Whilst the transformation towards digital healthcare is accelerating, there is still a substantial risk of excluding people with a distance to the online world. Groups like people with a low ...socioeconomic position, people with a migrant background or the elderly, who are already most at risk of experiencing health inequalities, are simultaneously experiencing increased digital exclusion. Researchers play a role in determining how eHealth access is framed and can thus impact how the barriers to its use are addressed. This qualitative meta-review critically evaluates the way researchers (as authors) discuss eHealth use in digitally marginalised groups. Specifically, it seeks to understand how eHealth is framed to address existing health systems problems; how the barriers to eHealth use are presented and which solutions are provided in response; and who authors suggest should be responsible for making eHealth work. The results of this review found four paradoxes in how current literature views eHealth use. Firstly, that health systems problems are complex and nuanced, yet eHealth is seen as a simple answer. Secondly, that there are many political, social and health systems-based solutions suggested to address eHealth use, however most of the identified barriers are individually framed. This focus on personal deficits results in misallocating responsibility for making these systemic improvements. Thirdly, although eHealth is meant to simplify the tasks of patients and healthcare workers, these are the groups most often burdened with the responsibility of ensuring its success. Lastly, despite tailoring eHealth to the user being the most suggested solution, researchers generally speak about groups as a homogenous entity – thus rendering tailoring difficult. Ultimately, this review finds that a shift to focus research on addressing systemic issues on a systems level is necessary to prevent further exacerbating existing health inequalities.
•This review examined framing of eHealth use amongst digitally marginalised groups in research.•eHealth is presented as a simple solution to highly complex health system problems.•Patients and health workers are seen as most responsible for addressing barriers.•Though barriers are framed as individual problems, solutions to improve eHealth are systems focused.•We urge researchers to shift to a systems paradigm to avoid perpetuating health inequalities.
Inclusion health focuses on people in extremely poor health due to poverty, marginalisation, and multimorbidity. We aimed to review morbidity and mortality data on four overlapping populations who ...experience considerable social exclusion: homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals.
For this systematic review and meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library for studies published between Jan 1, 2005, and Oct 1, 2015. We included only systematic reviews, meta-analyses, interventional studies, and observational studies that had morbidity and mortality outcomes, were published in English, from high-income countries, and were done in populations with a history of homelessness, imprisonment, sex work, or substance use disorder (excluding cannabis and alcohol use). Studies with only perinatal outcomes and studies of individuals with a specific health condition or those recruited from intensive care or high dependency hospital units were excluded. We screened studies using systematic review software and extracted data from published reports. Primary outcomes were measures of morbidity (prevalence or incidence) and mortality (standardised mortality ratios SMRs and mortality rates). Summary estimates were calculated using a random effects model.
Our search identified 7946 articles, of which 337 studies were included for analysis. All-cause standardised mortality ratios were significantly increased in 91 (99%) of 92 extracted datapoints and were 11·86 (95% CI 10·42–13·30; I2=94·1%) in female individuals and 7·88 (7·03–8·74; I2=99·1%) in men. Summary SMR estimates for the International Classification of Diseases disease categories with two or more included datapoints were highest for deaths due to injury, poisoning, and other external causes, in both men (7·89; 95% CI 6·40–9·37; I2=98·1%) and women (18·72; 13·73–23·71; I2=91·5%). Disease prevalence was consistently raised across the following categories: infections (eg, highest reported was 90% for hepatitis C, 67 65% of 103 individuals for hepatitis B, and 133 51% of 263 individuals for latent tuberculosis infection), mental health (eg, highest reported was 9 4% of 227 individuals for schizophrenia), cardiovascular conditions (eg, highest reported was 32 13% of 247 individuals for coronary heart disease), and respiratory conditions (eg, highest reported was 9 26% of 35 individuals for asthma).
Our study shows that homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals experience extreme health inequities across a wide range of health conditions, with the relative effect of exclusion being greater in female individuals than male individuals. The high heterogeneity between studies should be explored further using improved data collection in population subgroups. The extreme health inequity identified demands intensive cross-sectoral policy and service action to prevent exclusion and improve health outcomes in individuals who are already marginalised.
Wellcome Trust, National Institute for Health Research, NHS England, NHS Research Scotland Scottish Senior Clinical Fellowship, Medical Research Council, Chief Scientist Office, and the Central and North West London NHS Trust.
