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Article ; Online: Aiming for Health Equity: The role of Public Health Policy and Primary Healthcare Comment on "Universal Health Coverage for Non-Communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare".

Burström, Bo

International journal of health policy and management

2022 Volume 11, Issue 5, Page(s) 714–716

Abstract: This commentary refers to the article by Fisher et al on lessons from Australian primary healthcare (PHC), which highlights the role of PHC to reduce non-communicable diseases (NCDs) and promote health equity. This commentary discusses important elements ...

Abstract	This commentary refers to the article by Fisher et al on lessons from Australian primary healthcare (PHC), which highlights the role of PHC to reduce non-communicable diseases (NCDs) and promote health equity. This commentary discusses important elements and features when aiming for health equity, including going beyond the healthcare system and focusing on the social determinants of health in public health policies, in PHC and in the healthcare system as a whole, to reduce NCDs. A wider biopsychosocial view on health is needed, recognizing the importance of social determinants of health, and inequalities in health. Public funding and universal access to care are important prerequisites, but regulation is needed to ensure equitable access in practice. An example of a PHC reform in Sweden indicates that introducing market solutions in a publicly funded PHC system may not benefit those with greater needs and may reduce the impact of PHC on population health.
MeSH term(s)	Australia ; Health Care Reform ; Health Equity ; Health Promotion ; Humans ; Noncommunicable Diseases/prevention & control ; Primary Health Care/economics ; Universal Health Insurance
Language	English
Publishing date	2022-05-01
Publishing country	Iran
Document type	Journal Article ; Comment
ZDB-ID	2724317-5
ISSN	2322-5939 ; 2322-5939
ISSN (online)	2322-5939
ISSN	2322-5939
DOI	10.34172/ijhpm.2021.112
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Aiming for Health Equity

Bo Burström

International Journal of Health Policy and Management, Vol 11, Iss 5, Pp 714-

The role of Public Health Policy and Primary Healthcare; Comment on “Universal Health Coverage for Non-Communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare"

2022 Volume 716

Abstract	This commentary refers to the article by Fisher et al on lessons from Australian primary healthcare (PHC), which highlights the role of PHC to reduce non-communicable diseases (NCDs) and promote health equity. This commentary discusses important elements and features when aiming for health equity, including going beyond the healthcare system and focusing on the social determinants of health in public health policies, in PHC and in the healthcare system as a whole, to reduce NCDs. A wider biopsychosocial view on health is needed, recognizing the importance of social determinants of health, and inequalities in health. Public funding and universal access to care are important prerequisites, but regulation is needed to ensure equitable access in practice. An example of a PHC reform in Sweden indicates that introducing market solutions in a publicly funded PHC system may not benefit those with greater needs and may reduce the impact of PHC on population health.
Keywords	inequalities in health ; equity in healthcare ; health policy ; primary healthcare ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	Kerman University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Experience of moral distress among doctors at emergency departments in Stockholm during the Covid-19 pandemic: a qualitative interview study.

Brune, Clara / Agerholm, Janne / Burström, Bo / Liljas, Ann

International journal of qualitative studies on health and well-being

2024 Volume 19, Issue 1, Page(s) 2300151

Abstract: Purpose: The COVID-19 pandemic and consequent strain on healthcare globally shed light on the concept of moral distress among healthcare workers, albeit to a smaller extent among doctors at emergency departments. This study aimed to examine moral ... ...

