This study examines gender differences in self-perceived health and psychological distress among self-employed workers and employees in Barcelona, Spain, during the COVID-19 pandemic. This cross-sectional study used data from the 2021 Barcelona Health Survey. We included a subsample of workers aged 25-64 years (892 men and 885 women). Employment status was classified into four categories: permanent employee, temporary employee, self-employed, or employer. Two health outcomes were analysed: self-perceived health and psychological distress. Gender-stratified analyses were performed. Unlike men, female employers were less likely to belong to higher social classes, less likely to live with a partner, and more likely to have children than other employed women. Self-perceived health did not differ by employment status in either sex; however, psychological distress outcomes diverged: male employers reported better psychological status than male employees, whereas female employers had higher odds of poor psychological status than other employed women. These findings suggest that many female employers may be necessity-driven entrepreneurs, particularly affected by the impacts of the pandemic. Although results for female employers should be interpreted with caution due to the small sample size, they are consistent with a structural interpretation linking gendered care responsibilities, labour market segmentation, and health inequalities.
This article systematically reviews quantitative studies of the impacts of changes to the UK social security system since 2010 on health outcomes from 10 peer reviewed databases and the grey literature as outlined in the Prospero protocol CRD42021282605. Study quality was assessed using an adaptation of the Effective Public Health Practice Project tool (EPHPP). Studies were reported following the Synthesis without Meta-analysis (SWiM) guidelines. Certainty of the impact of welfare reform on mental health was considered using GRADE principles. Of 8504 records screened, eighteen studies were included in the review. Fifteen looked at mental health outcomes: 12 showed worsening mental health, two showed mixed effects and one showed no effect. Three studies showed that reforms harmed health when measured using life expectancy or mortality. No effects on physical health were reported from three studies, and findings were mixed for the impact on general health. Four studies reported on the impact of reforms on inequalities in one or more health outcome with mixed results. The certainty of our findings on mental health was rated very low. Changes to the UK social security system between 2010 and 2020 were associated with poorer population level mental health and mortality derived health measures.
This comment aims to comprehensively analyse the alarming increase in suicide rates in India, emphasizing demographic variations, contributory factors, and existing preventive measures. The study also explores the effectiveness of the National Suicide Prevention Strategy (NSPS), Mental Healthcare Act (MHCA), and other initiatives in addressing this public health crisis. This comment concludes that while India has taken crucial steps in formulating suicide prevention strategies, effective implementation remains a challenge. Recommendations include increasing access to mental health support, enhancing telepsychiatry services, and promoting responsible media coverage. Collaboration between the health and education sectors, along with targeted prevention tactics for high-risk groups, is essential to curb the growing suicide crisis in India. The study underscores the urgency of a holistic and collaborative approach to mental health awareness and intervention.
The Rights of Persons with Disability Act (RPWD), 2016 marked a shift in the approach to disability policy in India. It was designed to ensure protection and inclusion of people with disabilities in the society. Our study attempted to analyse the RPWD, 2016 to examine its provisions. We conducted an in-depth document analysis of the RPWD act of 2016, additional notifications with regards to this act, and the scientific literature on disability. The findings indicated that the act's approach to mental disability and its integration was inadequate. The challenges of disability certification were not addressed sufficiently, and the assessment procedures were elusive in multiple contexts. Additionally, provisions for caregivers and people with disabilities were ambiguous in various areas. Despite the lacunae, the act had certain strengths, including moving away from a stigmatizing medical model to a social model of disability, advocating for nondiscrimination, and policy recognition of the government's role in providing for opportunity and support for people with disabilities and their caregivers, among others. We concluded that while the act is a noteworthy step for protection and inclusion of people with disabilities in the society, it has gaps that require revisions to ensure successful implementation.
In an attempt to avoid the inequitable outcome of the COVID-19 pandemic whereby High-Income Countries received the overwhelming majority of vaccine doses after they became available, the World Health Organization initiated negotiations in December 2021 on a legally binding Pandemic Agreement. This paper uses a variety of documents and personal experience to examine how the Canadian government communicated with its domestic stakeholders about the stances that Canada was taking during the negotiations and to illustrate what positions Canada was advancing at the negotiations table in Geneva. This article argues that the government lacked transparency in its communications and gave no indication that it was listening to the feedback it was receiving. During the negotiations, aside from advancing a progressive position of gender equality, the government pushed to weaken the obligations of countries and the commercial sector to ensure that vaccines, treatments and technology would be available on an equitable basis globally in any future pandemic. Now that the Pandemic Agreement has been adopted by the World Health Assembly, there is still the task of agreeing on an annex on pathogen access and benefit sharing. Past experience suggests that during these negotiations Canada will favor commercial over public health interests.
