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Social Inequalities in Health as a Global Challenge

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 15072

Special Issue Editors


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Guest Editor
Department of Sociology: Methods and Theory, Complutense University of Madrid, 28223 Madrid, Spain
Interests: social determinants of health; social support; mental health; aging; social inequalities; social exclusion; indigenous people

E-Mail Website1 Website2
Guest Editor
1. Department of Social Work and Social Services, Complutense University of Madrid, 28223 Madrid, Spain
2. School of Social Work, Universidad de Tarapacá, 1000000 Arica, Chile
Interests: aging; indigenous people; quality of life; health differences; loneliness; social support

Special Issue Information

Dear Colleagues,

The social determinants of health constitute one of the main global concerns, given their global nature and their growing importance in the framework of contemporary societies. Recently, the Organisation for Economic Co-operation and Development (OECD) has drawn attention to the urgency of addressing the reduction of social inequalities and poverty through the creation of the Development Assistance Committee (DAC)'s Community of Practice on Poverty and Inequalities. Specifically, inequalities in the field of health constitute one of the most evident consequences of socioeconomic inequalities. The Great Recession of 2008 first and the more recent COVID-19 pandemic have unequivocally shown that the social gradient in health (including mental health) constitutes a global challenge that all societies and social protection systems must urgently address to prevent the unequal distribution of diseases and health from perpetuating itself as a key social problem.

The social gradient in health refers to a wide set of inequality factors: socioeconomic status, social class, gender and sexual and gender diversity, age, socio-occupational status, race and sociocultural diversity, migratory status, and belonging to indigenous communities. As a whole, all of these factors draw different degrees of risk for citizens and different probabilities of suffering a deterioration in health and/or psychological distress. In addition, the different axes of inequality interact in an intersectionality framework that makes essential studies that address the complexity of the relationship between social inequalities and health in said framework. In this sense, the response of health and social protection systems to these challenges must be based on solid and up-to-date empirical evidence.

Indeed, the COVID-19 pandemic has made these gaps and inequities painfully visible. The empirical evidence that is beginning to be available shows that the impact of the pandemic itself is shaped by the distribution of socioeconomic inequalities. This empirical evidence reinforces the information is already available with respect to the Great Recession of 2008 and highlights that social inequalities are a fundamental cause of disease and poor health (especially in times of change and social crisis) and constitute a global challenge.

This Special Issue welcomes articles that specifically advance our understanding of the social gradient in health as a global challenge, which may include, but is not limited to the following:

  • New developments in the study of the relationship between socioeconomic status, social class, and health.
  • Uncertainty, social risk, labor exclusion, and health.
  • Job insecurity, exclusion jobs, and the deterioration of mental health.
  • Socioeconomic inequalities, poverty, social exclusion, and health.
  • Homelessness and health.
  • Sex and gender diversity, LGBTI people, and inequalities in health and in access to health systems.
  • Gender and health.
  • Inequality in access to health systems and the deterioration of health.
  • Health inequalities for indigenous peoples.
  • Pandemic, social inequalities, and suicide.
  • Social inequalities during the aging process and its impact on health.
  • Impact of the pandemic on mental health.
  • Economic crisis, social inequalities, and health.
  • New health risks for young people: pandemic, youth, and mental health problems.
  • Intersectionality and health.
  • Health responses and/or health policy to tackle the social gradient in health.
  • Inequality in access to health systems and its impact on health.
  • Climate change, forced population movement, and health.

We are very excited about editing a Special Issue on Social Inequalities in Health as a Global Challenge, and cordially invite the submission of high-quality papers that address any of the topics above. Papers that combine a high academic standard coupled with a focus on policy or practice and the implementation of solutions, strategies, and approaches to eradicate the social gradient in health are also welcome. We invite the submission of quantitative research, qualitative research, rigorous literature reviews, policy analysis, and implementation research.