Abstract	Purpose: The COVID-19 pandemic and consequent strain on healthcare globally shed light on the concept of moral distress among healthcare workers, albeit to a smaller extent among doctors at emergency departments. This study aimed to examine moral distress as perceived by medical doctors working at emergency departments in Stockholm during the pandemic, with the purpose of investigating causes of moral distress and methods to manage moral distress. Methods: Semi-structured interviews were conducted with twelve doctors working at two emergency departments. A questionnaire was developed based on previous research and the interviews were analysed qualitatively through thematic analysis. Results: The themes "The factors that precipitated moral distress", "Experience of workplace support" and "Coping strategies" as well as seven subthemes and 15 codes were identified. The informants reported on various situations with different causes of moral distress. Common causes were resource depletion, such as hospital bed shortages, and following stricter triage criteria. Informants reported varying ways of managing moral distress. Conclusions: Informants experienced moral distress when faced with challenges such as resource depletion, rules and regulations, and colleagues' decisions. The informants who chose to seek support received it from their workplace, which helped them cope with their experiences. Some informants chose to not seek support.
MeSH term(s)	Humans ; COVID-19 ; Pandemics ; Emergency Service, Hospital ; Qualitative Research ; Morals
Language	English
Publishing date	2024-01-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2232726-5
ISSN	1748-2631 ; 1748-2623
ISSN (online)	1748-2631
ISSN	1748-2623
DOI	10.1080/17482631.2023.2300151
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Article ; Online: What Is Happening in Sweden?

Burström, Bo

International journal of health services : planning, administration, evaluation

2019 Volume 49, Issue 2, Page(s) 204–211

Abstract: Election to the parliament was held in Sweden on 9 September 2018. None of the traditional political blocks obtained a majority of the vote. The nationalist Sweden Democrats party increased their share of the vote from 13% in 2014 elections to 17% of the ...

Abstract	Election to the parliament was held in Sweden on 9 September 2018. None of the traditional political blocks obtained a majority of the vote. The nationalist Sweden Democrats party increased their share of the vote from 13% in 2014 elections to 17% of the vote in 2018. As no traditional political block wants to collaborate with the Sweden Democrats, no new government has yet been formed, more than 2 months after the election. Health care was a prominent issue in the elections. Health care in Sweden is universal and tax-funded, with a strong emphasis on equity. However, recent reforms have emphasized market-orientation and privatization in order to increase access to care, and may not contribute to equity. In spite of a majority of the population being opposed to profits being made on publicly funded services, privatization of health and social care has increased in the last decades. The background to this is described. Health is improving in Sweden, but inequalities remain and increase. The Swedish Public Health Policy from 2003 has been revised in 2018, on the basis of a national review of inequalities in health. The revised policy further emphasizes reducing inequalities in health.
MeSH term(s)	Delivery of Health Care/legislation & jurisprudence ; Delivery of Health Care/organization & administration ; Health Policy/legislation & jurisprudence ; Health Status ; Humans ; Politics ; Private Sector/legislation & jurisprudence ; Sweden/epidemiology
Language	English
Publishing date	2019-01-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	184936-0
ISSN	1541-4469 ; 0020-7314
ISSN (online)	1541-4469
ISSN	0020-7314
DOI	10.1177/0020731418822236
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Article ; Online: EQ-5D-3L Health Status Among Homeless People in Stockholm, Sweden, 2006 and 2018.

Burström, Bo / Irestig, Robert / Burström, Kristina

Frontiers in public health

2021 Volume 9, Page(s) 780753

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Health Status ; Humans ; Quality of Life ; Self Report ; Surveys and Questionnaires ; Sweden/epidemiology
Language	English
Publishing date	2021-12-20
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2021.780753
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Article: History lessons for tackling inequalities in health.

Whitehead, Margaret / Burström, Bo

SSM - population health

2021 Volume 16, Page(s) 100980

Language	English
Publishing date	2021-11-25
Publishing country	England
Document type	Journal Article
ISSN	2352-8273
ISSN	2352-8273
DOI	10.1016/j.ssmph.2021.100980
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Article ; Online: Did the choice reform in Stockholm change social disparities in use of outpatient health services for children?

Hjern, Anders / Nyberg, Christine / Burström, Bo

Acta paediatrica (Oslo, Norway : 1992)

2023 Volume 112, Issue 9, Page(s) 1973–1981

Abstract: Aim: The aim of this study was to investigate whether the choice reforms in healthcare in Stockholm county in 2008 and 2013 changed the sociodemographic user patterns of outpatient healthcare services for children.: Methods: The study used regional ... ...

