doi: 10.56294/hl2022127

 

ORIGINAL

 

Evaluating the Effectiveness of Policy Interventions in Reducing Lead Exposure among Vulnerable Populations

 

Evaluación de la eficacia de las intervenciones políticas para reducir la exposición al plomo de las poblaciones vulnerables

 

Pradeepta Sekhar Patro1 , Supriya Awasthi2 , Jamuna.K. V3 , Mukesh Sharma4

 

1Siksha ‘O’ Anusandhan (Deemed to be University), Department of Immunology, IMS and SUM Hospital. Bhubaneswar, India.

2Noida International University, School of Allied Health Sciences. Greater Noida, India.

3JAIN (Deemed-to-be University), Department of Forensic Science. Bangalore, India.

4Arya College of Pharmacy. Jaipur, India.

 

Cite as: Sekhar Patro P, Awasth S, Jamuna KV, Sharma M. Evaluating the Effectiveness of Policy Interventions in Reducing Lead Exposure among Vulnerable Populations. Health Leadership and Quality of Life. 2022; 1:127. https://doi.org/10.56294/hl2022127

 

Submitted: 11-08-2022                   Revised: 29-10-2022                      Accepted: 14-12-2022              Published: 15-12-2022

 

Editor: PhD. Prof. Neela Satheesh

 

ABSTRACT

 

Introduction: lead exposure continues to be a major public health issue, especially for vulnerable populations, including children and low-income communities. This has led to policy interventions, but the impact on reducing lead exposure is under scrutiny. The objective of this study is to evaluate the effectiveness of policy measures in reducing lead exposure among susceptible populations. 

Method: we undertook a systematic review of the literature to identify studies that assessed the effectiveness of policy interventions to reduce lead exposure. The search included peer-reviewed articles from 2000 to 2020, and studies were included if they (1) measured changes in lead exposure levels or (2) were a policy intervention targeted at a vulnerable population. Quality assessments of the studies were conducted using predefined criteria with data being synthesized through narrative.

Results: out of the twenty studies that met the inclusion criteria, most focused on lead paint abatement, lead service line replacement, or lead-safe renovation practices. These results point toward a substantial decrease in lead exposure following the introduction of policy interventions that can range as high as a 73 % reduction in blood lead levels in children across multiple studies. Moreover, lead-exposure prevention policies implementing education and awareness programs showed favorable impacts by increasing knowledge among parents and encouraging the practice of safer behaviors to lower lead exposure.

Conclusions: these findings highlight the potential for policy interventions to significantly reduce lead exposure in susceptible populations. These results also stress the importance of regular assessment and refinement of these policies to guarantee continuing success that reduces lead exposure throughout the years. Further research should evaluate their cost-effectiveness and barriers to implementation and effectiveness.

 

Keywords: Populations; Interventions; Implementing; Behaviors; Effectiveness; Promoting.

 

RESUMEN

 

Introducción: la exposición al plomo sigue siendo un importante problema de salud pública, especialmente para las poblaciones vulnerables, incluidos los niños y las comunidades con bajos ingresos. Esto ha dado lugar a intervenciones políticas, pero el impacto en la reducción de la exposición al plomo está bajo escrutinio. El objetivo de este estudio es evaluar la eficacia de las medidas políticas para reducir la exposición al plomo entre las poblaciones susceptibles. 

Método: se realizó una revisión sistemática de la bibliografía para identificar estudios que evaluaran la eficacia de las intervenciones políticas para reducir la exposición al plomo. La búsqueda incluyó artículos revisados por pares desde 2000 hasta 2020, y se incluyeron los estudios que (1) medían los cambios en los niveles de exposición al plomo o (2) eran una intervención política dirigida a una población vulnerable. Se evaluó la calidad de los estudios mediante criterios predefinidos y se sintetizaron los datos a través de la narrativa.

Resultados: de los veinte estudios que cumplían los criterios de inclusión, la mayoría se centraban en la reducción de la pintura con plomo, la sustitución de las tuberías de servicio de plomo o las prácticas de renovación seguras con plomo. Estos resultados apuntan a una disminución sustancial de la exposición al plomo tras la introducción de intervenciones políticas que pueden alcanzar una reducción del 73 % en los niveles de plomo en sangre de los niños en múltiples estudios. Además, las políticas de prevención de la exposición al plomo que aplican programas de educación y concienciación mostraron efectos favorables al aumentar los conocimientos de los padres y fomentar la práctica de comportamientos más seguros para reducir la exposición al plomo.

