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Introduction:

There is a public health crisis, due to a lack of research that is produced from public health programs. Most public health research is done as a part of the national health program and as such does not stand alone as a research initiative. The focus of this paper is to determine the need for the research in the public health literature and to review what is currently available. The paper is divided into four major topics: public health research training in the United States; public health literature; public health research funding; and, challenges for the future.Public health researchers are interested in public health issues and have many methods at their disposal. Most of the methods are well known and are routinely used in the biomedical literature. Although many researchers are familiar with public health, they seldom work with public health topics. The methods they use and the results of such studies are often unrelated to the public health literature.

Background:

A study of Public Health Research Methods, in which the author will investigate and analyze the significance, benefits, and impact of social research on the present and future. The analysis will also study factors that influence research conduct and results and the significance of the research. Public health studies people's health and disease and the determinants of these states' health policies. Public health science is the application of scientific methods in public health practice. Public health is the organized, comprehensive effort that promotes, maintains, and improves people's health (Angeli et al. 2020). It is a shared responsibility in which a wide range of professionals work closely together to influence and change the health status of individuals, communities and populations. Public health also provides services that improve the community's health. "public health" does not imply providing services for only one group. "Public health" is a broad field, and it is recognised that it is insufficient to treat only communicable diseases. The term "public health" refers to: The practice and science of protecting health through organised society, as distinguished from medicine, which is the organised efforts to treat the sick (Assefa et al. 2022).

Key Literature:

  1. Bartley M. An Introduction to Concepts, Theories and Methods on Health Inequality Cambridge: Polity Press; 2017 - This landmark book presents a comprehensive examination of health inequalities. It offers a theoretical framework for understanding social determinants of health as well as the role social exclusion has in perpetuating disparate health outcomes.
  2. Marmot M. Social Determinants of Health Inequalities. Lancet 2005;365(9464):1099-1104 - Sir Michael Marmot's influential article explores the social determinants of health and inequality's effect on population health. It highlights social exclusion as an essential contributor to health disparities.
  3. Whitehead M. The Concepts and Principles of Equity and Health Promotion. Health Promot Int 1991;6(3):217.228 - This paper offers a conceptual framework for understanding health equity. It explores the interrelations among social factors, health behaviors and outcomes while emphasizing how important social exclusion can be in attaining equity in health outcomes.
  4. Solar, O. and Irwin, A. (2010). A Conceptual Framework for Action on Social Determinants of Health Discussion Paper 2 (Policies and Practice). Geneva: World Health Organization - This publication from the World Health Organization (WHO) provides a comprehensive conceptual framework for understanding and addressing social determinants of health. It highlights social exclusion's influence in creating health disparities and provides advice for policy interventions designed to promote wellness while decreasing disparities.
  5. Pega F, et al. Global, regional and national burdens of ischemic heart disease and stroke due to long working hours for 194 countries between 2000-2016: A systematic analysis using WHO/ILO Joint Estimates of Work-related Burden of Disease and Injury 2021-2025 2021 2021;154:106595 - This study investigates the link between long working hours and global prevalence rates of ischemic heart disease and stroke, as well as precarious employment conditions, social exclusion, and adverse health outcomes - all hallmarks of precarity that need to be addressed with greater urgency when it comes to public health policymaking.

Rationale for the Study:

Existing literature provides substantial evidence of an association between social exclusion and public health outcomes, but more research needs to be conducted on this relationship in order to deepen our understanding and develop effective strategies against health disparities. Therefore, conducting this study was necessary; its main goals included:

  1. Evidence Gap: While numerous studies have examined the social determinants of health, more evidence on social exclusion's effects on public health outcomes remains limited. This research endeavors to fill that void by conducting an in-depth literature review and highlighting areas requiring further exploration.
  2. Policy Implications: By exploring the link between social exclusion and public health, this study can inform the creation of evidence-based policies and interventions to address health disparities at their source, while contributing to designing targeted strategies designed to mitigate social exclusion and foster health equity.
  3. Health Equity: Recognizing how social exclusion impacts public health outcomes is crucial to realizing health equity. This research can reveal pathways between social exclusion and disparate health conditions, and guide efforts toward creating equitable opportunities for health.
  4. Intervention Development: By identifying specific populations and contexts where social exclusion has the most detrimental effects on public health, this study can assist in devising interventions designed to target and mitigate its adverse consequences on wellbeing.

