搜索结果：International journal of social determinants of health and health services

Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.

The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.

Periodontitis is known to negatively affect oral health-related quality of life. Fewer studies have considered self-reported impacts of gingival health, despite evidence it can affect most people's daily lives. Data limitations have also meant it was previously not possible to assess self-perceived gum health internationally. This study aimed to explore differences in the associations between gum health, socio-demographics, measures of health, wellbeing and oral health-related impacts in six countries using standardised international datasets among a nonprobabilistic sample of patients attending dental services. Linked patient-reported and dentist-reported data were collected from the World Dental Federation (FDI) Oral Health Observatory. Descriptive statistics and chi-square tests were used to analyse data from China (n = 2241), Colombia (n = 1029), India (n = 999), Italy (n = 711), Japan (n = 1271) and Lebanon (n = 798). Prevalence of patients reporting spitting or seeing blood when brushing and categorical periodontal status were the dependent variables, with age, sex, education, self-rated oral and general health, wellbeing, life satisfaction and oral health-related impacts included as independent variables. Spitting or seeing blood when brushing was associated with education in five countries, while dentist-reported periodontal status worsened with age, lower education levels and among males. Worsening of both dependent variables was associated with poorer self-rated oral and general health in all countries, having a greater effect on oral health. Mixed results were seen for the association between spitting and seeing blood and wellbeing. In all countries worsening of the dependent variables was associated with life being less satisfying. Similar patterns were seen with oral health-related impacts in most cases. Country-specific patterns and variations were also detected. The exploratory findings can act as a basis for further research into country-specific patterns which are important for contextualising the findings, and for advocacy and understanding gingival health-related impacts and needs of patients in the countries investigated to date. This study found a number of associations between both patient and dentist-reported gum health and socio-demographic variables, measures of wellbeing, life satisfaction and oral health-related impacts. In particular, the importance of considering patient-reported outcomes and effects on daily life should be considered alongside clinical variables.

Social determinants of health (SDH), such as socioeconomic status, education, healthcare access, and social support, play a significant role in shaping individuals lived experiences. Dual sensory loss (DSL), a distinct disability involving both vision and hearing loss, poses greater challenges for daily living compared to the general population. This scoping review synthesized evidence on how various SDH indicators influence the life experiences of older adults with DSL. Five scientific databases were searched from January 2014 to May 2024. Articles focusing on individuals aged 60 and older with DSL, in the context of at least one SDH indicator, were included. A total of 69 studies met the eligibility criteria. Most studies addressed the following SDH indicators: disability (n = 46), social inclusion and non-discrimination (n = 21), gender (n = 10), and access to healthcare services (n = 9). Disability-related indicators revealed higher risks of mobility limitations, cognitive decline, depression, anxiety, social isolation, and workplace discrimination, all adversely affecting mental health and quality of life. Older adults with DSL encounter significant barriers to accessing healthcare, such as absence of adequate assistive devices, communication challenges, and high healthcare costs. Many report dissatisfaction with the quality of care received. Our review identifies disparities that increase the vulnerability of older adults with DSL and restrict their access to healthcare, rehabilitation, and social participation. These findings warrant further research on underexplored SDH factors, using robust data sources that collects information on the lived experiences of older adults with DSL. Addressing these social determinants requires a comprehensive approach, including raising awareness, improving service access, enhancing social support networks, and ensuring inclusive policies and practices.

In 2020, approximately 800 women died daily as a result of largely preventable complications of pregnancy and delivery globally. Almost 95% of these deaths occurred in low- and middle-income countries. Even though antenatal care, institutional delivery, and postnatal care constitute lifesaving maternal and newborn healthcare services, uptake is variable between countries in sub-Saharan Africa. Thus, this study examined the coverage and factors influencing the utilisation of maternal and newborn health services in sub-Saharan Africa. This current study pooled datasets from the Demographic Health Surveys conducted in 27 countries in sub-Saharan Africa between the years 2010-2020. The outcome variables were maternal and newborn health services measured by antenatal care visits, institutional delivery, and postnatal care visits among 58,648 women of reproductive age between the ages of 15-49. Multilevel analysis was employed to examine the associated factors at a p&#x2009;<&#x2009;0.05 level of significance. The overall analysis of the prevalence of maternal and newborn health services among women of reproductive age in sub-Saharan Africa was 67.3%, 74.5%, and 32.5% for 4&#x2009;+&#x2009;antenatal care visits, institutional delivery and visits to postnatal care within 48 hours of delivery, respectively. Antenatal care visits were highest in Sierra Leone at 91.4%, and Institutional delivery was highest in Gabon at 97.6%, whilst Niger had the lowest prevalence for antenatal care visits and institutional delivery at 38.0% and 42.3%, respectively. Cote d'Ivoire reported the highest prevalence of postnatal care with 78.8%, whilst Malawi reported the lowest with 7.3%. Moreover, women with secondary/higher education were more likely to utilise antenatal care (aOR=2.09; 95% CI:1.96-2.23) and have institutional delivery (aOR=2.54; 95% CI:2.34-2.74) compared to those with no education. Furthermore, being employed was associated with a higher likelihood of utilising postnatal care (aOR=1.28; 95% CI:1.22-1.34) within 48 hours of delivery compared to women without formal employment. The study concluded that women of reproductive age in sub-Saharan Africa who were educated were more likely to seek antenatal care and have institutional delivery, whilst women who were employed were more likely to utilise postnatal care within 48 hours of delivery. Therefore, future initiatives should focus on empowering and strengthening the education of girls and women in sub-Saharan Africa.

