The COVID-19 pandemic has upended nearly all the safeguarding systems in the lives of children and youth, such as family life, school, extracurricular activities, sports, unstructured social opportunities, health care, and church. With many of the typical promotive and protective factors disrupted all at once, and for so long, the mental health of children and youth has deteriorated in many areas, but not all, and for many children and youth, but not all. It is important to acknowledge, however, that the mental health of children and youth was in crisis before the pandemic, with 1 in 7 children and youth worldwide having a mental disorder. Given the continued decline in this area of health, children and youth may well be on the cusp of a “generational catastrophe” that could involve lasting harms if immediate action is not taken. Of particular concern are marginalized and vulnerable children and youth—they are the ones unduly enduring the brunt of this global crisis. Accordingly, child and youth mental health recovery must be prioritized, along with the reduction of inequity within and across countries. A commitment to public health strategies that never include harming children and youth as a tolerated side effect must also be made.
Tracy Vaillancourt and Peter Szatmari
Rayna Sage, Genna Mashinchi, and Craig Ravesloot
The ways in which disability impacts people and their health in rural places are a result of the interaction between the person and the rural environment in which they live. Disability is defined as ongoing difficulties engaging in daily activities and social roles due to physical or mental conditions. The United Nations Convention on the Rights of People with Disabilities (UN-CRPD) implemented policy in 2008 that recognized that disabled people are worthy of autonomy and dignity. The social and physical environment are constructed in ableist ways that make it difficult for people with disabilities to realize their independence and this is particularly true in many rural places. Person–environment fit and urbanormativity (the favoring of urban spaces at the expense of rural ones) are important concepts in understanding the experiences of rural disabled people. There is little existing research regarding the epidemiology of disability and rural health, but rural people report higher and earlier rates of disability than urban people and rural places have higher rates of older adults with higher rates of disability. Furthermore, rural people with disabilities experience various secondary health conditions and higher rates of mortality compared to urban people with disabilties. The lack of access to health care and advocacy help explain some of the differences in health outcomes when comparing rural and urban people. The disability rights movement led to the creation of different types of advocacy and service organizations across the globe to address these disparities. An important way to improve the experiences and health of rural people with disabilities is to ensure they have access to quality and dependable in-home services and community-based rehabilitation, which currently tend to be under-funded with dramatic worker shortages in many rural places. A final promising approach to improving the health of rural disabled people is through evidence-based health promotion programming that targets early indicators of health problemsand recovery and health-sustaining efforts following a health problem.
There are 1 billion migrants in the world today, which means that one in seven of the world’s population are migrants. Of these, 272 million are international migrants and 763 million are internal migrants. It is estimated that around 70 million of the world’s migrants, both internal and international, have been forcibly displaced. Many things force people to leave their homes in search of a better future: war, poverty, persecution, climate change, desertification, urbanization, globalization, inequality, and lack of job prospects. Migrants remain among the most vulnerable members of society even when their living conditions improve after migration. Migrant women and children are a particularly vulnerable group and have a great need for basic and preventive health care. Many refugees and migrants are young and in good health, but hard living conditions and difficulty accessing basic health care can affect their state of health. Many of them face inhuman journeys during migration and live in refugee camps with very low standards of hygiene; when they find a job, they are often exploited. All these things can also affect their mental health. Migrants struggle with similar challenges as other marginalized groups when it comes to access to health care, but they face the additional barriers of mobility, language barriers, cultural differences, lack of familiarity with local health care services, and limited eligibility for publicly and privately funded health care. Governments should provide affordable preventive and basic health care to refugees and migrants not only because it is a human right but also because in the long term it can lower the costs of the whole health care system.
Solveig A. Cunningham and Hadewijch Vandenheede
There are over 230 million international migrants worldwide, and this number continues to grow. Migrants tend to have limited access to and knowledge about resources and preventative care in their communities of reception, but nonetheless they are often in better health by many measures compared with native-born people in their communities of reception and with the people they left behind at their place of origin. With time since arrival, however, immigrants’ health advantages often dissipate and they experience increases in health problems, especially obesity and diabetes, which are chronic diseases that are increasingly prevalent in the overall population as well and are associated with multiple co-morbidities and limitations. It may be that immigrants have specific health endowments leading to these health patterns, or that the processes involved in migration, including exposure to new environments, behavioral change, and stress of migration may also affect risks of obesity and other chronic conditions. Understanding the health patterns of migrants can be useful in identifying their specific health needs, as well as contributing to our understanding of how specific environments, changes in environments, and individual health endowments interplay to shape the long-term health of populations.
Emily Q. Ahonen
Occupational health and safety concerns classically encompass conditions and hazards in workplaces which, with sufficient exposure, can lead to injury, distress, illness, or death. The ways in which work is organized and the arrangements under which people are employed have also been linked to worker health. Migrants are people who cross borders away from their usual place of residence, and about one in seven people worldwide is a migrant. Terms like “immigrant” and “emigrant” refer to the direction of that movement relative to the stance of the speaker. Any person who might be classified as a migrant and who works or seeks to work is an immigrant worker and may face challenges to safety, health, and well-being related to the work he or she does. The economic, legal, and social circumstances of migrant workers can place them into employment and working conditions that endanger their safety, health, or well-being. While action in support of migrant worker health must be based on systematic understanding of these individuals’ needs, full understanding the possible dangers to migrant worker health is limited by conceptual and practical challenges to public health surveillance and research about migrant workers. Furthermore, intervention in support of migrant worker health must balance tensions between high-risk and population-based approaches and need to address the broader, structural circumstances that pattern the health-related experiences of migrant workers. Considering the relationships between work and health that include but go beyond workplace hazards and occupational injury, and engaging with the ways in which structural influences act on health through work, are complex endeavors. Without more critically engaging with these issues, however, there is a risk of undermining the effectiveness of efforts to improve the lot of migrant workers by “othering” the workers or by failing to focus on what is causing the occupational safety and health concern in the first place—the characteristics of the work people do. Action in support of migrant workers should therefore aim to ameliorate structural factors that place migrants into disadvantageous conditions while working to improve conditions for all workers.