Conclusiones: estos resultados ponen de relieve el potencial de las intervenciones políticas para reducir significativamente la exposición al plomo en poblaciones susceptibles. Estos resultados también subrayan la importancia de evaluar y perfeccionar periódicamente estas políticas para garantizar un éxito continuado que reduzca la exposición al plomo a lo largo de los años. Futuras investigaciones deberían evaluar su rentabilidad y los obstáculos que dificultan su aplicación y eficacia.

 

Palabras clave: Poblaciones; Intervenciones; Aplicación; Comportamientos; Eficacia; Promoción.

 

 

 

INTRODUCTION

Lead exposure is a main public health problem that threaten the health and wellbeing of millions around the world. Lead has been used widely in paints, plumbing, and products, but its toxic effects on humans are well known.(1) Various population groups such as infants, young children, and pregnant women are more susceptible to lead poisoning due to the direct exposure with lead products or the lead-infested environment. As a result, governments and health organisations, have introduced different policy interventions to mitigate lead exposure in these groups. In this essay we examine the impact of these policy interventions in reducing lead exposure in at risk populations. Regulating lead-containing products is one of the most consequential policy interventions to reduce lead exposure. Lead has been used in things like paint, gasoline, and other everyday household and industrial applications.(2) The use of lead in construction materials, plumbing, paints, and other products became more restricted as scientific evidence showed that it had negative health effects on humans. Introduction In 1992, in the United States, the Environmental Protection Agency passed the Lead-Based Paint Hazard Reduction Act which prevented the use of lead in paints for residential use.(3) Even after such a common sense policy, the reduction was not enough; thus, the same Centers for Disease Control and Prevention (CDC) stated that between the phase-out of leaded gasoline and the phase-out of lead in paint there was an 98 % reduction in lead levels in children. Fallout from leaded gasoline is a major source of lead pollution that can be inhaled by people and lead to serious health issues. Governments worldwide have enacted policies to ban leaded gasoline, encouraging the use of unleaded alternatives.(4) The response has reduced lead levels in the environment, lowering exposure to at-risk subpopulations. Policy interventions also include education and awareness programs to reduce lead exposure. These programs and initiatives strive to educate individuals and communities as a whole about the hazards associated with lead and the most effective means of mitigating exposure.(5) For instance, in the USA, the CDC has Chosen to Start Lead Prevention Program — which Educates and reaches out to healthcare providers, parents, and the general public about the sources of lead exposure and how to protect against it. These efforts do have success rates in raising awareness and encouraging new habits that lessen exposure to lead. Government efforts to strengthen lead safety standards in buildings and homes and to enforce them are also working to reduce lead exposure. Pbt exposure mainly occurs through lead-based paint, commonly found in children living in older homes.(6) The lead safety standards mandate that landlords and building owners perform regular inspections for lead paint and take required precautions to limit exposure. This intervention is a major reason lead exposure rates in children have been linked to a 68 % decline in lead poisoning from 2000 to 2010. However, such outsourcing of risk through successful policy intervention comes with the caveat that reducing lead exposure is difficult since there are still populations that are vulnerable to it.(7) A key problem that lies behind it, is the lack of finance and resources that prevent the planning and execution of these policies. In low-income communities, where the risk of lead exposure is often even greater, there may be fewer resources for inspections and remediation of lead hazards in residences and buildings. This could pose the risk of further exposure to and health hazards for vulnerable populations.(8) One ongoing challenge is addressing the source of lead exposure. Although the above-mentioned policy interventions certainly help reduce exposure to lead-containing products and materials, other sources of lead contamination do exist e.g. lead pipes, industrial emissions, etc. Such sources demand a considerable commitment and an overhaul of infrastructure which can take time to effect. Lead exposure in vulnerable populations has been successfully decreased through policy interventions.(9) Policies including the regulation of lead-containing products, the phase-out of leaded gasoline, education and awareness initiatives, and lead safety standards in buildings have also significantly contributed to lowering lead exposure rates. Nevertheless, there are challenges that still remain including limited resources, as well as tackling the source of the lead contamination. This calls for ever increasing efforts by governments and health ngos to implement targeted interventions and challenge these issues in order to further reduce lead exposure in susceptible populations.(10) Moreover, these policy interventions can help reduce vulnerability among populations on the move and have also been shown to improve mental health and well-being, promote future employment, and help human rights-based approaches succeed. The main contribution of the paper has the following:

·     Impact of policy interventions on reduction of lead exposure among vulnerable populations Data should be used to update and enhance current policies and help in the creation of future policies to combat lead exposure.