This research paper seeks to investigate the link between public health and social exclusion by conducting a literature review, conducting further analysis, filling existing evidence gaps and emphasizing social determinant analysis as a means of creating policies and interventions which promote health equity while decreasing disparities in health.

Research Questions:

  1. How does social exclusion contribute to health disparities and inequities across populations and contexts?
  2. What are the pathways through which social exclusion impacts public health outcomes?
  3. What are the key social determinants that contribute to social exclusion and its adverse impact on public health?
  4. How can interventions and policies address social exclusion to achieve improved public health outcomes and advance health equity?
  5. What are the potential synergies and trade-offs associated with addressing social exclusion as one of several determinants of health in order to decrease health disparities?
  6. What are the long-term ramifications of social exclusion on public health, in terms of both physical and mental wellbeing outcomes? How do social and structural factors interact with social exclusion to influence public health outcomes?
  7. What are the effective strategies and best practices used by different regions or countries to combat social exclusion and improve public health outcomes?
  8. How can public health research, policies, and interventions better incorporate a social justice lens in order to combat exclusion and promote health equity?

Aim:

To explore the complex relationship between public health and social exclusion, exploring mechanisms, impacts, interventions and challenges related to social exclusion and health disparities.

Objectives:

  1. To analyze the current status of public health service and the challenges faced by those delivering the service
  2. To look at the current structure of public health services and delivery in Kenya.
  3. To look at and analyze the key concepts of public health with emphasis on Public health policy formulation.
  4. To analyze the role of public health services in the promotion of good health.

Methodology

Research Design or Approach:

This approach involves integrating qualitative and quantitative research methods to understand the topic comprehensively. The primary form of inquiry will be qualitative research, which allows for developing a comprehensive understanding of a complex issue. Secondary research includes a review of previous public health literature and an analysis of primary data. The combination of both forms of research will help to uncover key trends and patterns in the public health literature which in turn will help the researcher construct the data and draw conclusions based on those trends. Quantitative research such as literature reviews, surveys and surveys will be utilized to detect trends and patterns discovered through qualitative research (Angeli et al. 2020). This form of investigation allows researchers to quickly search through literature for trends or identify patterns among publications to better determine common themes or relationships among findings. Furthermore, quantitative research will allow comparison between current public health research in Kenya with international public health research on public health.

Inclusion and Exclusion Criteria:

This study aims to explore the relationship between social exclusion and public health outcomes, as well as public health service delivery and public health systems in Kenya. Therefore, the following inclusion and exclusion criteria will be followed:

Inclusion Criteria:

  1. All types of studies including experimental, observational and qualitative studies which are relevant to the research question.
  2. Publications in English and all other related publications
  3. Review articles, book chapters, theses, and unpublished data.

Exclusion Criteria:

  1. Meta-analyses, literature reviews, and studies on individuals who do not live in Kenya.
  2. Publications which are published before 2000 and those published in languages other than English.
  3. Published articles which do not meet the inclusion and exclusion criteria.

Search Strategy:

This research will utilize keyword and database searching. The databases used will be:

  1. Pubmed
  2. EMBASE
  3. CAB Direct
  4. Medline
  5. Scopus
  6. Google Scholar

All selected articles will be imported into the reference manager and organized based on the inclusion and exclusion criteria, into folders on the computer. The review will search for articles in peer-reviewed journals with a focus on those dealing with social exclusion and its impacts on public health outcomes, as well as social services and systems within Kenya. Articles on these topics will be carefully reviewed, to narrow down the scope of the literature and the list of relevant studies will be reduced to the main focus of this research. The review will be focused on the health outcomes of poverty and unemployment, the economic and social reasons behind poverty and unemployment, and the policy implications of dealing with these issues as social determinants of health.