Prof. Dr. Esteban Sánchez Moreno
Dr. Lorena Patricia Gallardo-Peralta
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • health
  • mental health
  • quality of life
  • health inequalities
  • social inequalities
  • labor market
  • economic crisis
  • access to health systems
  • gender
  • social risk and health
  • aging
  • socioeconomic status
  • poverty and social exclusion

Published Papers (9 papers)

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Research

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14 pages, 1143 KiB  
Article
Loneliness and Psychosocial Resources among Indigenous and Afro-Descendant Older People in Rural Areas of Chile
by Lorena P. Gallardo-Peralta, José Luis Gálvez-Nieto, Paula Fernández-Dávila and Constanza Veloso-Besio
Int. J. Environ. Res. Public Health 2023, 20(3), 2138; https://doi.org/10.3390/ijerph20032138 - 24 Jan 2023
Viewed by 1588
Abstract
(1) Background: loneliness is a problem that becomes increasingly acute in old age, with greater repercussions among socially disadvantaged groups such as indigenous and Afro-descendant older adults. The aim of this research is to analyze the psychosocial variables related to loneliness in old [...] Read more.
(1) Background: loneliness is a problem that becomes increasingly acute in old age, with greater repercussions among socially disadvantaged groups such as indigenous and Afro-descendant older adults. The aim of this research is to analyze the psychosocial variables related to loneliness in old age. (2) Methods: a multi-ethnic sample was involved, with the participation of eight indigenous peoples and Afro-descendant tribal people (n = 1.348). Various gerontological scales previously validated among the Chilean population (De Jong Gierveld Loneliness Scale, Brief Resilient Coping Scale, Health Problems Questionnaire, and Family APGAR questionnaire) and a model are contrasted, establishing the relationship between psychosocial variables and loneliness. (3) Results: Structural equation modeling (SEM) showed the existence of indirect relationships between health problems, via family functioning and resilience, and loneliness. Resilience and family functioning were directly related to loneliness (WLSMV-χ2 (df = 345) = 875.106, p < 0.001; CFI = 0.992; TLI = 0.991; RMSEA = 0.034 [C.I. 90% = 0.031–0.037]). (4) Conclusions: loneliness has cross-culturally affected older Chilean people living in rural areas and it appears that the COVID-19 pandemic has had a negative effect on well-being. This study proves that loneliness is related to several psychosocial variables that can be intervened. Full article
(This article belongs to the Special Issue Social Inequalities in Health as a Global Challenge)
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16 pages, 423 KiB  
Article
Mental Health and Homelessness in the Community of Madrid (Spain): The Impact of Discrimination and Violence
by Iria Noa de la Fuente-Roldán, Ana Isabel Corchado-Castillo and Ana Dorado-Barbé
Int. J. Environ. Res. Public Health 2023, 20(3), 2034; https://doi.org/10.3390/ijerph20032034 - 22 Jan 2023
Viewed by 1624
Abstract
The aim of this study was to analyze the impact of experiences of violence and discrimination on mental health among people in situations of homelessness (PSH). For this purpose, a quantitative, descriptive, and correlational investigation was conducted by conducting a survey with 603 [...] Read more.
The aim of this study was to analyze the impact of experiences of violence and discrimination on mental health among people in situations of homelessness (PSH). For this purpose, a quantitative, descriptive, and correlational investigation was conducted by conducting a survey with 603 PSH living in the Community of Madrid (Spain). The results show high levels of mental health impairment, as well as approximately half of the participants having experienced discrimination and violence in the course of their homelessness. Perceived experiences of discrimination are associated with higher levels of mental health impairment (OR = 0.458; p = < 0.001; 95% IC 0.31–0.68). This deterioration is also related to a negative self-assessment of the general state of health among participants (OR = 0.262; p = < 0.001; 95% IC 0.12–0.57). However, impaired mental health is not associated with experiences of violence. The findings also indicate that there are intersections in terms of being female, young, and foreign that result in greater psychological impairment and a higher risk of experiencing violence and discrimination. This study provides an insight into the PSH experiences in relation to mental health, violence, and discrimination and the need to implement actions aimed at improving their psychosocial wellbeing from the perspective of respect for citizens’ rights. Full article
(This article belongs to the Special Issue Social Inequalities in Health as a Global Challenge)
17 pages, 439 KiB  
Article
The Impact of COVID-19 on Nursing Homes: Study Design and Population Description
by Vicente Rodriguez-Rodriguez, Fermina Rojo-Perez, Carmen Perez de Arenaza Escribano, María-Ángeles Molina-Martínez, Gloria Fernandez-Mayoralas, Diego Sánchez-González, Jose-Manuel Rojo-Abuin, Carmen Rodríguez-Blázquez, Maria João Forjaz and Salomé Martín García
Int. J. Environ. Res. Public Health 2022, 19(24), 16629; https://doi.org/10.3390/ijerph192416629 - 10 Dec 2022
Cited by 5 | Viewed by 2371
Abstract
Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is [...] Read more.