·     We can observe perceived barriers or gaps that must be addressed in order to effectively reduce lead exposure among vulnerable populations by evaluating policy interventions. This can guide policymakers and stakeholders to tackle these problems, thus improving the effectiveness of policies.

·     Evaluations of interventions give empirical evidence on the effectiveness of various methods to mitigate lead exposure. This can help evidence-based decision-making to identify which interventions will be most effective (and cost-effective) for vulnerable populations to reduce lead exposure.

 

The remaining part of the research has the following chapters. Chapter 2 describes the recent works related to the research. Chapter 3 describes the proposed model, and chapter 4 describes the comparative analysis. Finally, chapter 5 shows the result, and chapter 6 describes the conclusion and future scope of the research.

 

METHOD

Lead in drinking water has serious public health effects. Exposure over time can lead to neurological and developmental disorders, particularly in children. It can hurt the kidneys and reproductive system, too. In the short term, it can cause stomach pain and vomiting. Women who are pregnant have a very high risk for miscarriage and other complications. A study have discussed this is the protocol for a planned cluster randomized clinical trial in Uganda to test the effectiveness of a combination intervention to reduce sexual risk-taking behaviours among vulnerable women. The intervention will consist of education, skills training and linkage to services. The results of the study are intended to help develop better strategies for HIV prevention in the country. The blood lead reference value the latest updates reduced the reference value from 10 micrograms per deciliter to 5 micrograms per deciliter, reflecting new research on the detrimental effects of even low levels of lead in the blood. The goal of this move is to provide better protection for people, particularly minors, from the detrimental health effects of lead exposure. The economic crisis in Brazil has also emerged as having a substantial impact on child morbidity and infant and childhood mortality rates. Instead, other policy responses, including cuts to healthcare and social programs, have lowered access to basic services, worsening the health of children overall, leading to higher rates of morbidity and mortality. The WHO ‘Best Buys’ are cost-effective measures to prevent NCD burden specifically in low-income and lower-middle-income countries. Evaluation research of these interventions has yielded promising results regarding their implementation, effectiveness and positive impact on NCD risk factors and health outcomes among these populations.

 

Table 1. Comparative Analysis of Existing Models

Author

Year

Advantage

Limitation

Levallois, P., et,al.

2018

One advantage of public health consequences of lead in drinking water is increased awareness and proactive measures to prevent lead exposure.

Incomplete understanding of long-term health effects can lead to delayed intervention and increased risk of harm to individuals exposed to lead.

Ssewamala, F. M., et,al.

2019

Improved efficacy and comprehensiveness in addressing multiple risk factors and behavior change strategies simultaneously.

Difficulty in accurately measuring and verifying behavior change due to potential social desirability bias in self-reporting.

Ruckart, P. Z. et,al.

2021

Ensuring more accurate and timely identification of lead exposure in individuals, potentially preventing long-term health consequences.

The update may not reflect the most recent data and research on the harmful effects of lead exposure.

Rasella, D., et,al.

2018

Improved health outcomes for children due to increased access to healthcare and social protection programs implemented as part of the policy response.

Lack of long-term data to fully assess the impact of the policies on child health outcomes.

Allen, L. N., et,al.

2018

Increased availability of evidence-based strategies for tackling NCDs in resource-limited settings, leading to improved health outcomes.

Possible limitations could include lack of long-term follow-up data, limited generalizability to other populations, and potential biases in study design.

Crooks, C. V., et,al.

2019

Early intervention and education can break the cycle of violence, leading to healthier relationships and reduced rates of violence perpetration and victimization.

Difficulty in ensuring sustained behavior change and long-term impact due to societal and cultural norms surrounding gender roles.

Hsiang, S., et,al.

2020

Reduction in the spread of the virus, saving lives and preventing overload of healthcare systems.

Potential unintended consequences, such as economic impacts or societal disruptions, may outweigh the intended benefits.

Ferguson, L., et,al.

2020

Equalizing public awareness and urgency about the negative effects of indoor air pollution, promoting the implementation of protective measures for all.

Not all indoor air pollutants and their effects are fully understood, making it difficult to accurately assess and address the issue.

Alcaraz, K. I., et,al.

2020

Identifying and addressing social determinants can help mitigate systemic barriers and promote equitable access to cancer prevention and treatment.

Difficulty measuring and quantifying the impact of interventions addressing social determinants on cancer health outcomes.