Screening:

To begin the screening process, an initial search of 1,000 studies will be screened; 50 will then be chosen as candidates. A second round will involve screening 50 more studies using inclusion/exclusion criteria to select original studies only and will take place every 20 studies at a time until all 100 have been eliminated utilizing Boolean and proximity operators to narrow it down further. Articles selected will be further scrutinized, with final selection comprising of those articles having the most scientific validity and utility. An Endnote reference manager will be employed for selection and exclusion purposes.

Data Extraction:

Manual Data Extraction and Content Analysis will be carried out, along with manual Content Analysis of selected papers by our research team. Using this analysis to generate codes, categories, themes and conceptual frameworks that depict links between social exclusion and public health outcomes in Kenya; social services systems in Kenya and health outcomes analysis using literature from this review as the source material to create this framework and assess how social services contribute to health outcomes; also including an examination of whether reform or improvement of services might help. According to Armstrong and Rosbrook-Thompson, 2023, an extraction method will be implemented that involves recording data by coding each paper, inspecting each one closely, recording key codes and themes, as well as noting any significant findings. This data extraction technique will create a framework to interpret findings of analysis presented to other researchers, policy-makers, or researchers for interpretation or presentation purposes. Initial codes may then be reanalyzed manually so as to ensure validity and robustness of the framework while manual data analysis gives researchers the chance to explore data in its context.

Quality Appraisal:

To assess the quality of selected papers, this study will utilize McMaster University and National Heart, Lung and Blood Institute's Quality Assessment Tool for Quantitative Studies as a reliable and valid means to determine methodological quality in studies on social determinants of health. Papers that satisfy at least seven of this tool's methodological quality elements will be included while those which do not conform with any criteria will be excluded from participation. The Quality Appraisal of Systematic Reviews tool was created to assist in critical appraisal of systematic reviews and other evidence syntheses (Bates et al. 2020). It features eleven critical appraisal criteria and a two-step approach which aim to increase validity and consistency. This tool was created by Cochrane Group for their Effective Practice and Organization of Care Group.

Ethical Considerations:

This research endeavors to explore a public health issue which could have an adverse impact on an individual's health and outcomes. To protect the rights of all participants involved, this research study's protocol will ensure they will be safe from harm, as well as complying with all pertinent protocols and regulatory requirements. At all stages, all participants will be informed about the study requirements and risks, their right to opt out, confidentiality, informed consent, and autonomy. Participants in our study are guaranteed their right to privacy, confidentiality, and to withdraw at any time without incurring penalties or incurring losses as a result. The authors recognize and are prepared to address any potential issues resulting from research involving human participants, with review by both principal investigator, research ethics board, and any applicable ethical bodies. Furthermore, research teams are expected to follow ethical guidelines developed specifically for this type of investigation.

Analysis:

Qualitative studies will be analyzed using the constant comparative method, with its aim being to create a substantial theory that can explain relationships among variables (McCall et al. 2019). Following our literature review and research question analysis, results will be synthesized into a conceptual framework which describes social exclusion's effects on health - this conceptual framework includes both macro level interventions as well as micro level strategies; providing us with guidance for research or policy actions taken later. As part of this research project we will use this conceptual framework as our starting point when conducting analyses, syntheses, or interpretations on findings related to this research project.

Discussion and Conclusion:

The results of this review will have significant ramifications on several key aspects relating to public health and social exclusion, providing invaluable information for designing interventions and implementing public health policies. However, this review could uncover no link between social exclusion and health outcomes, or could find no significant correlations at all. Literature reviews serve not only to assess the connection between social exclusion and health outcomes, but also to highlight any gaps and establish potential avenues of future research that might fill these voids. They could also reveal any links or pathways which already exist but are poorly understood, providing additional areas of inquiry that could help conduct further studies and fill in these voids.

Limitations:

This study's limitations include its limited focus on grey literature and peer-reviewed documents published only in English, making it more difficult than usual to locate relevant research. There may also be difficulties finding relevant literature across many reviews of social determinants of health literature. Including peer-reviewed articles only covers articles available within the public domain without covering private documents while its exclusion may limit search and limit research relevant for understanding this topic. It will be published with relevant bodies upon completion.

