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Social Determinants of Health Inequities and Prevention

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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 September 2017) | Viewed by 111433

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Assoc. Prof. Lisa Wood

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School of Population Health, The University of Western Australia (M431), 35 Stirling Highway, CRAWLEY WA 6009, Australia

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on social determinants of health inequities and prevention in the International Journal of Environmental Research and Public Health. This is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal, I refer you to https://www.mdpi.com/journal/ijerph.

There is now compelling evidence that social, economic and environmental factors account for enormous disparities in health and wellbeing in both developed and developing countries. Social determinants, such as employment and education opportunities, access to housing, neighborhood environments and social marginalisation, can both create and perpetuate existing health inequalities. War, racism, homelessness, technological change and loneliness are among other issues that can also be viewed through a social determinants of health lens. Many of the social determinants of health lie outside of the direct influence of the health sector and require policy and practice interventions that span multiple disciplines and sectors.

This Special Issue is open to any subject area related to the impacts of social determinants on health inequities, with a particular focus on prevention and evidence that can inform policy and practice efforts to address socially determined causes of health disparity. Fresh approaches to looking at the relationship between social determinants and reducing health inequalities are encouraged. The listed keywords below suggest just a few of the many possibilities.

Assoc. Prof. Lisa Wood
Guest Editor

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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

Social determinants
Inequality
Health inequity
Public health
Health disparities
Social factors influencing health
Inter-generational disadvantage
Barriers and enablers to health

Published Papers (13 papers)

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Research

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11 pages, 313 KiB

Open AccessArticle

Health Disparities in the Relationship of Neighborhood Greenness to Mental Health Outcomes in 249,405 U.S. Medicare Beneficiaries

by Scott C. Brown, Tatiana Perrino, Joanna Lombard, Kefeng Wang, Matthew Toro, Tatjana Rundek, Carolina Marinovic Gutierrez, Chuanhui Dong, Elizabeth Plater-Zyberk, Maria I. Nardi, Jack Kardys and José Szapocznik

Int. J. Environ. Res. Public Health 2018, 15(3), 430; https://doi.org/10.3390/ijerph15030430 - 01 Mar 2018

Cited by 95 | Viewed by 11007

Abstract

Prior studies suggest that exposure to the natural environment may be important for optimal mental health. The present study examines the association between block-level greenness (vegetative presence) and mental health outcomes, in a population-based sample of 249,405 U.S. Medicare beneficiaries aged ≥65 years living in Miami-Dade County, Florida, USA, whose location did not change from 2010 to 2011. Multilevel analyses examined relationships between greenness, as measured by mean Normalized Difference Vegetation Index from satellite imagery at the Census block level, and each of two mental health outcomes; Alzheimer’s disease and depression, respectively, after statistically adjusting for age, gender, race/ethnicity, and neighborhood income level of the individuals. Higher block-level greenness was linked to better mental health outcomes: There was a reduced risk of Alzheimer’s disease (by 18%) and depression (by 28%) for beneficiaries living in blocks that were 1 SD above the mean for greenness, as compared to blocks that were 1 SD below the mean. Planned post-hoc analyses revealed that higher levels of greenness were associated with even greater mental health benefits in low-income neighborhoods: An increase in greenness from 1 SD below to 1 SD above the mean was associated with 37% lower odds of depression in low-income neighborhoods, compared to 27% and 21% lower odds of depression in medium- and high-income neighborhoods, respectively. Greenness may be effective in promoting mental health in older adults, particularly in low-income neighborhoods, possibly as a result of the increased opportunities for physical activity, social interaction, or stress mitigation. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

12 pages, 297 KiB

Open AccessArticle

Investigating the Associations between Ethnic Networks, Community Social Capital, and Physical Health among Marriage Migrants in Korea

by Harris Hyun-soo Kim

Int. J. Environ. Res. Public Health 2018, 15(1), 147; https://doi.org/10.3390/ijerph15010147 - 17 Jan 2018