Bidi, a hand-rolled tobacco product widely used in South Asia, significantly contributes to tobacco-related diseases and serves as a vector for labor exploitation and systematic human rights violations. This perspective essay explains how the bidi industry employs women and children to create hazardous occupational conditions, reinforces gender and educational inequities, and perpetuates intergenerational cycles of poverty and labor dependency. We highlight neglected global tobacco policy and controls on labor and safety. We advocate for integrating informal bidi labor into existing health and labor protections and call for greater recognition of these production-side injustices within the global tobacco control discourse.
Getting health insurance for children's health care appears to be on the rise around the world. Nonetheless, progress is sluggish, and several cases of infections in children remain unaddressed, resulting in child mortality. A deeper understanding of health insurance coverage can improve health care utilization. Therefore, this study aims to find the impact of child-specific, maternal, household-related, and regional variables on child health insurance coverage in Punjab, Pakistan. The study is based on microdata (of 35,453 children aged 5 to 17 years) obtained from the Multiple Indicators Cluster Survey (MICS) to investigate the socioeconomic determinants of child insurance coverage. The study employed logistic regression and found that a child aged 10 to 14 was 15 percent less likely to have health insurance coverage than the reference category (i.e., child aged 5 to 9 years). A child with a functional disability had 1.3 times more chances to avail of health insurance than a child without any functional disabilities. Children from poorer households were 2.6 times more likely to have health insurance than those from the poorest households. The study concludes that an intervention based on raising maternal education levels, economic upliftment of households, and targeted support for the children of southern Punjab could improve child health insurance coverage in Punjab.
Stunting in children in Kalimantan, Indonesia, a resource-rich region commonly seen as economically advantaged but with large social and economic inequities across provinces and districts, is examined in this secondary analysis. Many Kalimantan communities lack access to education, steady jobs, health services, and adequate nutrition, perpetuating childhood undernutrition despite the region's natural abundance and prosperity. We carefully examined 6038 children, using stature as the outcome and income as the exposure. Province, domicile, maternal age, marital status, education, occupation, children's age, gender, and early breastfeeding initiation were included as controls. Our binary logistic regression analysis matched earlier findings. The poorest people were 2.150 times more likely to be stunted (95% CI 2.096-2.205). A lower level increased the risk of stunting by 1.540 times (95% CI 1.504-1.577). The middle class was 1.397 times more likely to be stunted than the wealthy (95% CI 1.365-1.429). Richer people had 0.949 times the risk of stunting (95% CI 0.928-0.970). These findings show that economic growth and regional development in Kalimantan have not led to equitable nutritional outcomes for young children, highlighting the need for targeted, poverty-sensitive nutrition policies, improved social protection for underserved households, and context-specific interventions to address structural inequalities in early-life health.
Research studies focusing on intimate partner violence (IPV) and depression among sexual and gender minorities (SGMs) are conducted more in developed countries, with few research conducted in Nepal. This study aimed to find out the prevalence of IPV and depression among SGMs in Nepal, assess the relationship between IPV and depression, identify challenges faced by SGMs in accessing mental health services, and provide recommendations to address them. A cross-sectional mixed-method study was used to collect data from 122 SGMs in Kathmandu, Nepal, from February-May 2024. Participants were recruited using respondent-driven sampling and completed self-administered questionnaires via QualtricsXM. Approximately 81.1% of participants experienced at least one form of emotional violence in their lifetime, 59.8% experienced physical violence, and 36.9% experienced sexual violence. Similarly, 33.6% of participants reported moderate to severe depression. Bivariate linear regression analysis showed a positive relationship between IPV and depression (B = 0.458, p < .001). Participants highlighted barriers to accessing mental health services, including limited availability, lack of LGBTQIA+-friendly care, and financial constraints. Participants emphasized expanding online mental health services, providing cost-free care, and increasing government support to improve SGMs' access to mental health services. This study highlighted the need to address socioeconomic and structural barriers to reduce distal (e.g., violence) and proximal minority stressors, and its psychological consequences among SGMs in Nepal.