Nursing homes for the elderly in Spain have experienced high rates of infection and mortality from COVID-19, although rates have varied from one region to another. Madrid is the region where most institutionalized older adults have died from the coronavirus. However, there is little known about the psychosocial and environmental factors involved in the high incidence of COVID-19 among the institutionalised population in this region. This article describes the protocol of a study on nursing homes during the SARS-CoV-2 pandemic in the Autonomous Community of Madrid (hereafter: Region of Madrid or Madrid Region) and provides information on the study design, measures used, and characteristics of the population studied. A questionnaire about life in nursing homes during the COVID-19 pandemic was designed and a total of 447 persons over 60 years of age without cognitive impairment—220 in private nursing homes and 227 in public nursing homes—participated by answering questions about different topics: personal situations during the pandemic, feelings and methods of coping, residential environment, health, quality of life, ageism, and self-perception of ageing. The institutionalised person profile discussed in this study was an old woman, widowed, without children, with a low level of education, with multimorbidity, and who perceived her health and quality of life positively. Most of the participants were very concerned about COVID-19 and its effects. In fact, 38% had been diagnosed with COVID-19, of whom 20% were admitted to hospital and 20% had suffered negative impacts, such as pain and neurological problems. In addition, 70% of the residents remained confined to their rooms, which increased their perceptions of loneliness and social isolation. The worst-rated aspects of the nursing home resulted from the restrictive measures imposed on nursing homes during the pandemic. This research offers useful material for understanding the pandemic and its consequences from the perspective of the older institutionalised population, which could provide insights for designing public policies. Full article
(This article belongs to the Special Issue Social Inequalities in Health as a Global Challenge)
15 pages, 493 KiB  
Article
The Impact of Public Health Education on Migrant Workers’ Medical Service Utilization
by Deshui Zhou, Lanyan Cheng and Hainan Wu
Int. J. Environ. Res. Public Health 2022, 19(23), 15879; https://doi.org/10.3390/ijerph192315879 - 29 Nov 2022
Cited by 3 | Viewed by 1177
Abstract
Based on the dynamic monitoring survey data of China’s migrant population (CMDS) in 2017, this study analyzes the impact of public health education on migrant workers’ medical service utilization. The study found that public health education can significantly promote the utilization of migrant [...] Read more.
Based on the dynamic monitoring survey data of China’s migrant population (CMDS) in 2017, this study analyzes the impact of public health education on migrant workers’ medical service utilization. The study found that public health education can significantly promote the utilization of migrant workers’ medical services and has a greater effect on the older generation groups, those who received secondary and higher education, and those working in first-tier cities. By distinguishing different types of public health education, it is found that smoking control education has the most obvious effect. Further differentiating disease types, the study found that the promotion effect of receiving occupational disease education is the highest, while the effect of receiving STD/AIDS education is relatively low. The mechanism test indicates that public health education has significantly improved migrant workers’ utilization of medical services by influencing their health literacy, social network, and psychological integration. Full article
(This article belongs to the Special Issue Social Inequalities in Health as a Global Challenge)
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16 pages, 955 KiB  
Article
Sexual Harassments Related to Alcohol and Drugs Intake: The Experience of the Rape Centre of Turin
by Barbara Mognetti, Marco Bo, Giovanni Nicolao Berta, Antonella Canavese, Paola Castagna, Federica Collini, Veronica Santa, Alberto Salomone and Sarah Gino
Int. J. Environ. Res. Public Health 2022, 19(22), 15090; https://doi.org/10.3390/ijerph192215090 - 16 Nov 2022
Cited by 2 | Viewed by 1463
Abstract
A cross-sectional study was conducted that describes the characteristics of sexual violence episodes related to the intake of alcohol and drugs observed among women that turned to the “Centro Soccorso Violenza Sessuale” (SVS) of the Sant’Anna Hospital in Turin between 1 January 2008, [...] Read more.
A cross-sectional study was conducted that describes the characteristics of sexual violence episodes related to the intake of alcohol and drugs observed among women that turned to the “Centro Soccorso Violenza Sessuale” (SVS) of the Sant’Anna Hospital in Turin between 1 January 2008, and 31 December 2017. Two hundred twenty-two patients were enrolled, 25 of which were minors, 141 were Italians, and most of them knew their aggressor and were raped in a private home. One hundred and fifty-five of them declared to the healthcare personnel to have taken alcoholic substances and/or drugs in conjunction with the event (86 reported having drunk alcohol, 36 having taken drugs and 33 disclosed both alcohol and drug abuse). If the woman knew her abuser, alcohol consumption was described as voluntary in more than 80% of cases, while in relation to drugs the consumption was equally voluntary or fraudulent. About 73% of women who reported having drunk alcohol just had amnesia or amnesia related to other symptoms, while amnesia was present in about 63% of women who reported only drug use. Physicians observed physical injuries on 156 women. Patients who reported to have assumed alcohol presented a significantly higher risk to suffer any physical injury and have a significantly increased risk to suffer injuries to their head and/or neck. The results obtained underline how even in Northern Italy alcohol intake represents the most widespread psychoactive substance in case of drug-facilitated sexual assault. There is therefore a need to promote education and prevention campaigns among citizens, especially among the youngest. Full article
(This article belongs to the Special Issue Social Inequalities in Health as a Global Challenge)
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10 pages, 347 KiB  
Article
Protective Factors, Risk of Violence and Discrimination and Mental Health Indicators of Young LGB People