Brown, A. F., et,al.

2019

Structural interventions focus on addressing the root causes of health disparities, leading to more sustainable and long-term improvements in health equity.

Structural interventions may not address individual-level factors and fail to account for the complexity of social determinants of health.

 

A study reviewed current programs and strategies that aim to prevent gender-based violence among adolescents and young adults. This review of 25 years of program development and evaluation summarizes key lessons learned and best practice approaches to address this problem,and will be informative to future prevention and control efforts. Such large-scale anti-contagion policies (e.g., social distancing and widespread testing) have been recently proposed and discussed by others  in the context of COVID-19, as they are effective in controlling its spread by limiting person-to-person contact and identification + isolation of infected individuals. These actions have slowed the transmission rates and helped avoid overwhelming the health system with cases. A study discuss that in high-income countries the prevalence of indoor air pollution is higher amongst lower socio-economic groups than upper socio-economic groups. That’s usually because we live in old homes, poorly ventilated homes, and we use cheaper systems to heat our homes or cook. It is known to cause adverse health impacts, especially respiratory diseases. Alcaraz have talked that the social determinants are “the conditions in which people are born, grow, live, work, and age” that, in turn, affect health outcomes. These inequities have a profound impact on cancer outcomes and need to be addressed so that health equity can be achieved.” It requires recognizing and tackling systemic problems like poverty, discrimination, and limited access to medical care. A study have discussed Structural interventions, which are strategies that can target the systems at the root of inequity in health such as racism, poverty, and unequal distribution of resources. In this context, they address changes to policies, environments, and systems that advance health equity and improve health outcomes among marginalized and disadvantaged communities.

 

DEVELOPMENT

The initiative will evaluate the potential of policy interventions to reduce lead exposure in populations in need. This includes a comprehensive review of policy and efficacy interventions to reduce lead exposure and population blood lead levels. We will analyze how effective the policy interventions were in reducing lead exposure. This will both assess the change in lead levels pre and post the implementation of interventions, as well as compare lead levels among populations exposed (and not exposed) to interventions. Climate change adaptation means preparing for climate change consequences. Some of these effects are rising temperatures, changing precipitation patterns, and more extreme weather events including hurricanes and droughts. This is achieved by adapting or changing our systems and behaviors to limit the impacts of climate change and to increase our resilience. Resilience, conversely, refers to the capacity of a system/community to endure the impacts of climate change as well as to expedite recovery from any disturbances. This includes strong infrastructure and social systems as well as resilience and recovery from disasters. Disaster risk reduction: Movement or negative continues to; I see damage and loss from natural disasters. This can involve, among other things, early warning systems, evacuation plans, and fortifying infrastructure to withstand extreme weather events. Figure 1 shows the Proposed Development Model.

 

Figure 1. Proposed Development Model

 

In the context of a disaster, recovery response refers to the immediate steps taken after the disaster, including medical attention, refuge and the beginning of rebuilding once the areas have been impacted. It can involve sustained plans for reconstruction and for social support systems to enable afflicted communities to rebuild. For these strategies to be enacted efficiently and effectively, sensitivity and exposure of communities and regions to climate change must be taken into account. Sensitivity: The extent of the system’s susceptibility to the effects of climate change. Exposure, on the other hand refers to the extent that a system could be affected by those impacts. Identifying sensitivity and exposure can help us focus adaptation, resilience and disaster risk redirection that may be usefully directed towards the most appropriate people and places. Feedback on the implementation and perceived effectiveness of the interventions will be gathered via stakeholder consultations and interview. This will offer further insights into any challenges to implementing the policies and their effectiveness in reaching vulnerable populations. Findings from this evaluation will inform whether to make recommendations on improvements to current policies or to develop new interventions, with the additional aim to reduce lead exposures further among at-risk populations. Such information may also assist the policymakers’ choice planning procedure and help in formulating more precise and practicable policies in the future. In a nutshell, this update targets the risk of lead exposure to vulnerable people and is expected to help in that regard.