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&#x2009;=&#x2009;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.

Wars have multiple complex effects on population health. Countries suffer extensively from disruptions to their societies, economies, and environment. Understanding the pathways of disruption helps to adapt and mitigate the catastrophic effects of war. We used a previously published 12-dimensional framework on the health impacts of war to derive pathways of influence under three phases. The first phase, before overt aggression, includes economic sanctions, trade wars, and embargoes, often combined with covert military action and disrupted supply chains, infrastructure, and health services. The second phase of overt aggression has multiple direct and indirect effects on health: (a) morbidity and mortality; (b) population displacements with psychosocial implications; (c) opportunity costs from military expenditures often reversing economic growth and widening inequalities; (d) environmental degradation; (e) air and soil pollution from explosives; (f) destroyed infrastructure include housing, basic amenities, and health infrastructure; (g) destroyed arable land, deforestation, and loss of biodiversity; (h) and contamination of water sources. The third phase occurs during peace negotiations and when peace appears and consists of long-term effects. The latter includes transgenerational impacts on human well-being. Considering the wide health, social, and environmental implications of wars lasting for generations, we reiterate the call for an "end to all wars."

Intense armed conflict in Gaza gives rise to record-breaking humanitarian catastrophe. More than destructions of physical residence, the cost to health and well-being remains pressing concerns among people displaced by war. While the international community provide various forms of assistance, deliveries are challenged as blockades, according to reports, are in effect. Access to aid is reported to have been effectively restricted. Alongside with this are the reports of violations of medical neutrality - the targeting of medical facilities, making access to healthcare, treatment, and medical supplies extremely difficult if not impossible. Drawing on the WHO's framework of social determinants of health in conflict settings, this article situates the Gaza violence as a clear and profound case of how conflict dismantles the structural foundations of health and well-being. While mere peace does not guarantee positive health outcomes, peace inherits a cardinal role when war involves aid restrictions and breaches of medical neutrality. Peace becomes more fundamental to health and well-being under these cases of conflict environment. This is not to argue that peace is alternative to health. Rather, as drawn from the Gazan experience, peace is argued to be the foundation of health, indivisible to it. Peace, therefore, precedes health.

Despite Ghana's free maternal health services policy, antenatal care (ANC) utilization remains suboptimal. This study examines the predisposing, enabling, and need factors associated with ANC use among women in Ghana. Using the 2022 Ghana Demographic and Health Survey (GDHS), this study examined 5,302 women aged 15-49 to identify key determinants of ANC use. Antenatal care utilization was defined as completing at least four visits. Guided by the Andersen's healthcare utilization model, predictors were categorized into predisposing (age, education, marital status, religion), enabling (household income, residence, health insurance), and need factors (self-rated health, pregnancy loss). Descriptive statistics and chi-square tests were used to assess differences in ANC utilization. A modified Poisson regression was applied to estimate adjusted prevalence ratio (aPR) for the association between predisposing, enabling, and need factors and ANC utilization. Overall, 88.1% of women utilized ANC. Women aged 25-34 were more likely to use ANC compared to those aged 15-24 (&#x2009;aPR =&#x2009;1.04; 95% CI: 1.00-1.07). Women with secondary (&#x2009;aPR =&#x2009;1.09; 95% CI: 1.05-1.14) and higher education (&#x2009;aPR =&#x2009;1.10; 95% CI: 1.04-1.15) were associated with greater ANC use. Married women (&#x2009;aPR =&#x2009;1.07; 95% CI: 1.03-1.10) and Muslim women (&#x2009;aPR =&#x2009;1.04; 95% CI: 1.01-1.07) were more likely to use ANC, whereas women practicing traditional/other religions were less likely to use ANC (&#x2009;aPR =&#x2009;0.83; 95% CI: 0.75-0.92). Women from rich households (&#x2009;aPR =&#x2009;1.08; 95% CI: 1.04-1.12) and those with health insurance (&#x2009;aPR =&#x2009;1.29; 95% CI: 1.14-1.46) were more likely to use ANC. Residence, self-rated health, and pregnancy loss were not significant predictors. Key determinants of ANC utilization included age, education, marital status, religion, household income, and health insurance coverage. This suggests that reducing socioeconomic and cultural obstacles is essential for improving maternal health coverage. Future research is needed to understand the indirect barriers that continue to discourage women from seeking ANC in Ghana.