by Marta Evelia Aparicio-García, Eva M. Díaz-Ramiro, Susana Rubio-Valdehita, M. Inmaculada López-Núñez and Isidro García-Nieto
Int. J. Environ. Res. Public Health 2022, 19(21), 14401; https://doi.org/10.3390/ijerph192114401 - 03 Nov 2022
Cited by 2 | Viewed by 1458
Abstract
Lesbian, gay and bisexual (LGB) people have more risk of suffering from violence and situations of discrimination than heterosexual people. The current study compares LGB people with heterosexual people in protective factors, violence, health and well-being factors. The sample comprises 609 Spanish people [...] Read more.
Lesbian, gay and bisexual (LGB) people have more risk of suffering from violence and situations of discrimination than heterosexual people. The current study compares LGB people with heterosexual people in protective factors, violence, health and well-being factors. The sample comprises 609 Spanish people between 14 and 25 years old. We established a cross-sectional design. A survey including questions about sociodemographic information and protective, violence and health and well-being factors was designed ad hoc for this study. The results show that the LGB group (n = 342) is more at risk of verbal and physical violence and feels more isolated than the heterosexual participants (n = 267). In contrast, heterosexual participants report having more employment discrimination. No significant differences were found in social support or psychological health. These results are important to understand the state of social normalization and non-discrimination for LGB people in certain contexts in Spain, and its impact on psychological health. Full article
(This article belongs to the Special Issue Social Inequalities in Health as a Global Challenge)
18 pages, 990 KiB  
Article
Adulthood Employment Trajectories and Later Life Mental Health before and after the Onset of the COVID-19 Pandemic
by Ignacio Cabib, Carlos Budnevich-Portales and Ariel Azar
Int. J. Environ. Res. Public Health 2022, 19(21), 13936; https://doi.org/10.3390/ijerph192113936 - 26 Oct 2022
Viewed by 1275
Abstract
Background: This life course study has two aims. First, to explore how diverse employment trajectories across adulthood are related to older people’s mental health in Chile, a country with no research in this field, and second, to analyze these associations before and after [...] Read more.
Background: This life course study has two aims. First, to explore how diverse employment trajectories across adulthood are related to older people’s mental health in Chile, a country with no research in this field, and second, to analyze these associations before and after the onset of the COVID-19 pandemic. Methods: We use data from the nationally-representative and longitudinal ‘Chilean Social Protection Survey’ sequence analysis to reconstruct employment trajectory types, and bivariate and multivariate analyses to measure their association with depressive symptoms. Results: Our findings indicate that formal labor force patterns in adulthood show the lowest burden of depressive symptomology before and after the onset of the overwhelming COVID-19 pandemic when controlling for traditional risk factors. Conclusion: We emphasize that policymakers in both the labor market and public health domains must consider the relationship between informal employment pathways in adulthood and poorer mental health in old age. Public policies should improve the conditions and quality of jobs during adulthood and promote more formalization in the labor market to address the high uncertainty involving low social protection, which is strongly associated with severe mental health problems in later life. Full article
(This article belongs to the Special Issue Social Inequalities in Health as a Global Challenge)
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20 pages, 1853 KiB  
Article
Measurement and Decomposition of the Health Poverty of Rural Residents in China
by Haiyan Jia, Xiaoyu Sai, Yangyue Su and Ying Huang
Int. J. Environ. Res. Public Health 2022, 19(19), 12876; https://doi.org/10.3390/ijerph191912876 - 08 Oct 2022
Viewed by 1823
Abstract
Narrowing the health gap and promoting health equality is the key to effectively blocking the intergenerational transmission of rural poverty. Previous studies have mainly focused on the relationship between health and poverty, but assessments of health poverty are lacking, especially with regard to [...] Read more.
Narrowing the health gap and promoting health equality is the key to effectively blocking the intergenerational transmission of rural poverty. Previous studies have mainly focused on the relationship between health and poverty, but assessments of health poverty are lacking, especially with regard to the health poverty of rural residents. Based on China’s large sample household survey data, this study uses the Alkire–Foster (AF) method to measure and decompose the health poverty of rural residents. The results show that the health poverty of Chinese rural residents greatly improved from 2016 to 2018. However, significant regional differences exist with regard to the level of health poverty. The marginal contribution of economic poverty alleviation is diminishing; the equalization of health services and security has shifted to a policy focus. Community environmental management has also become an important aspect of health poverty governance, and individual health literacy and behavior have played an important role in endogenous poverty alleviation. Ultimately, this paper offers some insightful policy implications. This study extends the multidimensional poverty measurement system and reveals the relationship between health poverty and regional economic and social development. The findings also enhance the understanding of the health poverty of rural residents in developing countries. Full article
(This article belongs to the Special Issue Social Inequalities in Health as a Global Challenge)
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Review