Abstract	Aim: The aim of this study was to investigate whether the choice reforms in healthcare in Stockholm county in 2008 and 2013 changed the sociodemographic user patterns of outpatient healthcare services for children. Methods: The study used regional data on healthcare use linked to sociodemographic data from national registers in the total population of children 0-15 years in the Stockholm county. Change in use of healthcare services was analysed in multiple linear regression in a difference in differences approach of socio-economic indicators. Results: The choice reform of 2013 increased children's overall use of specialised care by around 30% until 2017 while primary care use decreased by the same degree. The mean number of physician visits in specialised care for children with severe asthma increased from 3.9 to 5.2 per year. Overall, children in families with low maternal education, low disposable income and a non-Western background increased their use of specialised care more than children from families with a more privileged socio-economic situation. Conclusion: There was no indication that the choice reform in Stockholm county increased the social disparities in use of primary and specialised outpatient care for children, rather the opposite.
MeSH term(s)	Humans ; Child ; Poverty ; Ambulatory Care ; Physicians ; Family ; Educational Status
Language	English
Publishing date	2023-06-14
Publishing country	Norway
Document type	Journal Article
ZDB-ID	203487-6
ISSN	1651-2227 ; 0365-1436 ; 0803-5253
ISSN (online)	1651-2227
ISSN	0365-1436 ; 0803-5253
DOI	10.1111/apa.16864
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Article ; Online: How did providers of home care for older adults manage the early phase of the Covid-19 pandemic? A qualitative case study of managers' experiences in Region Stockholm.

Agerholm, Janne / Burström, Bo / Schön, Pär / Liljas, Ann

BMC health services research

2023 Volume 23, Issue 1, Page(s) 1173

Abstract: Background: In the spring of 2020, the Covid-19 outbreak sent a shock wave through the Swedish society and placed an extraordinary pressure on the health and social care system for older people. In the initial phase there were few guidelines for care ... ...

Abstract	Background: In the spring of 2020, the Covid-19 outbreak sent a shock wave through the Swedish society and placed an extraordinary pressure on the health and social care system for older people. In the initial phase there were few guidelines for care providers to follow and staff in home care organisations often had to tackle challenges posed by the pandemic as they appeared. The aim of this study was to understand how the spread of Covid-19 was managed in organisations providing home care to older adults in different municipalities in Region Stockholm, and what actions were taken to minimise the spread of the disease among clients and staff. Method: A descriptive qualitative study was performed based on eight interviews with managers of home care providers for older adults in three different municipalities in Region Stockholm.Three of the eight providers operate within an integrated care system. Data were analysed using conventional content analysis. Results: Three themes were identified covering actions taken to handle the spread of the virus, feelings of insecurity and anxiety, and internal and external factors influencing how the pandemic was tackled. There was no single strategy followed by all municipalities or organisations, however, there were similarities between the organisations. One such example was the introduction of cohort care and the experience of lacking personal protective equipment. Providers in the integrated care system emphasized some advantages with their system that was seen as facilitators for minimising the risk of spreading the virus, like the joint meetings with managers from both health and social care and the close contact with healthcare professionals in relation to dissemination of hygiene instructions. Conclusion: Social care workers providing home care to older persons are an important group in preventing dissemination of infectious diseases like Covid-19. For better readiness and preparedness for future pandemics, municipal home care services would need larger stocks of personal protective equipment, clear guidelines and more training on how to reduce dissemination of disease. Ways to achieve closer communication between health and social care providers should also be investigated.
MeSH term(s)	Humans ; Aged ; Aged, 80 and over ; COVID-19/epidemiology ; Pandemics/prevention & control ; Home Care Services ; Social Workers ; Health Personnel ; Qualitative Research
Language	English
Publishing date	2023-10-27
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-023-10173-8
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Article ; Online: Rural-Urban Inequalities in Poor Self-Rated Health, Self-Reported Functional Disabilities, and Depression among Chinese Older Adults: Evidence from the China Health and Retirement Longitudinal Study 2011 and 2015.