Political violence caused by war, armed conflicts, or state violence against its own people is a major determinant of health. Transitional justice is both a value and a set of practices aimed at preventing the recurrence of state political violence. This study proposes a revised conceptual framework that establishes the relationship between people's attitudes toward transitional justice practices and their physical health, happiness, and sense of solidarity in self-defense amid geopolitical tensions. The study uses Taiwan as an illustrative case of transitional justice in a post-authoritarian democracy with historical state political violence and under threats of external political violence. The analysis is based on data from a cross-sectional, nationally representative survey conducted in 2020, with a final sample size of 1048 participants. The study found positive associations between different dimensions of attitudes toward transitional justice and respondents' well-being and willingness to defend themselves. The findings suggest that recognition of the state's unjust political violence and reconciliation among social members may be related to people's well-being. Furthermore, transitional justice should be seen not only as a domestic issue but also as one with significant geopolitical implications.
The global refugee crisis has exacerbated health disparities, particularly among middle-aged and older refugees, yet limited research exists on this vulnerable group, especially in low-income countries. This study investigates the predictors of health accessibility among middle-aged and older Afghan refugees in Pakistan in light of the social determinants of health, operationalized across four dimensions: health spending, health provider facilities, health information, and health communication. Using microdata from the 2022 Health Access and Utilization Survey (n = 423) at the household level, the study employed descriptive statistics, chi-square test, and logistic regression to examine the association between sociodemographic factors and health accessibility. The findings revealed discrepancies in gender distribution, literacy levels, and language proficiency. Education was found to be a significant predictor of health providers and health information, while reading ability was negatively associated with health providers and communication, suggesting that basic literacy may not necessarily translate into functional health literacy. The findings underscore the need for inclusive and targeted health policies that extend beyond service provision and address both structural and communication barriers faced by aging refugees. Policy makers and humanitarian organizations should prioritize context-specific, culturally sensitive interventions to promote healthy aging outcomes among vulnerable refugees in Pakistan.
This brief note responds to recent critiques of the article, "The Predestined Failure of the Market Mechanism in Ensuring Health for All in Times of a Pandemic: The Case of the Republic of Korea." The critiques primarily stem from interpreting structural arguments through a managerial and episodic lens. First, this response clarifies the theoretical application of state theory (drawing on Wright and Jessop) to distinguish the structural constraints of the state from the behavioral choices of the government, thereby rejecting claims of structural determinism. Second, it reiterates that South Korea's public health measures and medical-care capacity must be understood as inseparable components evolving within a single market-dependent configuration. The analytic focus is on institutional rigidity and path dependency, rather than a post-hoc evaluation of policy choices. Finally, it addresses concerns regarding expenditure estimates, arguing that the high costs incurred during the pandemic reflect the structural burden of purchasing critical-care capacity from a private market. Ultimately, this note underscores the necessity of analyzing public health responses within their broader political economy and institutional contexts.
This letter responds to "The Predestined Failure of the Market Mechanism." While ambitious, its structurally determinist framing underplays the role of government policy discretion. The central thesis risks creating a tautological argument where the premise of market-driven failure is insulated from empirical challenge. The analysis also overlooks key factors. State mandates reallocating ICU beds challenge the 'powerless state' premise. Furthermore, the bed crisis is more accurately explained not by market supply failure, but by the government's 'isolate-for-all' strategy-a state-driven demand crisis. We propose a falsifiable alternative: a 'competent but rigid' government model. This model highlights how path dependency from the 2015 MERS outbreak created a 'success trap,' explaining both early successes and later struggles through this institutional legacy and offering concrete lessons on strategic rigidity.
This qualitative study examined lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized sexual and gender identities (LGBTQIA+) primary care in Manila using a lens of minority stress theory within a social-ecological model. Focus group discussions, key informant interviews, and policy document analysis identified needs, barriers, and policy/institutional determinants. Unmet needs in mental health, sexual and reproductive health, HIV/sexual transmitted infections (STI) care, and gender-affirming care were analyzed. Individually, internalized stigma, anticipated discrimination, misinformation, and financial constraints discouraged disclosure and timely care. Interpersonally, family acceptance facilitated use, whereas rejection and peer-circulated misinformation impeded it. Institutionally, provider bias, limited LGBTQIA+ competency, confidentiality breaches, and recurring stock-outs constrained equitable access. Community organizations and informal networks bridged gaps but faced unstable funding and oversight. At the policy level, weak legal protections, decentralized governance, and financing gaps produced variable access and limited coverage for LGBTQIA+-relevant services. The analysis clarifies cross-level pathways by which policy ambiguity and institutional deficits amplify interpersonal and individual stressors. It specifies practical components of gender-affirming care in primary care-respectful identity practices, privacy-preserving records, and structured counseling/referral for gender-affirming hormone therapy. Recommended actions include mandatory provider training, stronger privacy safeguards, routine sexual orientation, gender identity and expression, and sex characteristics (SOGIESC)-disaggregated data, sustainable contracting with community groups, integrated mental health/HIV/sexual and reproductive health (SRH) with gender-affirming hormone treatment (GAHT) pathways, and financing reforms. Limitations include single-city scope, recruitment through service-linked channels, and a qualitative, cross-sectional design.