Cited by 4 | Viewed by 3731

Abstract

This study examines factors associated with the physical health of Korea’s growing immigrant population. Specifically, it focuses on the associations between ethnic networks, community social capital, and self-rated health (SRH) among female marriage migrants. For empirical testing, secondary analysis of a large nationally representative sample (NSMF 2009) is conducted. Given the clustered data structure (individuals nested in communities), a series of two-level random intercepts and slopes models are fitted to probe the relationships between SRH and interpersonal (bonding and bridging) networks among foreign-born wives in Korea. In addition to direct effects, cross-level interaction effects are investigated using hierarchical linear modeling. While adjusting for confounders, bridging (inter-ethnic) networks are significantly linked with better health. Bonding (co-ethnic) networks, to the contrary, are negatively associated with immigrant health. Net of individual-level covariates, living in a commuijnity with more aggregate bridging social capital is positively linked with health. Community-level bonding social capital, however, is not a significant predictor. Lastly, two cross-level interaction terms are found. First, the positive relationship between bridging network and health is stronger in residential contexts with more aggregate bridging social capital. Second, it is weaker in communities with more aggregate bonding social capital. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

19 pages, 1488 KiB

Open AccessArticle

Neighborhood Perceptions and Cumulative Impacts of Low Level Chronic Exposure to Fine Particular Matter (PM_2.5) on Cardiopulmonary Health

by Kristen M. C. Malecki, Amy A. Schultz and Rachel S. Bergmans

Int. J. Environ. Res. Public Health 2018, 15(1), 84; https://doi.org/10.3390/ijerph15010084 - 06 Jan 2018

Cited by 14 | Viewed by 4688

Abstract

Adverse perceptions of neighborhood safety, aesthetics and quality including access to resources can induce stress and may make individuals more sensitive to cardiopulmonary effects of air pollution exposure. Few studies have examined neighborhood perceptions as important and modifiable non-chemical stressors of the built environment that may exacerbate effects of air pollution on cardiopulmonary health outcomes, particularly among general population based cohorts. This study examined associations between low-level chronic exposure to fine particulate matter (PM_2.5) and cardiopulmonary health, and the potential mediating or modifying effects of adverse neighborhood perceptions. Using data from the Survey of the Health of Wisconsin (SHOW), 2230 non-asthmatic adults age 21–74 were included in the analyses. The overall goals of this study were to assess if individuals who experience stress from neighborhood environments in which they live were more sensitive to low levels of fine particular matter (PM_2.5 μg/m³). Demographic predictors of air pollution exposure included younger age, non-White race, lower education and middle class income. After adjustments, objective lung function measures (FEV1 and FEV1 to FVC ratio) were the only cardiopulmonary health indicators significantly associated with chronic three-year annual averages of PM_2.5. Among all non-asthmatics, a ten unit increase in estimated three year annual average PM_2.5 exposure was significantly associated with lower forced expiratory volume (L) in one second FEV1 (β = −0.40 μg/L; 95% CI −0.45, −0.06). Among all individuals, adverse perceptions of the neighborhood built environment did not appear to statistically moderate or mediate associations. However, stratified analysis did reveal significant associations between PM_2.5 and lung function (FEV1) only among individuals with negative perceptions and increased reports of neighborhood stressors. These findings included individuals who felt their neighborhoods were poorly maintained (β = −0.82; 95% CI −1.35, −0.28), experienced stress from crime (β = −0.45; 95% CI −0.94, 0.04) or reported neighborhood is not well maintained (β = −1.13, CI −2.04, −0.24). These significant associations were similar for FEV1 to FVC ratio. Multi-pronged approaches addressing both neighborhood built environment aesthetics and air pollution regulation may be necessary to protect vulnerable and susceptible individuals and reduce persistent inequalities. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

