sources of area-based data that can be linked to social determinants like homelessness, unemployment, and deprivation of neighborhoods, to various negative health outcomes. It is through the use of this kind of data that has caused the UK Department of Health to set their goals of seeing action on reducing cardiovascular disease, cancer and infant mortality inequalities for 2015.
What do we do with this information?
Collecting this data is important, but how do we put it to use? Decades of cross-discipline public health research and practice has lead to the Health in all Policies (HiaP) approach to policy-making. It is a strategy that targets things like city design or transportation – the structural components of the social determinants of health.
HiaP encourages policymakers across all sectors of government to consider the health impacts of policies that are, on the surface, unrelated to health. City design is a good example of a policy target that can have an immediate impact on active transportation, air quality and healthy food availability. Think of this way: If cities are more walkable or have better public transit, people might walk more or drive less. If there are more healthy eating options around, people might make healthier food choices, and so on.
HiaP has been adopted by 16 countries or sub-national areas across the world, including Finland, Thailand, England and New Zealand.
Can HiaP work? Look at Finland
A classic example of HiaP in action is the dramatic reduction in heart disease that Finland achieved thanks to HiaP in the 1970s. At the time smoking was common and diets were heavy on meat and fat and light on vegetables. Combined with a sedentary lifestyle, it meant that Finland had the world’s highest death rate from cardiovascular disease.
North Karelia, a region in Finland’s east, was the focus of a project to reduce heart disease throughout the community. The North Karelia Project fostered partnerships involving the food sector, schools, health, the media and citizens in Karelia. The project led to public education campaigns, health promotion training for workers, encouraging healthy food choices and preventative programming in community centers to target risk factors and behaviors associated with heart disease.
This initiative has helped to reduce under-65 death by coronary heart disease year after year. By 1995, there was a 73% reduction in coronary heart disease in males compared to pre-program years, and it has been declining by 8% a year.
Cities and states in the United States are starting to adopt HiaP to improve health across communities. California’s Health in all Policies Task Force has representatives from 22 different state agencies working to design shared transportation, healthy food and healthy environment goals. City governments in San Fransisco and Baltimore and the state of Ohio also have HiaP initiatives that include transportation, development and employment in their health programs.
South Australia’s state HiaP model is one of the most well developed in the world. Their model integrates health into all cabinet decisions and lays out how people across sectors can analyze the health impact of policy actions.
Researchers found that policymakers in South Australia are more aware of the health impact of social policies, and have formed stronger partnerships across sectors of the government. The program is still young, and large-scale policy-based interventions tend to take years to show results, especially those that target chronic conditions.
Public health can lead the way in creating a more equitable, healthier society by continuing to look for long-term solutions through sound public health research and by encouraging health-focused policy across disciplines.
Thilina Bandara is a PhD student, Community and Population Health Sciences, University of Saskatchewan, Canada.
The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.
- External Link
- https://theconversation.com/to-tackle-inequalities-build-health-into-all-public-policies-35095
39 Comments
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wallace
In Japan, during my six-year journey with cancer and post-cancer treatment, my doctors have never prescribed drugs unnecessarily. When my symptoms were at their worst, I took several medications, including painkillers, but each one was carefully discussed with me, and I had a say in whether I wanted to take them. Now, I only take two medications.
I continued with my diet but reduced sugar intake as much as I was able for borderline diabetics. I also stopped drinking alcohol for that reason.
wallace
Every week I get a Line message from my pharmacist asking about the drugs I am taking and whether they have bad effects and giving me advice on what to do.
wallace
Jimizo
Every week I get a Line message from my pharmacist asking about the drugs I am taking and whether they have bad effects and giving me advice on what to do
Agreed. From "Welcia". Impresses me for sure.
You are right about that. I discuss everything with my doctors who I see every three months and my dieticians who visit every six months.
Bad Haircut
But you still do, by claiming that anyone who dares to question the manufactured consensus as a whacko. You should know yourself that science in any field is always evolving. For a long time the Big Bang theory was held to be the most likely origin of the universe, but new findings are leading some astrophysicists to question that. Just because they form a minority opinion, that doesn't necessarily make them wrong. The same goes for medicine and atmospheric science, and so on.