Around 700,000 people take their lives each year worldwide. Suicide accounts for approximately 1.3% of all deaths and therefore represents a major public health problem. The global age-standardized suicide rate is 9 per 100,000 population, yet there are large variations among genders, ages, countries, and world regions. The stress–vulnerability model of suicidal behaviors has been proposed to explain how a diathesis, developed through the influence of genetic and neurodevelopmental factors in relation to perinatal, postnatal, and life experiences, interacts with different risk and protective factors that either decrease or enhance the individual’s level of resilience to stress and suicidal risk. Public health suicide prevention strategies include suicide means restriction, reducing harmful substance use, promoting responsible media reporting, public-awareness campaigns, gatekeeper trainings, school-based interventions, crisis helplines, and postvention. Mental health strategies comprise identification, treatment, and rehabilitation of persons in distress and at risk for suicide. Multicomponent strategies that use a combination of evidence-based methods from public and mental health sectors are recommended. Future work should aim at enhancing the quality of epidemiological data, improving the research on protective and ideation-to-action factors, expanding the quantity and quality of data coming from low- and middle-income countries, and evaluating the cost-effectiveness of different suicide prevention strategies.
Amy L. Ai, Hoa B. Appel, and Sabrina L. Dickey
Cardiovascular disease (CVD) is the leading cause of death in the United States, but the burden of CVD falls disproportionately on racial and ethnic minority populations. Blacks are especially impacted by CVD. Since the 2010s, mortality from CVD has declined and life expectancy disparity between White and Black males has decreased. However, the mortality rate in Blacks remains the highest among all racial and ethnic groups. For example, concerning survival differences between White and Black patients with acute myocardial infarction, 5-year mortality for Black patients is significantly higher than that for White patients. Also, hypertension or high blood pressure and stroke, two of the most disabling diseases, burden Blacks much more than other groups. Furthermore, several major CVD comorbidities or risk factors are linked with disparity in Blacks, especially diabetes, obesity, and chronic kidney diseases. Physical inactivity is a major risk factor. Blacks and Hispanics, as well as Asian American women, all have higher rates of physical inactivity compared with Whites. The literature indicates the remarkable psychosocial and environmental issues that underlie CVD disparities in Black populations. Specifically, the social determinants of health (SDOH) have been shown to be significant indicators of CVD morbidity and mortality causing a disproportionate impact on racial and ethnic minorities and low socioeconomic status populations. These SDOH involving economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context provide a framework for a multifactorial approach to understand the impact of CVD on the Black community. The Black community has a history of trauma from racism and discrimination, which is still evident in the existence of structural racism. Trust in the health care system within the Black community remains an ongoing issue and stems from the unethical Tuskegee Study. The lack of trust in the U.S. health care system by the Black community is evident in the limited number of Black participants in research and the excess of health disparities within the Black community. Utilizing SDOH provides a context for understanding the complexity of addressing health disparities among historically marginalized groups. A unifactorial approach will not suffice when there are a number of physical, psychosocial, economic, and environment factors that adversely impact the health of underserved and underrepresented groups such as African Americans. Stringent policies to address racism, discrimination, and adequate access to health care for the Black community must be implemented to decrease the presence of CVD as a health disparity. Without the presence of a social and physical environment that provides adequate resources, such as health care services, quality education to attain employment and be health literate, employment to afford access to health care, and the support to engage in preventive care, African Americans will continue to suffer from various health disparities, such as CVD, and have shorter life spans compared to other racial and ethnic groups.
William A. Vega and Esther J. Calzada
Undermining educational attainment at any stage is a threat to life course health. A strong educational platform is required for adequate human development in the 21st century because it provides a foundation for lifelong knowledge, skills, and competencies that protect health. The importance of educational attainment for health has been acknowledged but remains understudied as an interdisciplinary issue. In US American society, unequal educational opportunity is a historical reality and is reflected in health disparities among African American and Latinx populations over the life span. Reform efforts have been initiated for decades, yet gains in educational attainment show limited progress and wide disparities in lifetime health persist. Educational attainment is a fundamental social determinant of health because it leverages higher income, improves the management of other social determinants of health, improves social skills, improves occupational life chances, and extends life expectancy. The reverse is also true. Low educational attainment that is intergenerational imperils human development by failing to prepare youth with the capabilities to overcome structural disadvantages and poverty, which themselves imperil development. African American and Latinx populations in the United States, who together represent nearly 100 million people and who will be the largest component of the majority-minority American population by the year 2046, confront a web of aversive social determinants, including poverty in de facto segregated communities, violence and trauma, toxic exposures, poorly compensated and often temporary employment, a lack of universal health insurance, racism, and sexism in their daily lives. Clearly, there are social, biologic, and psychological issues associated with the educational attainment and health gradient, and early childhood learning experiences represent a critically important opportunity for human potential by advancing cognitive performance, problem-solving ability, motivation to learn, and overall structural and functional brain development. Families from low educational attainment backgrounds experience the negative impacts of social determinants in their daily lives, and their children’s life chances are diminished by poorly funded schools with ineffective educational programs. Putative causes and potential responses to overcoming the historical problem of neglect have been identified, and there are promising efforts at educational system reform aiming to promote health with effective programs and comprehensive strategies that will close the gaps in educational attainment.