Health and Health Care Inequities, Infectious Diseases and Social Factors: Volume 39

In the context of US kidney disease care in 2020, this chapter highlights challenges of managing COVID-19–related acute pathology, sustaining safe chronic dialysis treatment for individuals with kidney failure during a pandemic, and identifying ways to effectively address intersections of race/ethnicity, SES, and health.

Medical literature and American Society of Nephrology (ASN) online member forum review, and Emory School of Medicine Renal Grand Rounds participant observation: April 2020–March 2021.

Among persons infected with COVID-19, especially persons of African descent, acute kidney injury (AKI) risk was elevated and associated with need for long-term dialysis. Dialysis-dependent chronic kidney disease patients constituted a high-risk group for COVID-19 infection and hospitalization, due to underlying chronic conditions as well as required travel to clinics for multiple weekly dialysis treatments with exposure to possibly infected staff and other patients.

Findings that are discussed are based on a limited time frame. The longer-term impact of COVID-19 for patient outcomes and for the structure of kidney disease care is a fertile area for continued study, especially in relation to broad health equity goals.

Racial justice activism in 2020 highlighted the imperative to address socioeconomic and racially structured inequities in the United States, and health equity goals and strategies that target kidney disease care have been outlined. The acute/chronic continuum of kidney disease care is a fertile area for research that is informed by the COVID-19 experience and population health inequity challenges.

One explanation for why people wear masks to prevent the spread of COVID-19 focuses on political party affiliation. This study explores the role of values in attempts by five South Dakota cities to pass local mask mandates.

A nonrandom convenience sample used search engines to find documents on mask mandates in South Dakota. The working hypotheses are: (1) the debate over mask mandates is a form of value conflict over freedom of choice and the role of government that reflect those held by Emerson, Thoreau, and Spencer and (2) the mandates themselves prescribe Value-Rational rather than Instrumental-Rational action to control the pandemic.

Antimaskers valued freedom of choice, and were willing to defy authority while promasker health professionals valued science and were willing to sacrifice themselves for the health of their patients. South Dakota cities encouraged mask wearing but did not include penalties for noncompliance. The vociferous opposition to the mask mandates resembles the opposition cities encountered when deciding to fluoridate drinking water in the 1950s and 1960s.

A case study cannot be generalized and may reflect sampling and researcher bias. Future research could include a content analysis of documents and videos presenting both sides of the debate.

This case study may provide the first in-depth analysis of values in the masking debate.

This paper explores the rural experiences of the COVID-19 pandemic and seeks to understand the variations in these experiences between rural residents working in health care and those outside of health care occupations. This paper considers the impacts on physical health and access to health care (including challenges related to caretaking) as well as on mental health.

We interviewed 16 individuals living in rural communities in New Mexico between August and November 2020. These interviews were conducted through a virtual meeting platform (Zoom) or by phone and recorded. Then these interviews were transcribed and analyzed for key themes, and all themes were coded by at least two team members for inter-rater reliability.

Rural residency is linked to a wide range of health and health care inequities. From health care provider shortages, lack of internet infrastructure, and disruptions in access to resources when the closest resources are outside of the state, rural residents in New Mexico faced a wide range of unique challenges during the pandemic. This study also details from where rural residents obtain their health information, and we consider how politicization of the pandemic has impacted rural communities. The experiences of rural residents demonstrate how some policies fail to take into consideration the unique contexts of rural communities. All participants strongly identified with their roles as members of rural communities.

These interviews were conducted prior to the peak of pandemic transmission in these communities, so a follow-up should be conducted which reflects on the later stages. Future pandemic scholarship should consider the experiences of rural communities and address the unique challenges, needs, and strengths in developing best practices.

This paper provides unique insight into the lived experience of rural residents during the pandemic, and highlights disparities and challenges faced by health care workers as well as rural community members more broadly.

Pandemic along with causing disruption in economy and health of the communities, has also exposed the vulnerabilities of the people and the government. Innumerable research papers reported that this is leading to an increase in psychological issues like depression, OCD, anxiety, etc.,. However, our past experiences with pandemics has shown that the survival of communities depends on the level of adaptability and change management. This study aims to observe the influence of the disruption in emotional health measured in terms of Level of Adaptability and Level of Resistance to Change as a result of Lockdown.