Conflict-of-interest (COI) between doctors and the pharmaceutical industry is widespread and is present in the majority of practitioners. The effects of COI on how doctors prescribe and hence on the health of their patients is negative. This article first summarizes the widespread nature of COI and then examines what forms it takes and how doctors view COI. It next looks at the two ways that have been used to try and limit its influence - managing COI and avoiding COI - and shows that managing COI by limiting gifts to small amounts and relying on declaring COI are based on false assumptions and have little chance of producing any positive results. It then goes on to review the measures that have been shown to be beneficial, particularly policies and legislation restricting or prohibiting certain types of COI among medical students, residents and practicing doctors. Finally, this article looks at how to build upon the successes that have occurred and what more could be done.
Commercial activities (eg, lobbying, water extraction) have important implications for population health and health equity. Identifying these activities can inform public health policy, practice, and surveillance. The aims of this study were to adapt a cross-industry typology of corporate activities (the HEALTH-CORP typology) to the Food & Beverage (F&B) industry and identify expert-informed measurement priorities for this industry. Activities within the HEALTH-CORP typology are categorized into domains of corporate influence (eg, political practices, environmental practices). Health experts (n = 22) rated the importance of measuring each domain on a 4-point scale (from 'not important' (0) to 'very important' (3)) and provided written feedback to guide the adaptation. We used qualitative and non-parametric quantitative techniques (eg, Mann-Whitney U tests) to analyze and implement participants' feedback. The domain political practices received the highest mean importance rating (M = 2.95, IQR = 0); employment practices received the lowest (M = 2.14, IQR = 2). Ratings for some domains differed by whether experts reported employment in low-and-middle income countries. The resulting HEALTH-CORP-FB typology contains 89 F&B industry activities (eg, profiteering, child-appealing packaging). The typology provides a resource for policy makers and other stakeholders and the findings lend insight into measurement and monitoring priorities for this industry.
Recent years have seen the development of conceptualisations of stigma which have moved beyond individual-level analyses towards exploring how stigma operates across multiple levels. While empirical research has examined the impact of stigma across various domains, there remains scant research exploring the lived experience of structural stigma. In this article, we examine structural stigma as a driver of multiple missed appointments, or 'missingness', in health care. We draw on qualitative data from 61 interviews with health and social care professionals and experts-by-experience of missingness in the United Kingdom, focusing on three stigmatised statuses: people from marginalised racial and ethnic groups, including those in the asylum system; people with mental health conditions; and people experiencing problem substance use. We adapt Link and colleagues' schema of stigma outcomes-keeping people down, in, and away-to explore how structural stigma shapes access to and experiences of health care. Our findings demonstrate a range of such processes through which barriers to effective engagement occur, and suggest that a focus on structural stigma will benefit policy, practice, and future research in this area.
This commentary critiques the concept of resilience in general drawing on the international literature, followed by an analysis of its application to Palestinians living in the Israeli occupied Palestinian territory (the West Bank, including Palestinian East Jerusalem, and the Gaza Strip).
In the fall of 2024, a U.S. Senate Hearing on the high price of Novo Nordisk's prescription drugs Ozempic and Wegovy underlined some of the deepest challenges in the U.S. health care system. This article utilizes critical approaches to both political economy and sociological discussions of medicalization as a means to address these challenges. Market-led organization and medicalization underlie not only these products' pricing, but also wider issues of cost control and health care organization. Congressional debate tends to either attribute blame on individual corporate actors, largely sidestepping larger structural issues, or defend industry and profit-oriented care, deflecting blame for high costs on the lifestyle choices of individual Americans. The article reestablishes an interrelation between critical political economy and medicalization, calling for a reorientation of health purchasing in the United States, along the lines of a single payer system that would, by necessity, interrogate the value of evolving drug (and other medical) provision for American society. This argument has strong practical political implications, potentially enabling policymakers to approach the emergence of 'wonder' drugs like Ozempic/Wegovy on terms that matter to both patients and U.S. society-price, medical necessity, access, and overall health care costs.