Medical doctors are dealing with patients face to face and they can see how different people are affected by different treatments, foods and the like. Some pay more careful attention to it than others, but when they publicise some objective evidence that goes against the conventional opinion of the day, they get chewed out for it. It may be easy for medical boards to deal with single cases of this, but when more and more doctors are noticing problems with a certain consensus through their objective data, then the authorities have a crisis on their hands if the public gets wind of it. What's worse - the public losing confidence in the medical establishment, or the medical establishment being forced to adapt to new information that challenges their interests?
Bad Haircut
So, trying to implicate meat by lumping it in with heavy smoking...
They seem to be giving away PhDs in cereal boxes these days.
Raw Beer
The greatest impact in improving public health policies would be to finally address the considerable level of conflicts of interest found at all levels, including the regulators, those designing policies and recommendations, and the MSM.
As I recently posted on another thread:
"Conflicts of interest for members of the US 2020 dietary guidelines advisory committee."
https://pubmed.ncbi.nlm.nih.gov/35311630/
"Results: Our analysis found that 95 % of the committee members had COI with the food and/or pharmaceutical industries and that particular actors, including Kellogg, Abbott, Kraft, Mead Johnson, General Mills, Dannon and the International Life Sciences, had connections with multiple members. Research funding and membership of an advisory/executive board jointly accounted for more than 60 % of the total number of COI documented."
These "experts" with conflicts of interest are telling us what we should eat, they determine the so called "scientific consensus" that is constantly parroted by agenda driven bureaucrats, and which some unscientific people seem to be very fond of. There are similar COIs among the drug regulators.
Bad Haircut
You're deliberately twisting a confluence of interests to mean "conspiracy theory. " Another clunky attempt at a fallacy. Doctors are busy people and simply don't have the time to know everything, so frequently take the path of least resistance and loyally follow what they receive in the literature. But don't forget that a hefty portion of the literature is riddled with conflicts of interest that arise from funding and memberships, as Raw Beer illustrated in the example above. Studies need to be funded somehow, and scientists who don't provide the results their funders/employers want don't usually last too long.
And don't forget scientists and doctors are human too. They can be influenced by fancy all-expenses-paid trips to exotic locations for conferences paid for by corporate entities; the implication is that the scientists and doctors recommend or prescribe the sponsors' products in kind. That's just how it works. They can also be cajoled into keeping their mouths shut when they notice something untoward by having their license or job threatened as we saw during the COVID period. Or they can be paid handsomely to provide dubious results as scientists for the tobacco companies were. To deny this goes on is to deny human nature.
I'm not claiming that all are dishonest, but large numbers do respond to certain incentives and disincentives to behave in certain ways.
Raw Beer
No, perceived bad health habits. As I wrote: With the meat-is-bad narrative that we have long been inundated with, people who care less about their health were more likely to do all of those things (eat meat, smoke, eat junk food...).
However, today health-conscious people are increasingly informing themselves and moving towards keto and/or carnivore diets.
Raw Beer
I remember early on in the pandemic, when they noticed that dark-skinned people were disproportionately affected. The common narrative was that it was due to social inequalities. However, nobody in the MSM ever mentioned that it was likely due to the fact that dark-skinned people living in America or Europe were much more likely to have insufficient vitamin D. In the UK, many (most?) of the doctors and other healthcare staff who died from covid had dark skin; they weren't poor.
Raw Beer
Even without having a specialty directly related to a topic, a certain level of education and critical thinking skills should be enough for most of us to spot nonsensical sophistry and BS.
In my case, in addition to that, my specialty is quite closely related to diet and pharmaceuticals...
Raw Beer
Yeah, but doctors often work for clinics who get money from the companies, or from the government thanks to regulations introduced by lawmakers who get money from companies. Doctors are not always free to prescribe what they think is best. Also, doctors tend to assume that whatever the regulators approve must be safe and effective.
And regarding diet, we recently had an article on JT about how most doctors had no classes about nutrition during med school, and those who did only had a few lectures. These doctors rely on dietary guidelines which were created by "experts", 95% of whom had strong financial ties to companies.
wallace
That has never been my experience in Japan during my cancer treatment. I attended three different hospitals.
I was referred to qualified dieticians.
GBR48
The UK's public health goals flatlined courtesy of Covid, Brexit's impact on the economy, doctors' consequent strikes, the blocks on migrant staff and drug shortages. Their cunning plan is to switch to digital, thereby excluding enough of the population - specifically the elderly, poor and vulnerable - to get the waiting list numbers down.
quote: If cities are more walkable or have better public transit, people might walk more or drive less.