Jiang, Haiting / Burström, Bo / Chen, Jiaying / Burström, Kristina

International journal of environmental research and public health

2021 Volume 18, Issue 12

Abstract: The household registration system (Hukou) in China classifies persons into rural or urban citizens and determines eligibility for state-provided services and welfare. Not taking actual residence into account may underestimate rural-urban differences. ... ...

Abstract	The household registration system (Hukou) in China classifies persons into rural or urban citizens and determines eligibility for state-provided services and welfare. Not taking actual residence into account may underestimate rural-urban differences. This study investigates rural-urban inequalities in self-reported health outcomes among older adults aged 60+, taking into account both Hukou and actual residence, adjusting for sociodemographic determinants, based on the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015. Self-Rated Health (SRH) was assessed with a single question, functional abilities were assessed with the Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) scales, and depression was assessed with the 10-item version of the Center for Epidemiologic Studies Depression Scale. Rural respondents had poorer socioeconomic status and higher prevalence of poor SRH, functional disabilities, and depression than urban respondents in both years, which were closely related to rural-urban differences in educational level and income. Impairments appeared at a younger age among rural respondents. Analyses using only Hukou registration and not actual residence resulted in underestimation of rural-urban differences. This study may serve as a basis for interventions to address rural-urban differences in health and social services and reduce health inequalities among Chinese older adults.
MeSH term(s)	Activities of Daily Living ; Aged ; China/epidemiology ; Depression/epidemiology ; Humans ; Longitudinal Studies ; Retirement ; Rural Population ; Self Report ; Urban Population
Language	English
Publishing date	2021-06-18
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1660-4601
ISSN (online)	1660-4601
DOI	10.3390/ijerph18126557
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Differences in Covid-19 mortality among persons 70 years and older in an integrated care setting in region Stockholm: a multi-level analysis between March 2020-February 2021.

Doheny, Megan / de Leon, Antonio Ponce / Burström, Bo / Liljas, Ann / Agerholm, Janne

BMC public health

2024 Volume 24, Issue 1, Page(s) 462

Abstract: Background: In Norrtälje municipality, within Region Stockholm, there is a joint integrated care organisation providing health and social care, which may have facilitated a more coordinated response to the covid-19 pandemic compared to the otherwise ... ...

Abstract	Background: In Norrtälje municipality, within Region Stockholm, there is a joint integrated care organisation providing health and social care, which may have facilitated a more coordinated response to the covid-19 pandemic compared to the otherwise decentralised Swedish system. This study compares the risk of covid-19 mortality among persons 70 years and older, in the municipalities of Stockholm, Södertälje, and Norrtälje, while considering area and individual risk factors. Methods: A population-based study using linked register data to examine covid-19 mortality among those 70 + years (N = 127,575) within the municipalities of interest between the periods March-August 2020 and September 2020-February 2021. The effect of individual and area level variables on covid-19 mortality among inhabitants in 68 catchment areas were examined using multi-level logistic models. Results: Individual factors associated with covid-19 mortality were sex, older age, primary education, country of birth and poorer health as indicated by the Charlson Co-morbidity Index. The area-level variables associated were high deprivation (OR: 1.56, CI: 1.18-2.08), population density (OR: 1.14, CI: 1.08-1.21), and usual care. Together, this explained 85.7% of the variation between catchment areas in period 1 and most variation was due to individual risk factors in period 2. Little of the residual variation was attributed to differences between catchment areas. Conclusion: Integrated care in Norrtälje may have facilitated a more coordinated response during period 1, compared to municipalities with usual care. In the future, integrated care should be considered as an approach to better protect and meet the care needs of older people during emergency situations.
MeSH term(s)	Humans ; Aged ; COVID-19/epidemiology ; Pandemics ; Sweden/epidemiology ; Delivery of Health Care, Integrated
Language	English
Publishing date	2024-02-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-024-17904-4
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