Community health and primary health care (PHC) concepts are contested globally. We analysed 122 Australian federal and state government policy documents relating to women's, Aboriginal community controlled, generalist and workers' community health services from the 1970s to 2022 using institutional theory to understand how ideas and interests had shaped community health and PHC in Australia. We found an initial flourishing of diverse ideas was contested and constrained over time to reflect a more biomedical, general practice-centric approach to PHC. This was influenced by federal government decisions to prioritise general practice, and state governments' emphasis on reducing hospital costs. This reflects the power of established institutions and biomedical framings that have constrained debate over what is possible and what practices can be considered. From the content of the policies we reviewed, community health ideas and a comprehensive vision of PHC have persisted in Aboriginal community controlled health services, in women's health policy, and in Victorian community health services. Since pursuing comprehensive PHC remains a vital global goal to improve population health and health equity, our examination of policy history can shed light on how ideas and interests have shaped community health and PHC, and how future policies could be strengthened.

People often describe the ongoing catastrophic situation in Palestine, particularly in the Gaza Strip, as a political and humanitarian crisis. However, a recent report (A/HRC/59/23) by United Nations Special Rapporteur Francesca Albanese highlights the necessity of understanding the complex commercial practices of corporations that contribute-directly or indirectly-to this catastrophe. The report reveals a critical yet often overlooked aspect of public health ethics: corporate complicity in unprecedented human suffering. This article demonstrates how commercial entities contribute to public health harms, with Palestine serving as a significant and urgent case study. Using the commercial determinants of health framework, this article argues that corporate practices-such as supplying goods and services, maintaining operations or financing actors implicated in international crimes to actors implicated in international crimes through military operations in occupied territories-can constitute complicity in serious human rights violations. These actions typically occur within legal and ethical grey areas, exacerbated by gaps in global governance, opaque corporate structures, and weak accountability mechanisms. The article advocates identifying and including complicity as a fundamental practice used by commercial entities primarily for profit. It also emphasises the need to expand research, advocacy, and regulatory oversight to address the intersection of corporate power, armed conflict, and population health.

There is growing concern about the health and overall well-being of societies stemming from neoliberal-oriented governments reducing their management of the economy, weakening programs and supports for the population, and shifting public goods to the private sector. As a result, a polycrisis exists in many nations related to various key social determinants of health. In this paper, we argue the Canadian polycrisis is due to the contradictions within Canadian society between the economic and political imperatives of capital accumulation (ie, profit making) with social reproduction (ie, societal continuity) associated with late-stage global capitalism. These contradictions threaten societal functioning: declining redistribution of income and wealth, reduced social spending, unwillingness to manage the market economy, and unrelenting privatization of activities once part of the public sphere. The result has been a Canadian polycrisis of growing food and housing insecurity, precarious employment, widening income and wealth inequalities, and a healthcare crisis. We argue responding to the polycrisis requires recognizing and dealing with the contradictions generated by neoliberal capitalism through profound reform or even transformation of the economic system toward a post-capitalist, socialist economy. We consider how such reforms or transformations can come about.

Poverty is acknowledged as an important social determinant of health, and health care professionals are responding to it in some settings, most notably in the primary care setting. The Income Security Health Promotion service offered by the St. Michael's Hospital Academic Family Health Team in Toronto, Ontario, Canada, is an example of a primary-care intervention to address patients' unmet income needs. Understanding the history and social conditions of existence of this service will be helpful to other primary care practitioners considering income interventions in their own setting. A qualitative case study was conducted to describe the origins, context and functioning of this intervention. Purposive sampling was used to recruit 12 key informants from the Family Health Team, including income security health promoters, clinicians and management. Interviews revealed the origins of the service as part of a new and well-resourced family practice, with a team of clinicians well-versed in the social determinants of health and with a strong social justice orientation. They described the required skill set of a promoter, and the importance of assimilating the role into the circle of care. Their experience offers important insights into how to create and sustain such a program in other primary care settings.

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.