No, they won't. Public transport is expensive. Climate change is making 'active travel' harder. People with families and jobs can't walk their weekly shopping home. Ban cars and people will order food online, killing retail centres.
quote: If there are more healthy eating options around, people might make healthier food choices.
Not much. Changing eating habits is like changing peoples religion. I'm vegan and would love to see the government throw cash at providing more vegan options. I suspect they had a go during Covid. There were a few small successes, but they don't have the cash anymore and will simply crimp supply chains to make meat more expensive.
We know that poverty will not go away. We know that the poorer/more marginalised you are, the worse your health is likely to be. And we know that underfunded government health campaigns work like chocolate teapots. So maybe we should axe all funding from further public health research (as it will just say the same) and spend it on providing better medical care and cheaper healthy food instead.
In the UK, Brexit has gutted public spending. Global economic damage and cold war limitations on supply chains will do the same thing for everyone else. Public services that governments fund in the future will be done on the cheap. So don't expect these grand plans to be widely adopted.
You should all eat a good diet and try to stay healthy, because state healthcare is only going to decline in the future. If you eat junk food for years and then waddle breathlessly to your local GP in the hope that they will wave a magic wand and save you, you will be out of luck.
The one thing they can do (and are) is encouraging kids in school to follow a healthy diet and do some exercise, 'unless you want to end up like your parents and grandparents'.
Bad Haircut
Some pills work well, but many don't and can cause more harm than good, especially if used for longer than necessary.
Are you seriously arguing for prescribing as much medication as necessary when lifestyle changes such as better food and more exercise can do just as well without the adverse effects many medications have?
Bad Haircut
Should be: Are you seriously arguing for prescribing as much medication as possible
Bad Haircut
Not at all. There's often more than one way to skin a cat. Sometimes medication is the best option, sometimes not. From the pharmaceutical companies' perspective it's the best possible way, but they are simply looking after their own interests - which may or may not align with the patients' best interests.
The body is a highly complex system, and what works for some won't work for others. Doctors and medical scientists are continually discovering new things and modifying or discarding old theories and hypotheses about how things work and what's safe or dangerous, and there's plenty of disagreement among these people about the facts. So to claim a consensus is about one thing or another is fallacious.
Bad Haircut
Indeed. But some people here insist that people without a certain piece of paper have no right to challenge certain information, which is of course complete nonsense.
Bad Haircut
He might be concerned that someone will try to dox him.
Jimizo
Sounds like good care.
I get the sense you are smart enough to listen to professionals about medication and diet.
Raw Beer
Naah, the most you have ever shown was a mild association between meat consumption and cancer or diabetes. In addition to what Bad Haircut wrote, there is the fact that when you look closely at the data, we find considerable confounders; meat consumption was also associated with smoking, obesity, lack of exercise....
With the meat-is-bad narrative that we have long been inundated with, people who care less about their health were more likely to do all of those things (eat meat, smoke, eat junk food...).
Hoever, today health-conscious people are increasingly returning to eating meat.
Bad Haircut
I do actually. Materials science. but also took some biology units.
You?
Raw Beer
Fluoride is a health intervention?!!!
I guess you didn't hear about the recent US federal court ruling against the use of fluoride in drinking water, saying that the risks outweighed the alleged benefits.
Someone involved in the case was recently on Jimmy Dore:
https://www.youtube.com/watch?v=wq7zy6glbSg
virusrex
Yes it is, demonstrated scientifically to improve importantly dental health as long as the concentrations are kept at appropriate levels which is quite easy.
https://my.clevelandclinic.org/health/treatments/11195-fluoride
Pretending that scientific matters can be decided by court rulings make absolutely no sense, it would not be the first (nor the last, unfortunately) time a court decide things based on things demonstrably wrong. It is important to note also that fluoridation is not exclusive to water, so in places where it is also included in food or dental products it can be made redundant to be also included in the water, this of course is very different from saying fluoridation is not a health intervention, it continues to be so, just done in a different medium.
Jimizo
You have very strong and very predictable views on a variety of issues regarding science - climate, diet, medication etc.
What are your credentials in any of these areas?
Jimizo
Any stats to back this up?
As a credentialed scientist with a doctorate, can you clarify your claim that those on a carnivore diet don’t fart?
