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Patients’ refusal of treatment based on the practitioner’s ethnic identity reveals a clash of values: neutrality in medicine versus patient-centered care. In Israel, patients of the two ethno-national populations, the Jewish majority and the Arab minority, are treated in the public healthcare system by both Jewish and Arab practitioners against the background of the violent Israeli-Palestinian conflict. The research objective was to examine the views of Israeli patients and healthcare professionals regarding patients’ refusal of treatment because of the practitioner's ethnic identity. A mixed methodology was used, consisting of a phone survey of a representative sample (N=760) of the Israeli population, comprising both Jews (N=505) and Arabs (N=255) and fifty in-depth interviews with 10 managers and 40 healthcare professionals, Jewish and Arab, employed at 11 public hospitals. The survey showed that about 30% preferred to be treated by a physician of their own ethnicity, and around 4% reported that they had refused at least once to be treated by practitioners on the grounds of their ethnicity. The interviews revealed that most refusal incidents recorded are unidirectional: Jewish patients refusing to be treated by Arab practitioners. Refusals are usually directed towards nurses and junior medical staff members, especially if recognized as religious Muslims; they are often initiated by the patients’ relatives and occur more frequently during periods of escalation in the conflict. The structural competency approach can be applied to increase awareness of the role of social determinants in shaping patients’ ethnic-based treatment refusals and to improve the handling of such incidents.
Corruption, Population Health and Migrant-related Health Inequalities. A Multilevel Study of 35 European Countries
Ghent University, Belgium
In this paper, I investigate (a) whether a relationship exists between national levels of corruption and citizen’s overall health, and (b) whether this relationship differs between natives and migrants. Drawing on data from seven waves of the European Social Survey (2004 – 2016; N = 296,195) for individuals aged up to 75 years old living in 35 European countries, I apply a two-level multilevel model (i.e. individuals are clustered within country-years) combined with country- and year-fixed effects. The results indicate that higher levels of perceived societal corruption are related to poorer overall health. Moreover, this association is found to be stronger among natives than among first- and second-generation non-EU migrants. In sum, the study underlines the importance of corruption as a contextual risk factor for poor overall health. Future studies, however, should devote special attention to why the host population is more vulnerable to the health consequences of perceived societal corruption.
Never and Under Cancer Screeners among Women Living in Switzerland: How are inequalities shaped over time?
Vladimir Jolidon1, Stéphane Cullati1,2, Claudine Burton-Jeangros1
1Institute of Sociological Research, University of Geneva, Switzerland; 2Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Switzerland
Background: Research has evidenced inequalities in cervical and breast cancer screening which persist over time. Comparing "never-screeners" and "under-screeners" may shed light on further determinants of inequalities.
Objectives: This study aims to explore non-screening prevalence of cervical and breast cancer over time in Switzerland. It distinguishes never from under screeners to investigate how associations with socioeconomic and family structure inequalities have changed between 1992 and 2012.
Methods: Data from 31’800 women aged 20-70 and 11’388 women aged 50-70 from the Swiss Health Interview Survey (1992-2012), a national cross-sectional survey conducted every 5 years, was analysed. Weighted prevalence ratios of never and under Pap smear and mammography were estimated with multivariate Poisson regressions, adjusting for socioeconomic, sociodemographic, healthcare consumption and health status variables.
Results: Preliminary findings suggested that, between 1992 and 2012, never and under Pap smear screening prevalence remained stable at 15.8% and 9.0% respectively, while never mammography screening prevalence decreased from 57.5% to 34.0% and under mammography screening from 42.4% to 35.7%. Women with higher education and income were less likely to never screen for Pap smear. Partnership reduced both Pap smear and mammography probability of never screening over the studied period, but was not associated with under screening. Having children only reduced Pap smear never screening.
Discussion: While never screening was independently associated with socioeconomic and family structure factors, this was not the case for under screening. Comparing never and under-screeners throughout the analysed period evidenced the role of family structure in cancer screening inequalities. This research suggests that never and under screening need to be tackled with different healthcare policies and a stronger focus on never-screeners may contribute to reducing inequalities.
Cervical Cancer (over-)Screening In Belgium: Cross Sectional Trends In Social Inequalities
Vincent De Prez
Ghent University, Belgium
Many women take Pap smears outside the three-yearly cytological screening interval and outside the 25-64-year-old recommended age-range. We approach this kind of deviation from the medical norm from a medicalization perspective. By charting the social composition of Pap smear uptakers and its evolution over time in Belgium, we aim to shed light on the social determinants of over-screening as medicalization of preventive behavior, and how these are mediated by the governmental limited-reimbursement initiative that was implemented in 2009.
Data from 15455 women from five waves (1997-2013) of the Belgian Health Interview Survey are used. Over-screening is operationalized as the deviation from screening recommendations in a twofold manner, namely based on the frequency of screening (3-yearly intervals), and the age of the target population (25-64). Logistic regressions are performed.
Pap smear uptake increased from 69,5% in 1997 to 72,9% in 2013. Among the screening women, the proportion that was screened within the last year remained stable around 68% between 1997 and 2008, but declined significantly to 52,4% in 2013.
Pap smear uptake is higher for women aged 30-50, having a high educational degree, and having high household income. These socio-economic indicators are not related to over-screening. Over-screening is highest in Brussels.
The women who get over-screened are a shrinking proportion in a generally growing group of women who get a Pap smear. Higher educated women are more susceptible to the medicalization of their preventive behavior and show more norm compliance. The limited-reimbursement initiative was successful.