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18 pages, 850 KiB  
Review
From Social Rejection to Welfare Oblivion: Health and Mental Health in Juvenile Justice in Brazil, Colombia and Spain
by Ángela Carbonell, Sylvia Georgieva, José-Javier Navarro-Pérez and Mercedes Botija
Int. J. Environ. Res. Public Health 2023, 20(11), 5989; https://doi.org/10.3390/ijerph20115989 - 29 May 2023
Cited by 2 | Viewed by 1358
Abstract
(1) Background: This study aims to examine and describe the policies of three Latin American countries: Colombia, Brazil, and Spain, and identify how they implement their support systems for health, mental health, mental health for children and adolescents, and juvenile justice systems that [...] Read more.
(1) Background: This study aims to examine and describe the policies of three Latin American countries: Colombia, Brazil, and Spain, and identify how they implement their support systems for health, mental health, mental health for children and adolescents, and juvenile justice systems that support judicial measures with treatment and/or therapeutic approaches specialized in mental health. (2) Methods: Google Scholar, Medline, and Scopus databases were searched to identify and synthesize of the literature. (3) Results: Three shared categories were extracted to construct the defining features of public policies on mental health care in juvenile justice: (i.) models of health and mental health care, (ii.) community-based child and adolescent mental health care, and (iii.) mental health care and treatment in juvenile justice. (4) Conclusions: Juvenile justice in these three countries lacks a specialized system to deal with this problem, nor have procedures been designed to specifically address these situations within the framework of children’s rights. Full article
(This article belongs to the Special Issue Social Inequalities in Health as a Global Challenge)
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