I’m sorry to repeat this, but I’m honestly fascinated by this claim and whether this is healthy or even possible. I follow a balanced diet and feel okay but I do sometimes fart.
I’ll be having a check up soon and was going to ask my doctor about this but he may be bought and paid for by someone or other.
Jimizo
You have very strong and very predictable opinions on a variety of matters regarding science.
Do you have any background whatsoever in any of these very different fields you express very strong opinions on?
Anything at all? Any science background whatsoever?
It does come across as you applying a one size fits all approach to these things after watching podcasts.
Jimizo
Physics. Reasonable experience of mechanical and electrical engineering - certainly no authority on either.
That does not qualify me to express very strong opinions on diet, pharmaceuticals, climate science etc.
Your approach to these different issues does come across as the garden variety follow the money/bought and paid for/big something or other approach common among conspiracy theorists.
I must admit it is convenient. You can dismiss the opinions of those who don’t align with your political views without needing any expertise in the area.
It isn’t very convincing though.
Jimizo
Depends on how you challenge it.
Challenging an idea based on actual knowledge of the area is different to dismissing it based on a general conspiracy theory principle of bought and paid for/compromised/big something or other.
The latter approach is very unimpressive. It’s very convenient and multi-purpose but is getting a bit boring now.
virusrex
No I am not, you are using as an excuse the explanation that medical professionals secretly change their recommendations and scientists the data they collect in order to push falsehoods only because this is profitable to them, and do this in every institution on every country of the planet, offering zero evidence of this actually happening. This is a textbook conspiracy theory (and one impossible to believe).
But they are required professionally to know about their field in order to be accredited, and since you are not saying that the professional associations are right in their recommendations and only a few busy doctors are wrong you contradict your new argument. If scientists prove something, the associations of medical professionals do the same, the doctors mirror those recommendations, either every professional is wrong (but you) or everybody is correct and you mistaken. It is easy to see which is the case.
No part of the argument depends on scientists and doctors being perfect, you disagree with them? then publish your report demonstrating it with valid data and methods that resist peer review (or better, expert review) because just claiming "they are not perfect, maybe they are wrong" is as valid as for everything else that is in consensus, from microbes causing infections to the heart role in the circulation. No proof of a better explanation? then the current one stands.
Once again baseless claims, doctors can be punished for repeating falsehoods in order to profit, that is desirable and good. Part of their professional duties is to act according to the best available evidence and just pushing personal beliefs when they are not proved (or worse, when they have been disproved) is a perfectly valid ground for suspension or removal of their professional credentials.
Yet you can't provide any evidence about the consensus being wrong, just that you believe it. Very importantly the consensus is reached when everybody (as in the world) end up reaching the same conclusions by looking at many different sources of evidence. Even "large numbers" would not be enough to do this, much less when you can't even prove these large numbers are actually lying.
Proved bad health habits, personally rejecting the scientific evidence is not an argument to dismiss it. The evidence is there and that is why there is a consensus about meat being unhealthy as a mayor source of nutrition compared with much healthier diets that are balanced.
The fallacy of appeal to popularity is obvious. If something proved to be unhealthy and risky becomes popular that does nothing to negate these negative aspects, it does prove that people that try to use this argument are not above using obvious fallacies when actual arguments are not available to defend what they are trying to push.
It should, but frequently it does not. Specially for people hopelessly out of their field of expertise or that have systematic antiscientific bias. Specially important for claimed levels of education, when someone argument depends not on logic or evidence but on a claimed degree of expertise this is obviously invalid.
Jimizo
What is that speciality?
I don’t get the coyness.
Suspicious…
TaiwanIsNotChina
Going to be a slight problem for the kids that require chemicals to survive.
virusrex
Fluoride is a health intervention and added to prevent health problems at concentrations that have no negative effect on humans. In this case the only toxic thing is the disinformation being spread this way.
Based on personal preference? because if there is no negative effect being correlated to them there is no justification to ban something.
To improve their health and survival rates? on the opposite, do it as much as possible.
The problem with irrational positions like these is that people that push for them take great pride on being irrational about them.
virusrex
No based on studies with a wide variety of evidence being analyzed, from epidemiological to molecular. The evidence is clear and has not been debunked, so it is still the best available.
I am just making evident that you used zero arguments instead tried to imply credentials not being valid as if that had any kind of value when obviously it has not. If you don't want flawed arguments to be pointed out the best solution is not using them in the first place.