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265 KiB

Open AccessArticle

Food (In)Security in Rapidly Urbanising, Low-Income Contexts

by Cecilia Tacoli

Int. J. Environ. Res. Public Health 2017, 14(12), 1554; https://doi.org/10.3390/ijerph14121554 - 11 Dec 2017

Cited by 42 | Viewed by 6848

Abstract

Urbanisation in low and middle-income nations presents both opportunities and immense challenges. As urban centres grow rapidly, inadequate housing and the lack of basic infrastructure and services affect a large and growing proportion of their population. There is also a growing body of evidence on urban poverty and its links with environmental hazards. There is, however, limited knowledge of how these challenges affect the ways in which poor urban residents gain access to food and secure healthy and nutritious diets. With some important exceptions, current discussions on food security continue to focus on production, with limited attention to consumption. Moreover, urban consumers are typically treated as a homogenous group and access to food markets is assumed to be sufficient. This paper describes how, for the urban poor in low and middle-income countries, food affordability and utilisation are shaped by the income and non-income dimensions of poverty that include the urban space. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

305 KiB

Open AccessArticle

Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants

by Amanda Stafford and Lisa Wood

Int. J. Environ. Res. Public Health 2017, 14(12), 1535; https://doi.org/10.3390/ijerph14121535 - 08 Dec 2017

Cited by 100 | Viewed by 33265

Abstract

Background: Homelessness is associated with enormous health inequalities, including shorter life expectancy, higher morbidity and greater usage of acute hospital services. Viewed through the lens of social determinants, homelessness is a key driver of poor health, but homelessness itself results from accumulated adverse social and economic conditions. Indeed, in people who are homeless, the social determinants of homelessness and health inequities are often intertwined, and long term homelessness further exacerbates poor health. Aggregated health service data can mask this, and case histories thus provide important insights. Methods: This paper presents three case histories of homeless patients seen at an inner city public hospital in Perth, Western Australia. The case histories draw on several data sources: hospital data, information collected from rough sleepers and clinical observations. Estimates of the cost to the health system of the observed hospital usage by the three patients are included. Findings: The case histories illustrate the interplay of social determinants of health in homelessness that help explain the high level of hospital usage by rough sleepers. The cumulative healthcare costs for the three individuals over a 33 months period were substantial. Hospital attendance plummeted even in the short term when housing needs were addressed. Conclusions: Treating homelessness as a combined health and social issue is critical to improving the abysmal health outcomes of people experiencing homelessness. In addition, the enormous economic costs of hospital care for people who are homeless can be reduced when housing and other social determinants are taken into account. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

332 KiB

Open AccessArticle

Social Environment and Hospitalisation after Release from Prison: A Prospective Cohort Study

by Alexander D. Love, Stuart A. Kinner and Jesse T. Young

Int. J. Environ. Res. Public Health 2017, 14(11), 1406; https://doi.org/10.3390/ijerph14111406 - 17 Nov 2017

Cited by 2 | Viewed by 5221

Abstract

This study examined the association between remoteness and area disadvantage, and the rate of subsequent hospitalisation, in a cohort of adults released from prisons in Queensland. A baseline survey of 1267 adult prisoners within 6 weeks of expected release was prospectively linked with hospital, mortality and reincarceration records. Postcodes were used to assign remoteness and area disadvantage categories. Multivariate Andersen–Gill regression models were fitted to test for associations between remoteness, area disadvantage and hospitalisation after release from prison. Over a total of 3090.9 person-years of follow-up, the highest crude incidence rates were observed in areas characterised by remoteness and area disadvantage (crude incidence rate (IR) = 649; 95%CI: 526–791), followed by remoteness only (IR = 420; 95%CI: 349–501), severe area disadvantage only (IR = 403; 95%CI: 351–461), and neither of these factors (IR = 361; 95%CI: 336–388). Unadjusted analyses indicated that remoteness (hazard ratio (HR) = 1.32; 95%CI: 1.04–1.69; p = 0.024) was associated with increased risk of hospitalisation; however, this attenuated to the null after adjustment for covariate factors. The incidence of hospitalisation for those who live in remote or socio-economically disadvantaged areas is increased compared to their counterparts in more urban and less socio-economically disadvantaged areas. Experiencing both these factors together may compound the hospitalisation in the community. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

