Editorial

Citation

Gavrielides, T. (2015), "Editorial", International Journal of Human Rights in Healthcare, Vol. 8 No. 4. https://doi.org/10.1108/IJHRH-10-2015-0037

Editorial

Article Type: Editorial From: International Journal of Human Rights in Healthcare, Volume 8, Issue 4.

Theo Gavrielides

Welcome to Issue 8.4 of the International Journal of Human Rights in Healthcare (IJHRH). As 2015 comes to a close, we look back to assess how well we did in addressing issues of health inequality. This year, our Journal published 21 original articles including a special issue focusing on human rights. Going into its ninth year, the Journal is acknowledged internationally for its unique, timely and practical focus on issues impacting on some of the most marginalised communities.

The cutting edge research articles that we have published have at least one common thread. They all agree that while health inequalities now receive high levels of media coverage and public policy attention, many of their causes often lie outside the health field. We have published evidence to show that there are direct and clear links between poverty/class and poor health/wellbeing. Just to give one example, in Britain alone, there would be about 202,000 fewer premature deaths every year (i.e. 500 death per day), if everyone had the low level of mortality recorded for those with university education.

We know that the biggest causes of health inequalities are not found in genes or bad luck! The real causes are low income, poor housing, low educational attainment, unemployment and discrimination. We also know that spending millions of pounds on public awareness campaigns, posters and adverts does little, if nothing at all, in addressing the problem. These quick and shallow interventions only scratch the surface. In fact, there is evidence to suggest that some public health messages on tobacco use, diet, exercise and alcohol use may even exacerbate existing problems (Scottish Parliament Health and Sport Committee, 2013). So, here at the IJHRH, we focus on publishing only evidence-based solutions to current healthcare issues while positing recommendations for those working on the ground including professionals, policy makers but also researchers and academics.

Therefore, I am pleased to open the last Issue of 2015 with a unique paper focusing on health inequalities in the Arab world. Admittedly, this is not a geographical area that our Journal has explored in detail. However, we are aware that, for example, in Egypt, there is no documented evidence on service users' perceptions of quality of care. This is particularly true when it comes to respecting human rights in mental health residential facilities. "Quality of life and human rights conditions in a public psychiatric hospital in Cairo" investigates El-Abbassia Mental Health Hospital, revealing numerous human rights violations. A cross-sectional study was performed using in-depth interviews with 36 patients, 58 members of staff and 15 family members. Furthermore, reviews of documents and observations by an independent assessment team were carried out to triangulate the fieldwork findings. The data point out that there are prominent issues of patients' neglect and human rights including direct violence.

The second paper takes us to India, which arguably has one of the more progressive disability frameworks in the developing world. We now have enough evidence to say that disabled people experience health inequalities in at least two ways. First, by living in poverty and second through the discrimination that exists in access to health services internationally. "The experiences of mothers caring for a child with developmental disabilities: a cross-cultural perspective" explores caregiving amongst parents caring for a child with intellectual and developmental disabilities in India. Three focus groups were used to interview parents at Action for Autism. The paper asks parents and service providers to see disability from a new perspective. First, we must accept the diagnosis and our child; then we need to regain control through parenting skills training. As a consequence, we should expect to witness positive changes in our children and in ourselves.

It is easy to criticise the healthcare system, service providers and the status quo. It is also true that research in the field of health inequalities tends to focus on what is wrong rather than what can be done to improve things. In a difficult financial climate that affects all public services internationally, finding solutions to persistent health inequalities becomes even harder. That is why I was particularly pleased to edit "Bedside healthcare rationing dilemmas: a survey from Portugal". This timely paper seeks to elicit, in a context of economic crisis, the social preferences for the micro allocation of scarce healthcare resources. Data were collected from an online questionnaire. The study's findings suggest that respondents support a pluralism of distributive principles in prioritising patients with an incident in utilitarianism and the reducing of inequalities in health, translated in the fair-inning and in emotional arguments of fragility. The original findings of this study also point out that patients have absolute trust in the given health professional to make the right decisions and choices for their health and that and that rationing decisions will be real in the short term. The paper concludes that the pursuit of efficiency and the equalizing of a lifetime health seem to be the right criteria that should guide any rationing policy at the micro level. This ground-breaking paper addresses several ethical principles inherent to micro allocation healthcare resources that are relevant to the healthcare and political agendas worldwide.

The following paper, "Examining childhood obesity and the environment of a segregated, lower-Income US suburb" complements our narrative on health and economics. The paper argues that the contribution of the built environment within communities plays a significant role in the higher rates of childhood obesity, particularly among black and Hispanic youth. In particular, the paper investigates neighbourhood assets and barriers to nutrition and physical activity in an under-served, majority-minority suburban community in New York State, USA using a community-based participatory research method called "Photovoice". The findings reveal complex and insightful perspectives of health inequalities in the suburbs, including limited access to fresh, healthy food, and safe spaces for physical activity. The paper also argues that improving nutrition and physical activity practices requires policy changes and civic engagement. The findings of this paper on the environmental barriers to childhood obesity are similar to those found in urban areas, suggesting similarities in low-income communities of colour.

The last paper of this Issue, "Suicide rates for different religious groups in the South Asian origin population in England and Wales: a secondary analysis of a national data set", looks at the 4,848 suicides that occurred in 2001 of which 125 (2.6 per cent) were identified as people of South Asian origin by the algorithm. The suicide rate for all people of South Asian origin was 5.50/100,000 compared to 9.31/100,000 for the population of England and Wales. The age SMR for those whose names were of Hindu, Muslim or Sikh origin were 0.88, 0.47 and 0.85, respectively. Female South Asians have lower rates of suicide, than their South Asian male counterparts. The findings help us reflect on the linkages between race, poverty and suicide, and whether the current healthcare system is tailored enough to prevent these phenomena.

In closing the 2015 series of our Journal, I want to thank you for choosing our Journal and wish you a happy new year. I very much look forward to an exciting year ahead. We have lined up a number of special issues covering critical topics such as Female genital mutilation with Dr Daniel Riesel as the Guest Editor and Gender-based violence and health with Dr Ritu Mahendru as its Guest Editor.

Reference

Scottish Parliament Health and Sport Committee (2013), "Official report", No. Col 3268-69, Scottish Parliament Health and Sport Committee, Edinburgh, 5 February