•Coronavirus disease 2019 (COVID-19) has emerged as a global health threat.•Older adults form a vulnerable section both to the physiological risks of infection as well as to the psychosocial ...offshoots of distancing and lockdown.•Loneliness, isolation, abuse, loss of autonomy, and restriction of health care access can accentuate their frailty and comorbidities.•The authors propose marginalization as the probable common pathway for human rights deprivation of older adults during the pandemic.•Measures of mitigating these effects enabling Healthy Aging are discussed.
The world has endured over six months of the Coronavirus disease 2019 (COVID-19). Older adults are at disproportionate risk of severe infection and mortality. They are also vulnerable to loneliness and social exclusion during the pandemic. Age and ageism both can act as significant risk factors during this pandemic, increasing the physical as well as psychosocial burden on the elderly. A review was performed in relation to the psychosocial vulnerabilities of the older adults during the pandemic, with insights from the similar biological disasters in the past. Besides the physiological risk, morbidities, polypharmacy and increased case fatality rates, various social factors like lack of security, loneliness, isolation, ageism, sexism, dependency, stigma, abuse and restriction to health care access were identified as crucial in pandemic situation. Frailty, cognitive and sensory impairments added to the burden. Marginalization and human rights deprivation emerged as a common pathway of suffering for the elderly during COVID-19. The implications of the emergent themes are discussed in light of psychosocial wellbeing and impact on the quality of life. The authors suggest potential recommendations to mitigate this marginalization on lines of the World Health Organization (WHO)’s concept of Healthy Ageing and the United Nations (U.N.) Sustainable Development Goals.
Throughout the history of the United States, there have been many social movements that have resulted in an array of historic societal outcomes-ranging from the end of racial segregation to women's ...voting rights to the legalization of same-sex marriages. Despite the positive outcomes derived from political activism, many psychologists have struggled with how to advocate for social justice while maintaining their professional responsibilities and ethical boundaries. The current article reviews the historical ways that psychologists have participated in political movements-from the use of psychological research in landmark U.S. Supreme Court cases to psychologist-led pushes for policy changes in psychology, medicine, and other mental health related fields. Next, a critical review provides some of the major controversies or dilemmas regarding psychology, social justice, and political participation-including (a) ethical concerns and professional boundaries, (b) the utility of political neutrality in psychology, (c) psychologists' balance and self-care, (d) psychologists' lack of advocacy training, and (e) beliefs concerning the role of social justice advocacy in psychology. Finally, the article concludes with a discussion of the concept "psychologist-activist"-highlighting the many ways that psychologists across various subfields and institutions can combat oppression on individual, interpersonal, group, and institutional levels.
Scientific advances in health care have been disproportionately distributed across social strata. Disease burden is also disproportionately distributed, with marginalized groups having the highest ...risk of poor health outcomes. Social determinants are thought to influence health care delivery and the management of chronic diseases among marginalized groups, but the current conceptualization of social determinants lacks a critical focus on the experiences of people within their environment. The purpose of this article was to integrate the literature on marginalization and situate the concept in the framework of social determinants of health. We demonstrate that social position links marginalization and social determinants of health. This perspective provides a critical lens to assess the societal power dynamics that influence the construction of the socio‐environmental factors affecting health. Linking marginalization with social determinants of health can improve our understanding of the inequities in health care delivery and the disparities in chronic disease burden among vulnerable groups.
According to the social defeat (SD) hypothesis, published in 2005, long-term exposure to the experience of SD may lead to sensitization of the mesolimbic dopamine (DA) system and thereby increase the ...risk for schizophrenia. The hypothesis posits that SD (ie, the negative experience of being excluded from the majority group) is the common denominator of 5 major schizophrenia risk factors: urban upbringing, migration, childhood trauma, low intelligence, and drug abuse. The purpose of this update of the literature since 2005 is to answer 2 questions: (1) What is the evidence that SD explains the association between schizophrenia and these risk factors? (2) What is the evidence that SD leads to sensitization of the mesolimbic DA system? The evidence for SD as the mechanism underlying the increased risk was found to be strongest for migration and childhood trauma, while the evidence for urban upbringing, low intelligence, and drug abuse is suggestive, but insufficient. Some other findings that may support the hypothesis are the association between risk for schizophrenia and African American ethnicity, unemployment, single status, hearing impairment, autism, illiteracy, short stature, Klinefelter syndrome, and, possibly, sexual minority status. While the evidence that SD in humans leads to sensitization of the mesolimbic DA system is not sufficient, due to lack of studies, the evidence for this in animals is strong. The authors argue that the SD hypothesis provides a parsimonious and plausible explanation for a number of epidemiological findings that cannot be explained solely by genetic confounding.