(1) Assess the level of disruption in the emotional health (in terms of Level of Adaptability and Level of Resistance to Change) of the people due to this Lockdown. (2)Impact of this disruption on physical health.

This is a cross-sectional survey of the urban Indian population. The sampling method used was the snow-ball sampling. Adaptability and Resistance to change have been considered as the measure of a person's emotional health and then correlated to their physical health.

The study hypothesized that people underwent emotional disruption and that affected their physical health negatively. But our findings showed that people were happy and used this time to improve their lives and relationships. The study found age having a significant association with both adaptability and resistance to change. There was inverse correlation between Resistance to change and physical health. And the level of Adaptability was considerably high in participants who were greater than 30 years and participants who were Self-employed or salaried.

The disruption in the lives of people due to Lockdown has given ample time for families to reconnect and relationships to improve. People have had time to introspect and hence have adapted well to the impending crisis.

The goal of this project is to link the analysis of gender construction to reproductive health, sexuality, and development within the postdisaster context of Nepal and thereby, inform our understandings of these linkages more broadly, as well as provide new opportunities for promoting gender equity, reproductive health, and development in areas of conflict or disaster.

Using life history narratives, I examine the intersections among reproductive health, gender, and sexuality before, during, and postdisaster.

These life history interviews shed light on how socialization processes shape and determine adolescent girls' future actions and women's life opportunities. At both the individual and state levels, issues related to gender, sexuality, and reproductive health are exacerbated in times of crisis.

Life histories provide rich, thick descriptions of social life. However, they are limited in terms of reliability and making generalizations about larger populations. This chapter engages the reader, scholars, students, practitioners, and policy makers in contemplating policy reform and initiation of context-based programs in times of natural disaster, political conflict, and other catastrophic events that disenfranchise those without agency and power.

This paper is unique in that it is the first to examine reproductive health and sexuality from the perspective of women living within a society bound by rigid gender and sexuality norms, but torn apart by natural disasters and the political and economic instability that follow in countries like Nepal.

The aim of this chapter is to explore the gender dynamics of the juncture of migration and health in the case of Ecuadorean migrations to Spain, the United States, and back.

By building on a feminist intersectional take on the social determination of health as defined by Latin American critical epidemiology, the project was designed within an activist research framework, and data were collected transnationally from 2015 to 2019 via surveys, individual and group interviews, participant observation in health and migration workshops and trainings for migrant communities, advocates, and health practitioners.

Our study identified and conceptualized various health processes and psycho-sociocultural coping mechanisms that migrants and relatives traversed and employed and pointed to how they manifested their agency in sustaining, reinforcing, and challenging dominant heteropatriarchal gender regimes.

While the findings cannot be generalized to all Ecuadorean migrants given sampling limitations, our research can help migrant communities further understand how their health and well-being may be affected by migration and, in turn, take precautionary and restorative measures.

The combination of various critical theories allowed us to uncover how migration as a risk factor affected the health of migrants, nonmigrating relatives and returnees in a nuanced and complex manner that traversed disciplinary silos and challenged both the mainstream biomedical approach, which typically exoticize, demean, and/or marginalize migrant health, and the literature's tendency to code migrants as victims as opposed to recognizing their protagonism.

Existing knowledge about differences in well-being is still incomplete. Based on the previous research, we hypothesize that there is a positive relationship between the use of health information from the media and well-being, and that the strength of this relationship increases with the number of years of schooling.

To test the hypotheses we used the data (n = 14,835) from the Eurobarometer survey which was conducted in several European countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, the Netherlands, Luxembourg, Portugal, Spain, Sweden, and the United Kingdom). We analyzed the data by applying hierarchical multiple regression analysis.

The findings indicate cross-national differences in the relationship between the use of health information from the media and well-being. Moreover, they suggest that the extent of education matters for this relationship, however its influence differs across countries.

Further research is needed to explain the differences found between the countries. The research results offer some suggestions for further research and for social policy initiatives to reduce educational differences in the relationship between the use of media information on health issues and well-being.

This chapter draws attention to the interrelationship between education, use of media information on health issues and well-being, as knowledge about this is scarce.

Micro hospitals are a new form of for-profit health-care facility with rapid expansion in some parts of the country. They continue to grow in Texas without in-depth public understanding or explicit policy guidance on their role in the health-care system. Our project aims to define socioeconomic and demographic characteristics of areas served by micro and regular hospitals, and by doing so help assess micro hospitals' impact in expanding health-care access for disadvantaged populations in Texas.