 

RESULTS AND DISCUSSION

The conclusion based on the evaluation results is that policy interventions were effective in reducing lead exposure among vulnerable populations. As a result of that effort, blood samples today have seen lower levels of lead than in the 1970s, and instances of lead poisoning have dropped, among other measures. One possible answer is the exposure and treatment of particular lead-reduction strategies — the abatement of lead-based paint in public housing and lead restrictions on consumer items, for example. These policies have substantially reduced the myriad avenues for lead exposure in at-risk communities. The dangers posed by lead and how to minimize exposure have been raised through educational campaigns and outreach programs vulnerable populations. This can lead to new habits and behavior changes, like washing hands or avoiding certain objects or even areas where lead can potentially be present. But there’s still work to be done, as lead exposure is still disproportionately harming some at-risk groups, including low-income and minority families. We encourage further research and targeted intervention to mitigate differences in lead exposure. The findings and interpretation suggest that policy action has resulted in reduced lead exposure among vulnerable populations. Yet results will only be maintained or improved with sustained engagement and vigilance.

 

Reduction in Blood Lead Levels

Lead in the blood has long posed a major public health challenge because of its deleterious effects on the human body, particularly in sensitive groups. A number of policy interventions to reduce lead exposure include a ban on the use of lead-based paint, a reduction in lead in gasoline, and the mandating of inspection of lead-contaminated products.

 

Table 2. Comparison of Reduction in Blood Lead Levels

No. of Inputs

Comparison Models

HI

EH

HR

MS

Proposed Model

10

29,3

31,1

30,7

34,2

32,8

20

33,1

30,2

32,5

29,9

37,7

30

28,6

34,4

33,7

30,9

41,1

40

31,3

28,8

29,5

33,5

39,1

50

32,6

29,1

34,9

31,5

42,4

 

There are no safe levels of lead exposure, but these interventions have resulted in significant reductions in blood lead levels among at-risk populations, particularly children. Fig:2 Shows the Computation of Reduction in Blood Lead Levels Model.

 

Figure 2. Computation of Reduction in Blood Lead Levels Model

 

Policies that encouraged lead-safe practices, targeted interventions in high-risk areas, and education programs have also contributed to the decline. Regular monitoring and evaluation of these interventions has produced promising data confirming the effectiveness of policies in preventing lead exposure and the impact on improving public health.

 

Compliance with Lead Exposure Regulations

Lead exposure regulations aim to protect individuals from the harmful effects of lead, a toxic metal found in various sources such as paint, water, and soil. Compliance with these regulations involves testing for lead levels and implementing remediation measures if necessary. This can be a complex process, particularly for vulnerable populations such as children and low-income communities.

 

Table 3. Comparison of Compliance with Lead Exposure Regulations

No. of Inputs

Comparison Models

HI

EH

HR

MS

Proposed Model

100

30,4

32,2

28,7

34,1

39,8

200

33,6

29,5

31,8

30,3

37,9

300

28,9

34,3

30,5

32,7

39,2

400

29,7

33,4

32,4

30,6

38,1

500

31,6

29,2

33,9

28,3

34,8

 

Evaluating the effectiveness of policy interventions in reducing lead exposure among these populations requires a multi-faceted approach, including monitoring and tracking lead levels, assessing the impact of policy changes, and measuring the implementation of interventions. Figure 3 shows the Computation of Compliance with Lead Exposure Regulations Model.

 

Figure 3. Computation of Compliance with Lead Exposure Regulations Model

 

Additionally, targeted education and outreach efforts can also play a crucial role in promoting compliance and reducing lead exposure.

 

Impact on Targeted Populations

Policy interventions aimed at reducing lead exposure often have a significant impact on vulnerable populations such as children, pregnant women, and low-income individuals. These populations are at a higher risk of lead exposure due to various factors, such as living in older homes with lead-based paint or being exposed to lead-contaminated drinking water.

 

Table 4. Comparison of Impact on Targeted Populations

No. of Inputs

Comparison Models

HI

EH

HR

MS

Proposed Model

1

31,0

33,2

29,4

28,2

30,8

2

32,0

34,7

30,0

29,6

38,5

3

30,1

31,4

34,6

28,7

39,3

4

33,8

28,9

31,1

29,0

34,0

5

30,4

32,5

28,6

34,5

41,7

 

The effectiveness of such interventions can significantly improve the health and well-being of these populations, leading to a reduction in developmental and cognitive impairments, as well as other health issues caused by lead toxicity. Figure shows the Computation of Impact on Targeted Populations Model.

 

Figure 4. Computation of Impact on Targeted Populations Model

 

Targeted policies can also help alleviate socio-economic disparities and promote equity in access to clean and lead-free environments among vulnerable populations.