323 KiB

Open AccessArticle

Prevalence of Mental Health Problems and Associated Risk Factors among Rural-to-Urban Migrant Children in Guangzhou, China

by Jun Wang, Ke Liu, Jing Zheng, Jiali Liu and Liming You

Int. J. Environ. Res. Public Health 2017, 14(11), 1385; https://doi.org/10.3390/ijerph14111385 - 14 Nov 2017

Cited by 25 | Viewed by 5586

Abstract

Rural-to-urban migration, which has achieved a huge scale during China’s economic reform, is a potential risk factor for the mental health of migrant children. To test this hypothesis, this study assessed the mental health status of rural-to-urban migrant children. Guided by Andersen’s behavioral model, the study explored the risk factors associated with mental health. The study recruited 1182 fifth/sixth-grade children from four private and four public primary schools in Guangzhou in 2014 in a descriptive cross-sectional design. Mental health status was measured by the strengths and difficulties questionnaire. Predisposing characteristics including demographics (e.g., age, gender), social structure (e.g., education, occupation) and health beliefs (health attitude) were recorded. Enabling characteristics including family and community resources and the need for health services were analyzed to explore the risk factors. The results indicate that more rural-to-urban migrant children were classified in the abnormal (21.0%) or borderline (18.8%) categories based on the total difficulties scores, the proportions of which were much higher than those of local children (9.8% abnormal, 13.8% borderline). Factors associated with a greater likelihood of mental health problems included single-parent families, seeking health information actively, family income cannot meet basic needs and poor perceived health status. Compared with the local children, the rural-to-urban migrant children had relatively poor mental health, hence monitoring and supporting mental health for rural-urban migrant children is critical. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

356 KiB

Open AccessArticle

Health in All Policies in South Australia—Did It Promote and Enact an Equity Perspective?

by Helen Van Eyk, Elizabeth Harris, Fran Baum, Toni Delany-Crowe, Angela Lawless and Colin MacDougall

Int. J. Environ. Res. Public Health 2017, 14(11), 1288; https://doi.org/10.3390/ijerph14111288 - 25 Oct 2017

Cited by 33 | Viewed by 5142

Abstract

Mobilising cross-sectoral action is helpful in addressing the range of social determinants that contribute to health inequities. The South Australian Health in All Policies (SA HiAP) approach was implemented from 2007 to stimulate cross-sector policy activity to address the social determinants of health to improve population wellbeing and reduce health inequities. This paper presents selected findings from a five year multi-methods research study of the SA HiAP approach and draws on data collected during interviews, observation, case studies, and document analysis. The analysis shows that SA HiAP had dual goals of facilitating joined-up government for co-benefits (process focus); and addressing social determinants of health and inequities through cross-sectoral policy activity (outcomes focus). Government agencies readily understood HiAP as providing tools for improving the process of intersectoral policy development, while the more distal outcome-focused intent of improving equity was not well understood and gained less traction. While some early rhetorical support existed for progressing an equity agenda through SA HiAP, subsequent economic pressures resulted in the government narrowing its priorities to economic goals. The paper concludes that SA HiAP’s initial intentions to address equity were only partially enacted and little was done to reduce inequities. Emerging opportunities in SA, and internationally, including the UN Sustainable Development Goals, may revive interest in addressing equity. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

1097 KiB

Open AccessArticle

Paid Sick Leave and Risks of All-Cause and Cause-Specific Mortality among Adult Workers in the USA

by Daniel Kim

Int. J. Environ. Res. Public Health 2017, 14(10), 1247; https://doi.org/10.3390/ijerph14101247 - 19 Oct 2017