And the best people to evaluate this are the medical and science professionals that do this professionally and whose advice is the best guide to know when and for how long to use each medical intervention.
That makes no sense, it is one single line of text and very clear, use anything and everything that improves the health and survival of children as proved by science. The rest is just something you made up because you could not refute anything the single line of text you quote is saying.
virusrex
And it is still a completely bad misinterpretation of something so short and clear. Do as much as necessary/possible of anything that improves their health and survival rates. By definition this means a benefit.
Jimizo
I think we are dealing with garden variety conspiracy theorists watching podcasts rather than with people with any actual expertise in this area.
Climate change, stolen elections, faked moon landings, scamdemics, carnivore/keto diets etc.
So completely predictable.
virusrex
Definitely not, if that were the case it would not sustain such a complete scientific consensus about the issue, you are the one that have not produce any kind of evidence to refute this consensus, just claim it is wrong because you refuse to believe it and then using some impossible global conspiracy to excuse not having that evidence on your side.
Bad health habits related to each other? is that so surprising? never mind that no report have ever explained the correlation with meat consumption as completely explained with its association with the other bad lifestyle indicators.
The opposite, specially because it is also resource intensive on top of coming with health risks.
But the quoted text is not about the way to do something but the end result. If the end result is an improvement over not doing it then it is still better to do as much as possible while this is true.
People go to consult medical professionals, not pharmaceutical companies, and as long as the result is better for the health of the patients it is still better to do it. Baselessly accusing doctors to put the profit of companies above the health of their patients is also a baseless accusation used as an excuse to avoid accepting that doctors and scientists know best and can show the evidence for the current recommendations.
Specially for antiscientific groups that systematically try to misrepresent the scientific consensus as invalid for personal profit.
And as debunked in the same article:
And that is why the US is an special case that contradicts the guidelines in every other country of the world, right? Because if not this still is a completely insufficient argument to prove the global consensus is in some kind of conspiracy to hide the actual evidence that anybody in any country could easily publish.
It is also a source severely criticized for taking the information out of context to exaggerate the COIs and remove very important details that put many different types of relationships between members and the industry in context.
https://www.sciencedirect.com/science/article/pii/S2475299124023473
One extra detail is that COIs do not mean that automatically a report is false or dubious, COIs allow for an explanation about why a report or a recommendation with problematic data, methods or conclusions is being published. But if no such problem is identified and everything is available for anybody to confirm then the report or recommendation can be correct with or without any COI (specially if an independent ethics committee evaluates those COIs).
So, a situation in one single country being misrepresented as if it was the actual global consensus, based on a report criticized for exaggerating that situation and that in no point puts in doubt the validity of the information used to reach determinations. This in no way proves the supposed global conspiracy that makes it impossible to find evidence to support your beliefs.
virusrex
That is the whole point, by leaving the appeal to actual, valid authorities in the field it is completely irrelevant what anybody here is (or claim it is). An elementary school child could be the one saying "the consensus of science is this" and it would make no difference because the appeal is to the valid auhority of the scientific or medical community of the world, not what the person writing the comment claims to be.
No, you claimed one, but this is as valid as anybody saying they are university professors in every field of science. An appeal to authority from an anonymous source has no value.
People without accreditation can't make that accreditation an argument, what is necessary to challenge something like the scientific consensus is actual scientific evidence published in a way that can be examined by the scientists. The problem is when people claim credentials to replace that evidence and try to do it anonymously, that makes no sense.
As long as the recommendations are congruent with the global scientific consensus there is no problem. Of course then comes the excuse of every single institution of the whole world being part of the conspiracy, which makes as much sense as in every other antiscientific claim. Flatearthers, homeopaths, creationists, etc.
Which has no importance when the obvious solution is to get that education after medical school (as with all specialties) or the doctor directing patients that require that specialized care to the experts that have that preparation. I mean, this is also true in Japan, and the population do not have the problem with obesity that would be expected if this was the reason.
Still a debunked claim when the experts have been clearly by independent ethical committees and the recommendations are congruent with the available evidence, something that any expert in the world can access and confirm by themselves.
virusrex
Diets high in meat and low on vegetables have been correlated with much higher cardiac risk, there is no need to implicate meat about something already known.
So, no actual argument against what you refuse to accept, so just a baseless claim about the credentials being invalid?