We (1) estimated hospital service areas (catchment areas) with a spatial model based on advanced Geographic Information System (GIS) methods using a proprietary ESRI traffic network; (2) assigned population socioeconomic measures to the catchment areas from the 2014–2018 American Community Survey 5-Year Estimates, weighted with an empirically tested Gaussian distribution; (3) used two-tailed t-tests to compare means of population characteristics between micro and regular hospital catchment areas; and (4) conducted logistic regressions to examine relationships between selected population variables and the associated odds of micro hospital presence.

We found micro hospitals in Texas tend to serve a population less stressed in health-care access compared to those who are more in need as measured by various dimensions of disadvantages.

Our analysis takes a cross sectional look at the population characteristics of micro hospital service areas. Even though the initial geographic choices of micro hospitals may not reflect the long-term population changes in specific neighborhoods, our analysis can provide policy makers a tool to examine health-care access for disadvantaged populations at given point in time. As the population socioeconomic characteristics have long been associated with health-care inequality, we hope our analysis will help foster structural policy considerations that balance growing health-care delivery innovations and their social accountability.

We used GIS based spatial modeling to dynamically capture the potential patient basis by travel time calculated with a street network dataset, rather than using the traditional static census tract to define hospital service areas. By integrating both spatial and nonspatial dimensions of healthcare access, we demonstrated that the policy considerations on the implications of equal opportunity for health-care access need to take into account the social realities and lived experiences of those experiencing the most vulnerability in our society, rather than a conceptual “equality” existing in the spatial and market abstraction.

How is medical knowledge produced and what are the implications of that knowledge production for medical practice? Using theoretical ideas on evidence-based medicine, standardization in medical research and practice, and biopower, I examine the relationship between medical knowledge and medical practice through the case of pelvic pain care in the US.

Data from ethnographic observations at two medical conferences as well as interviews with healthcare providers inform a critical analysis of the medical discourse.

The analysis reveals how evidence-based medicine is practiced in the context of medical conditions that lack objective evidence, as well as the unintended consequences of such practices. I provide an alternative approach to medical practice for conditions lacking traditional evidence through presenting outlier cases in the data.

In doing so, I make the broad theoretical argument that biomedical paradigms must emerge through the critical process of negative dialectics in order to reach past the limits of standardized medical care.

In sociologically analyzing the case of pelvic pain care, I reveal dire limits in the evidence-based approach to medical care for conditions and symptoms that may be deemed medical anomalies, demanding an alternative approach to care for such conditions.

Purpose: We present findings from a longitudinal investigation, the purpose of which was to compare health disparities of rural Latino older adult patients diagnosed with diabetes to their non-Latino White counterparts.

Methodology/Approach: A pre-post design was implemented treating Medicare Accountable Care Organization (ACO) participation by Rural Health Clinics (RHCs) as an intervention, and using diabetes-related hospitalizations to measure disparities. Data for a nationwide panel of 2,683 RHCs were analyzed for a study period of eight years: 2008–2015. In addition, data were analyzed for a subset of 116 RHCs located in Florida, Texas, and California that participated in a Medicare ACO in one or more years of the study period.

Findings: Two broad findings resulted from this investigation. First, for both the nationwide panel of RHCs and the three-state sample of “ACO RHCs,” there was a decrease in the mean disparities in diabetes-related hospitalization rates over the eight-year study period. Second, in comparing a three-year time period after Medicare ACO implementation in 2012 to a four-year period before the implementation, a statistically significant difference in mean disparities was found for the nationwide panel.

Research Limitations/Implications: There are a number of factors that may contribute to the decrease in diabetes-related hospitalization rates for Latinos in more recent years. Future research will identify specific contributors to reducing diabetes-related hospitalization disparities between Latinos and the general population, including the possible influence of ACO participation by RHCs.

Originality/Value of Paper: This chapter presents original research conducted using data related to rural Latino older adults. The data represent multiple states and an eight-year time period. The US Latino population is growing at a rapid pace. As a group, they are at a high risk for developing diabetes, the complications of which are serious and costly to the patient and the US healthcare system. With the continued growth of the Latino population, it is critical that their health disparities be monitored, and that factors that contribute to their health and well-being be identified and promoted.