Cited by 24 | Viewed by 6784

Abstract

Background: The USA is one of only a few advanced economies globally that does not guarantee its workers paid sick leave. While there are plausible reasons why paid sick leave may be linked to mortality, little is known empirically about this association. Methods: In a pooled USA nationally-representative longitudinal sample of 57,323 working adults aged 18–85 years from the National Health Interview Surveys 2000–2002, paid sick leave was examined as a predictor of all-cause and cause-specific mortality. Multivariate Cox proportional hazards models were used to estimate the impact of paid sick leave on mortality. Results: Having paid sick leave through one’s job was associated with 10% (hazards ratio, HR = 0.90; 95% CI = 0.81–0.996; p = 0.04), 14% (HR = 0.86; 95% CI = 0.74–0.99; p = 0.04), and 22% (HR = 0.78; 95% CI = 0.65–0.94; p = 0.01) significantly lower hazards of all-cause mortality after mean follow-up times of 11.1, 6.5, and 4.5 years, respectively. This study further identified associations of paid sick leave with 24% (HR = 0.76; 95% CI = 0.59–0.98; p = 0.03), and 35% (HR = 0.65; 95% CI = 0.44–0.95; p = 0.03) lower hazards of dying from heart diseases and unintentional injuries, respectively. Conclusions: To the author’s knowledge, this study provides the first empirical evidence on the linkages between paid sick leave and mortality and supports protective effects, particularly against heart diseases and unintentional injuries. The most salient association corresponded to a lag period of just less than five years. Social policies that mandate paid sick leave may help to reduce health inequities and alleviate the population burden of mortality among working adults in the USA. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

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356 KiB

Open AccessArticle

Social Hazards as Manifested Workplace Discrimination and Health (Vietnamese and Ukrainian Female and Male Migrants in Czechia)

by Dušan Drbohlav and Dagmar Dzúrová

Int. J. Environ. Res. Public Health 2017, 14(10), 1207; https://doi.org/10.3390/ijerph14101207 - 10 Oct 2017

Cited by 7 | Viewed by 3743

Abstract

Social hazards as one of the dimensions of workplace discrimination are a potential social determinant of health inequalities. The aim of this study was to investigate relations between self-reported health and social hazard characteristics (defined as—discrimination as such, violence or threat of violence, time pressure or work overload and risk of accident) among Vietnamese and Ukrainian migrants (males and females) in Czechia by age, education level and marital status. This study is based on data from a survey of 669 immigrants in Czechia in 2013. Logistic regression analysis indicates that the given independent variables (given social hazards and socio-demographic characteristics), as predictors of a quality of self-reported health are more important for immigrant females than for males, irrespective of citizenship, albeit only for some of them and to differing extents. We found out that being exposed to the selected social hazards in the workplace leads to worsening self-rated health, especially for females. On the other hand, there was no statistically significant relationship found between poor self-rated health and discrimination as such. Reality calls for more research and, consequently, better policies and practices in the field of health inequalities. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

353 KiB

Open AccessArticle

“Look at the Whole Me”: A Mixed-Methods Examination of Black Infant Mortality in the US through Women’s Lived Experiences and Community Context

by Maeve E. Wallace, Carmen Green, Lisa Richardson, Katherine Theall and Joia Crear-Perry

Int. J. Environ. Res. Public Health 2017, 14(7), 727; https://doi.org/10.3390/ijerph14070727 - 05 Jul 2017