To examine the association between women's empowerment, measured using the Survey-based Women's emPowERment (SWPER) Global Index, and receipt of quality antenatal care (ANC) in Ghana. Cross-sectional analysis of nationally representative survey data. Ghana. A total of 3837&#x2009;women aged 15-49 years who had a live birth or stillbirth in the 3 years preceding the 2022 Ghana Demographic and Health Survey and reported at least one ANC visit for the most recent pregnancy. Quality ANC was defined as receipt of four essential ANC components: blood pressure measurement, urine testing, blood sample collection and iron supplementation. Women's empowerment was assessed across three SWPER domains: attitude toward violence, social independence and decision-making, categorised as low, medium or high. Multilevel mixed-effects logistic regression models were used to examine associations while accounting for individual, household, community and regional-level factors. Overall, 90.9% of women received all four ANC components. In bivariate and partially adjusted analyses, higher empowerment in the attitude toward violence and social independence domains was associated with higher odds of receiving quality ANC. However, these associations were attenuated and no longer statistically significant in the fully adjusted multilevel model. The strongest independent associations with quality ANC were health-service utilisation factors. Late ANC initiation at 4-6 months (adjusted OR (AOR)=0.75, 95%&#x2009;CI 0.59 to 0.97)&#x2009;and &#x2265;7 months (AOR=0.28, 95%&#x2009;CI 0.16 to 0.49) reduced the likelihood of receiving quality ANC, whereas attending 4-8 visits (AOR=2.89, 95%&#x2009;CI 2.05 to 4.07)&#x2009;and &#x2265;nine visits (AOR=4.25, 95%&#x2009;CI 2.69 to 6.71) increased the likelihood. Receiving ANC at private hospitals was associated with lower odds of quality ANC compared with public hospitals (AOR=0.43, 95%&#x2009;CI 0.26 to 0.74). Regular radio exposure was positively associated with quality ANC, and substantial regional disparities persisted, particularly in the Western North, Northern, Savannah, North East and Upper East regions. In Ghana, women's empowerment indirectly influences the quality of ANC through pathways of early initiation and adequate continuity of care, whereas health-system factors and regional inequities remain the dominant independent determinants. Policy efforts should prioritise timely ANC initiation, continuity of care and equitable service delivery, alongside integrated empowerment strategies within broader health-system strengthening initiatives.

The assessment of barriers to health care access helps to form equitable health policy and programs for all. This article examines the institutional and noninstitutional barriers to health care access in India. The study uses the 75th round National Sample Survey (NSS) of consumption on health (2017-2018). Both institutional and noninstitutional barriers are analysed through descriptive analysis to explore some of the major barriers to health care access. A regression analysis is also conducted to arrive at the mean cost of such barriers. The result shows that 'unsatisfactory service quality' and a 'lack of preferred doctors/hospitals' are two major institutional barriers, and the 'ignorance of illness' is the major noninstitutional barrier to health care access. The result further shows that the 'unavailability of required services' incurs the highest mean cost of INR&#x20b9;998, followed by the 'unsatisfactory service quality' (&#x20b9;392) and a 'lack of preferred doctor/hospital' (&#x20b9;201). The cost of private health care also varies across socioeconomic determinants such as place of residence, age, gender, caste, and class.

