Monday, March 29, 2010

[EQ] An evaluation of gender equity in different models of primary care practices in Ontario

An evaluation of gender equity in different models of primary care practices in Ontario
 

Simone Dahrouge1,§, William Hogg1,2,3, Meltem Tuna1, Grant Russell1,2,3, Rose Anne Devlin3, Peter Tugwell3,4,  Elisabeth Kristjansoon4

 

1 C.T. Lamont Primary Health Care Research Centre, Élisabeth Bruyère Research Institute, Ottawa, Ontario, Canada

2  University of Ottawa, Department of Family Medicine, Ottawa, Ontario, Canada

3  University of Ottawa, Department of Epidemiology and Community Medicine, Ottawa, Ontario, Canada

4 University of Ottawa, Institute of Population Health, Ottawa, Ontario, Canada

BMC Public Health March 2010, 10:151 doi:10.1186/1471-2458-10-151

Available online at: http://www.biomedcentral.com/1471-2458/10/151

 

PDF [28p.] at: http://www.biomedcentral.com/content/pdf/1471-2458-10-151.pdf

The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries.

The authors of this study performed this evaluation in Ontario where primary care models resulting from reforms co-exist.

Background

 The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist.  

Methods

This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS) based, salaried, and capitation based.
We compared the quality of care delivered to women and men in practices of each model.
We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity) and three dimensions of quality of care using patient surveys (n=5,361) and chart abstractions (n=4,108). 

Results

Health service delivery measures were comparable in women and men, with differences < 2.2% in all  seven dimensions and in all models. Significant gender differences in the health promotion subjects  addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending Fee for service FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI) 1.05, 2.92).

There was no difference in the other three prevention indicators.Fee for service FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8). A similar trend was observed in Community Health Centers (CHC).

Conclusions

The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in Fee for service FFS but not in capitation based models. We recommend that efforts to monitor and address gender based differences in the delivery of chronic disease management in primary care be pursued….”

 


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[EQ] The impact of income inequalities on sustainable development in London

The impact of income inequalities on sustainable development in London

 

A report for the London Sustainable Development Commission

by Professor (Emeritus) Richard Wilkinson and Professor Kate Pickett on behalf of the Equality Trust

PDF http://www.equalitytrust.org.uk/docs/londonequality.pdf


Download the report at  http://www.equalitytrust.org.uk/node/331


“….The purpose of this report is not to reach conclusions on either acceptable levels of income inequality or how we might best achieve greater equality.

However, this is the start of a discussion and an exercise in learning how inequalities operate at the London level, how they affect environmental performance, and how social status and income inequalities amplify the effects of simple material deprivation….”

“….This report will show how improvements in societal wellbeing are now more likely to follow from greater equality rather than from further economic growth….”


Content

Foreword

Part I: Diminishing Returns To Economic Growth

Economic Growth and Wellbeing

Relative Income

Inequality drives Consumerism

Carbon Emissions and the Quality of Life

Convergence and Improvement

Part II: How Inequality Affects Health And Social Problems

Inequality and Social Cohesion

Improving the Quality of Life

Everyone Benefits

Part III: Application To London

An Index of Health and Social Problems for London

Inequality and Social Status

A More Equal London

Benefits of Greater Equality to Each London Borough

Intolerance

Part IV: Greater Equality And The Threat Of Climate Change

Climate Change

More Equal Societies are Greener

An Allegory of Two Cities in Crisis

Changes in Inequality

Conclusions

References

Appendix I: Sources for Figures

Appendix II: Sources of data

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.