Cited by 19 | Viewed by 9292

Abstract

In the US, the non-Hispanic Black infant mortality rate exceeds the rate among non-Hispanic Whites by more than two-fold. To explore factors underlying this persistent disparity, we employed a mixed methods approach with concurrent quantitative and qualitative data collection and analysis. Eighteen women participated in interviews about their experience of infant loss. Several common themes emerged across interviews, grouped by domain: individual experiences (trauma, grieving and counseling; criminalization); negative interactions with healthcare providers and the healthcare system; and broader contextual factors. Concurrently, we estimated the Black infant mortality rate (deaths per 1000 live births) using linked live birth-infant death records from 2010 to 2013 in every metropolitan statistical area in the US. Poisson regression examined how contextual indicators of population health, socioeconomic conditions of the Black population, and features of the communities in which they live were associated with Black infant mortality and inequity in Black–White infant mortality rates across 100 metropolitan statistical areas with the highest Black infant mortality rates. We used principal components analysis to create a Birth Equity Index in order to examine the collective impact of contextual indicators on Black infant mortality and racial inequity in mortality rates. The association between the Index and Black infant mortality was stronger than any single indicator alone: in metropolitan areas with the worst social, economic, and environmental conditions, Black infant mortality rates were on average 1.24 times higher than rates in areas where conditions were better (95% CI = 1.16, 1.32). The experiences of Black women in their homes, neighborhoods, and health care centers and the contexts in which they live may individually and collectively contribute to persistent racial inequity in infant mortality. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

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Review

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814 KiB

Open AccessReview

Child Nutritional Status in the Changing Socioeconomic Region of the Northern Amazon, Brazil

by Mônica P. L. Cunha, Rejane C. Marques and José G. Dórea

Int. J. Environ. Res. Public Health 2018, 15(1), 15; https://doi.org/10.3390/ijerph15010015 - 23 Dec 2017

Cited by 12 | Viewed by 4643

Abstract

The living conditions (i.e., socioeconomic, healthcare-related, nutritional, and environmental) to which children are exposed may influence their ability to reach their optimal growth potential. This review focuses on the relationship between the nutritional status of children under five years of age and social and environmental factors in Northern Brazil. Children living in this region have limited access to healthcare and face precarious socioeconomic and environmental conditions. This analysis was based on data from national health surveys, the consolidated food, nutrition surveillance system (SISVAN), and indicators of the DPSEEA (driving force, pressure, state, exposures, health effects, and actions) framework. The northern region has the worst living conditions in the country, and children under five years of age have significant height-for-age, weight-for-age, and weight-for-height deficits. Concomitantly, the prevalence of children who are overweight has increased significantly, although it remains lower than that in more developed Brazilian regions. Insufficient and/or inadequate dietary practices and early exposure to unfavorable living conditions are risk factors for nutritional deviations. Further advances in public health policies that consider regional characteristics, particularly in the north, where progress has been slower, are needed. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

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Other

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309 KiB

Open AccessPerspective

Social Determinants of Health, Disaster Vulnerability, Severe and Morbid Obesity in Adults: Triple Jeopardy?

by Lesley Gray

Int. J. Environ. Res. Public Health 2017, 14(12), 1452; https://doi.org/10.3390/ijerph14121452 - 24 Nov 2017

Cited by 16 | Viewed by 10136

Abstract

Severe and morbid obesity are associated with highly elevated risks of adverse health outcomes and the prevalence of severe obesity is increasing globally. To date, disaster literature has not considered severe and morbid obesity as a specific vulnerability, despite reports of people being left behind during disasters because of their body size, shape or weight. The complex causes of obesity are associated with the social determinants of health and one’s potential vulnerability to disasters. The absence of appropriate considerations may lead to people being exposed to disproportionate and potentially avoidable risk. The intersection of the social determinants of health, disaster vulnerability, severe and morbid obesity is explored. Previously identified vulnerable groups are also represented in severe and morbid obesity data. This poses the prospect for ‘triple jeopardy’ compounding the social determinants of health, disaster vulnerability and considerations with and for people with morbid obesity. When working to reduce disaster risk for vulnerable groups, the author proposes specific consideration is required to ensure ‘all-of-society engagement and partnership’ in an inclusive, accessible and non-discriminatory manner, to ensure no one is left behind. Full article

(This article belongs to the Special Issue Social Determinants of Health Inequities and Prevention)

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