2019-coronavirus disease (COVID-19) is causing insurmountable psychosocial impact on the whole mankind. Marginalized community, particularly those with substance use disorders (SUD), are particularly ...vulnerable to contract the infection and also likely to suffer from greater psychosocial burden. This article analyses the intricate bi-directional relationship between COVID-19 and addiction.
Pubmed and Google Scholar are searched with the following key terms- “COVID-19”, “SARS-CoV2”, “Pandemic”, “Addiction”, “Opioid”, “Alcohol”, “Smoking”, “Addiction Psychiatry”, “Deaddiction”, “Substance use disorders”, “Behavioral addiction”. Few newspaper reports related to COVID-19 and addiction have also been added as per context.
People with SUD are at greater risk of worse COVID-19 outcome. There is surge of addictive behaviors (both new and relapse) including behavioral addiction in this period. Withdrawal emergencies and death are also being increasingly reported. Addicted people are especially facing difficulties in accessing the healthcare services which are making them prone to procure drugs by illegal means.
COVID-19 and addiction are the two pandemics which are on the verge of collision causing major public health threat. While every effort must be taken to make the public aware of deleterious effects of SUD on COVID-19 prognosis, the resumption of deaddiction services and easier accessibility of prescription drugs are needs of the hour.
•Addiction and COVID-19 fuel each other to cause a global public health threat.•Resumption of deaddiction service and relaxation of accessibility of prescription drugs are needed.•Psychiatrists must be prepared for imminent hike in withdrawal symptoms and addictive behaviors.
The social position of learning disabled people has shifted rapidly over the last 20 years, from long-stay institutions, first into community homes and day centres, and now to a currently emerging ...goal of ""ordinary lives"" for individuals using person-centred support and personal budgets. These approaches promise to replace a century and a half of ""scientific"" pathological models based on expert assessment, and of the accompanying segregated social administration which determined how and where people led their lives, and who they were. This innovative volume explains how concepts of learning disability, intellectual disability and autism first came about, describes their more recent evolution in the formal disciplines of psychology, and shows the direct relevance of this historical knowledge to present and future policy, practice and research. Goodey argues that learning disability is not a historically stable category and different people are considered ""learning disabled"" as it changes over time. Using psychological and anthropological theory, he identifies the deeper lying pathology as ""inclusion phobia"", in which the tendency of human societies to establish an in-group and to assign out-groups reaches an extreme point. Thus the disability we call ""intellectual"" is a concept essential only to an era in which to be human is essentially to be deemed intelligent, autonomous and capable of rational choice. Interweaving the author's historical scholarship with his practice-based experience in the field, Learning Disability and Inclusion Phobia challenges myths about the past as well as about present-day concepts, exposing both the historical continuities and the radical discontinuities in thinking about learning disability.
Current research on drug use emphasizes harms and often neglects its pleasures and benefits. This one-sided view has supported policies that criminalize personal drug use. This study explores nuanced ...understandings of cannabis use from the perspectives of marginalized users in Nigeria.
This study is based on qualitative research conducted with street-involved young adults (n = 97) recruited through time-location sampling in Uyo, Akwa Ibom State in Nigeria. Data were collected through in-depth, individual interviews, transcribed, coded and analyzed thematically.
Cannabis offered corporeal and social pleasures, which were shaped by the socio-spatial context of use. It was also used in marginalized ways to relieve social stress, cope with trauma, enable daily functioning, and everyday survival struggle. This encouraged heavy use, which produced health harms including dependence as well as physical and mental health problems. Social and legal harms were of more concern to the participants than health ones. Unlawful policing practices, including physical abuses and financial extortion, exacerbated the health and social harms of structural violence they experience.
Cannabis use is a more nuanced practice than is captured in the dominant medico-legal discourse. Harms owe more to the socio-legal contexts of use than to the drug's pharmacology. Reducing harms requires the provision of healthcare services and structural interventions, not criminalizing a population already situated on the margins of a resource-poor society.
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