Background. Presented as a response to unmet social needs and a way toward a more equitable, sustainable, and healthier society, social prescribing (SP) is gaining international attention. However, it also faces challenges and criticisms, particularly regarding its evidence base, implementation processes, and relevance across diverse contexts. To date, little is known about its compatibility with preventive occupational therapy, notably with Lifestyle Redesign (LR), a landmark intervention that shares similarities with SP. Purpose. To synthesize knowledge about SP, its areas of compatibility and tension, as well as its linkages with LR. Key issues. While evidence regarding SP is conflicting, a critical examination of its connection with LR could help better meet the complex and evolving needs of older adults, especially those facing structural or social marginalization. Given their affinities, SP and LR present several promising points of integration, including: (1) offering LR within social prescription, (2) assigning a dedicated SP navigator to LR, and (3) positioning occupational therapists as SP navigators. Implications. Linking social prescribing and LR could contribute to tackling global public health priorities such as loneliness, social isolation, and chronic diseases, while advancing knowledge and practices that empower occupational therapists to address social determinants of health. Pr&#xe9;sent&#xe9;e comme une r&#xe9;ponse aux besoins sociaux non combl&#xe9;s et comme une voie vers une soci&#xe9;t&#xe9; plus &#xe9;quitable, durable et en meilleure sant&#xe9;, la prescription sociale (PS) suscite un int&#xe9;r&#xea;t croissant &#xe0; l&#x2019;&#xe9;chelle internationale. Elle fait toutefois face &#xe0; des d&#xe9;fis et &#xe0; des critiques, notamment en ce qui concerne la force de ses r&#xe9;sultats probants, son processus d&#x2019;implantation et sa pertinence dans des contextes vari&#xe9;s. Par ailleurs, on conna&#xee;t peu sa compatibilit&#xe9; avec l&#x2019;ergoth&#xe9;rapie pr&#xe9;ventive, notamment avec le Remodeler sa vie (RV), une intervention phare qui partage des similitudes avec la PS. But. Synth&#xe9;tiser les connaissances sur la PS, sur ses zones de compatibilit&#xe9; et de tension, ainsi que sur ses liens avec le RV. Questions cl&#xe9;s. Bien que les r&#xe9;sultats probants concernant la PS soient contradictoires, un examen critique de ses arrimages avec le RV pourrait aider &#xe0; mieux r&#xe9;pondre aux besoins complexes et &#xe9;volutifs des personnes a&#xee;n&#xe9;es, particuli&#xe8;rement celles qui sont confront&#xe9;es &#xe0; des situations de marginalisation sociale ou structurelle. Compte tenu de leurs affinit&#xe9;s, la PS et le RV pr&#xe9;sentent plusieurs pistes d&#x2019;int&#xe9;gration prometteuses, notamment : 1) offrir le RV dans le cadre de la PS; 2) assigner un navigateur ou une navigatrice en PS au RV; et 3) positionner les ergoth&#xe9;rapeutes comme des navigateurs et navigatrices en PS. L&#x2019;int&#xe9;gration de la PS et du RV pourrait contribuer &#xe0; r&#xe9;pondre &#xe0; des priorit&#xe9;s mondiales de sant&#xe9; publique telles que la solitude, l&#x2019;isolement social et les maladies chroniques, tout en faisant progresser les connaissances et les pratiques qui habilitent les ergoth&#xe9;rapeutes &#xe0; agir sur les d&#xe9;terminants sociaux de la sant&#xe9;.

Postnatal care (PNC) plays a crucial role in minimizing maternal and neonatal morbidity and mortality, but the uptake of services in Bangladesh remains below the recommended level. Although logistic regression has been widely used, it may miss complex nonlinear interactions among social, economic, and healthcare factors. This study contributes to the body of knowledge by using machine learning (ML) to identify the most significant determinants of PNC and to enhance prediction accuracy. We compared logistic regression to several ML models, including Random Forest, XGBoost, CatBoost, Support Vector Machine, AdaBoost, and Gradient Boosting, using nationally representative data from the 2022 Bangladesh Demographic and Health Survey (BDHS) with ADASYN oversampling to correct class imbalance. Among all models, Random Forest achieved the highest AUC (0.9050), closely followed by XGBoost (0.9036) and CatBoost (0.9028), all of which substantially outperformed logistic regression (AUC&#x2009;=&#x2009;0.8470). SHAP analysis of the Random Forest model indicated that delivery place, husband's occupation, rural residence, wealth index, and media exposure were the most influential predictors of PNC utilization, alongside maternal education, women's occupation, and age-related factors. The results indicate that ML is more effective than classical procedures for revealing latent patterns and making accurate predictions. Policy implications include encouraging facility-based deliveries, improving maternal education, reducing wealth disparities, and enhancing media coverage of health, particularly among rural and low-income groups. This paper not only identifies key drivers of PNC in Bangladesh but also demonstrates how ML can supplement traditional methods to reinforce maternal health policy and interventions.

The COVID-19 pandemic was a global public health crisis that demanded a "whole-of-society" response. In many countries, coordinating efforts across public and private health care sectors proved challenging. Yet South Korea maintained one of the world's lowest excess mortality rates despite having a predominantly privatized health care system, with 90.3% of hospital beds privately owned. This outcome was enabled in part by the government's strategy of disproportionately mobilizing and repurposing public hospitals as dedicated COVID-19 treatment facilities. These hospitals, historically few in number, chronically under-resourced, and marginalized as safety nets for vulnerable populations, became the backbone of Korea's health care system response. This qualitative study examines how this process unfolded and its consequences for public hospitals and marginalized populations they serve, drawing on in-depth interviews with public hospital staff and community activists, complemented by publicly available government reports and administrative data. Our findings reveal that the repurposing of public hospitals was carried out through a highly centralized, top-down process with minimal coordination, inadequate legal safeguards, and no institutional protection. This approach generated short-term gains but ultimately led to reduced patient trust, financial instability, and a staffing exodus that compromised the long-term capacity of the public health sector.