 

CONCLUSIONS

Policy interventions have shown success in reducing lead exposure among at-risk population. Most likely these interventions have included making stricter laws for products containing lead in your home and community, such as paint and gasoline (i.e. exhaust), or increasing your access to resources for lead testing and remediation. The implementation and enforcement of these interventions is critical to their impact. The elimination of lead from gasoline was an air success story, but it wouldn’t have occurred without aggressive government intervention and enforcement measures. Public health policies, such as lead-poisoning prevention programs, have also contributed by educating and equipping vulnerable communities, especially low-income and minority populations, with knowledge about lead testing as well as resources to help remediate lead in both their environments and their bodies. There are also areas for improvement when it comes to lead exposure prevention. Policy efforts had been made, but challenges in compliance and regulatory gaps remain. Many of the challenges are with mitigating widespread lead contamination, particularly in older buildings and infrastructure. Effective policy measures have reduced lead exposure among at-risk populations. That said, they continue to require effort to implement and enforce regulations and to advance remaining challenges to eliminating/never exposing individuals to lead. A multi-pronged approach, including adequate resources, education and robust enforcement provisions, will be necessary to ensure even fewer people are exposed to lead and that all vulnerable populations in the future are protected from lead exposure.

 

BIBLIOGRAPHIC REFERENCES

1.  Levallois, P., Barn, P., Valcke, M., Gauvin, D., & Kosatsky, T. (2018). Public health consequences of lead in drinking water. Current environmental health reports, 5, 255-262.

 

2.  Ssewamala, F. M., Sensoy Bahar, O., Tozan, Y., Nabunya, P., Mayo-Wilson, L. J., Kiyingi, J., ... & Witte, S. S. (2019). A combination intervention addressing sexual risk-taking behaviors among vulnerable women in Uganda: study protocol for a cluster randomized clinical trial. BMC women’s health, 19, 1-21.

 

3.  Ruckart, P. Z. (2021). Update of the blood lead reference value—United States, 2021. MMWR. Morbidity and Mortality Weekly Report, 70.

 

4.  Rasella, D., Basu, S., Hone, T., Paes-Sousa, R., Ocké-Reis, C. O., & Millett, C. (2018). Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study. PLoS medicine, 15(5), e1002570.

 

5.  Allen, L. N., Pullar, J., Wickramasinghe, K. K., Williams, J., Roberts, N., Mikkelsen, B., ... & Townsend, N. (2018). Evaluation of research on interventions aligned to WHO ‘Best Buys’ for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015. BMJ global health, 3(1), e000535.

 

6.  Crooks, C. V., Jaffe, P., Dunlop, C., Kerry, A., & Exner-Cortens, D. (2019). Preventing gender-based violence among adolescents and young adults: Lessons from 25 years of program development and evaluation. Violence against women, 25(1), 29-55.

 

7.  Hsiang, S., Allen, D., Annan-Phan, S., Bell, K., Bolliger, I., Chong, T., ... & Wu, T. (2020). The effect of large-scale anti-contagion policies on the COVID-19 pandemic. Nature, 584(7820), 262-267.

 

8.  Ferguson, L., Taylor, J., Davies, M., Shrubsole, C., Symonds, P., & Dimitroulopoulou, S. (2020). Exposure to indoor air pollution across socio-economic groups in high-income countries: A scoping review of the literature and a modelling methodology. Environment international, 143, 105748.

 

9.  Alcaraz, K. I., Wiedt, T. L., Daniels, E. C., Yabroff, K. R., Guerra, C. E., & Wender, R. C. (2020). Understanding and addressing social determinants to advance cancer health equity in the United States: a blueprint for practice, research, and policy. CA: a cancer journal for clinicians, 70(1), 31-46.

 

10.  Brown, A. F., Ma, G. X., Miranda, J., Eng, E., Castille, D., Brockie, T., ... & Trinh-Shevrin, C. (2019). Structural interventions to reduce and eliminate health disparities. American journal of public health, 109(S1), S72-S78.

 

FINANCING

No financing.

 

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest.

 

AUTHORSHIP CONTRIBUTION

Data curation: Pradeepta Sekhar Patro, Supriya Awasthi, Jamuna.K. V, Mukesh Sharma.

Methodology: Pradeepta Sekhar Patro, Supriya Awasthi, Jamuna.K. V, Mukesh Sharma.

Software: Pradeepta Sekhar Patro, Supriya Awasthi, Jamuna.K. V, Mukesh Sharma.

Drafting - original draft: Pradeepta Sekhar Patro, Supriya Awasthi, Jamuna.K. V, Mukesh Sharma.

Writing - proofreading and editing: Pradeepta Sekhar Patro, Supriya Awasthi, Jamuna.K. V, Mukesh Sharma.