Dissemination and Impact:

This research will have an immense effect on social services, public health and social policy. This review will offer a critical evaluation of existing literature regarding public health and social exclusion, further increasing knowledge in this field. Furthermore, its results will serve as guidance for further studies on this subject matter. This review can serve to guide future researchers when trying to answer such questions, while its results can also inform policymakers and public health leaders regarding what knowledge exists as well as gaps that need filling. An important part of this study will involve disseminating its findings through publications and presentations at conferences, national, and international gatherings; results will then be made available to stakeholders and relevant research groups. This research will aid in identifying the relationship between social exclusion and health outcomes and inform policy decisions to promote population wellness. Furthermore, its results may identify any gaps that need filling to provide comprehensive healthcare to people experiencing various forms of social exclusion issues.

Future Research:

Since this study primarily relies on literature reviews, additional opportunities exist for additional research to be conducted. Studies are needed on the relationship between social exclusion and health outcomes as well as the impact of social services on health outcomes; further investigations could include investigating social capital, support systems or extended family support mechanisms as potential areas of investigation; the current research does not explore their roles as providers or how best to support social services/welfare policy initiatives.

Final Thoughts:

This research study will bolster evidence in the field of public health and social determinants of health, helping answer questions regarding the relationship between social exclusion and health outcomes and this review providing a framework to discuss it further. Likewise, this research seeks to shed more light on how social services contribute to health outcomes as well as providing more insight into ways they could be reformed to better improve them for patients.

References

Angeli, F., Camporesi, S. and Dal Fabbro, G., 2021. The COVID-19 wicked problem in public health ethics: conflicting evidence, or incommensurable values?. Humanities and Social Sciences Communications, 8(1).

Armstrong, G. and Rosbrook-Thompson, J., 2023. Interrogating the Public Health Approach: Lessons from the Field of Urban Violence. In The Legitimacy of Healthcare and Public Health: Anthropological Perspectives (pp. 263-283). Cham: Springer International Publishing.

Assefa, Y., Gilks, C. F., Reid, S., van de Pas, R., Gete, D. G., and Van Damme, W. (2022). Analysis of the COVID-19 pandemic: lessons towards a more effective response to public health emergencies. Globalization and Health, 18(1), 10.

Bates, S., Reeve, B., & Trevena, H. (2020). A narrative review of online food delivery in Australia: Challenges and opportunities for public health nutrition policy. Public Health Nutrition, 1-11.

Bradby, H., Hamed, S., Thapar-Björkert, S. and Ahlberg, B.M., 2023. Designing an education intervention for understanding racism in healthcare in Sweden: development and implementation of anti-racist strategies through shared knowledge production and evaluation. Scandinavian Journal of Public Health, 51(4), pp.531-534.

Briand, S.C., Cinelli, M., Nguyen, T., Lewis, R., Prybylski, D., Valensise, C.M., Colizza, V., Tozzi, A.E., Campbell, L. A., Harmon, M. J., Joyce, B. L., & Little, S. H. (2020). Quad Council Coalition community/public health nursing competencies: Building consensus through collaboration. Public Health Nursing, 37(1), 96-112.

Hanckel, B., Ruta, D., Scott, G., Peacock, J.L. and Green, J., 2019. The Daily Mile as a public health intervention: a rapid ethnographic assessment of uptake and implementation in South London, UK. BMC Public Health, 19(1), pp.1-14.

Health, T. L. P. (2020). Education: a neglected social determinant of health. The Lancet. Public Health, 5(7), e361.

Lonne, B., Scott, D., Higgins, D. and Herrenkohl, T.I. eds., 2019. Re-visioning public health approaches for protecting children (Vol. 9). Cham: Springer International Publishing.

McCall, B., Shallcross, L., Wilson, M., Fuller, C., and Hayward, A. (2019). Storytelling as a research tool and intervention around public health perceptions and behaviour: a protocol for a systematic narrative review. BMJ open, 9(12), e030597.

Nazir, M., Hussain, I., Tian, J., Akram, S., Mangenda Tshiaba, S., Mushtaq, S., & Shad, M. A. (2020). A multidimensional model of public health approaches against COVID-19. International journal of environmental research and public health, 17(11), 3780.

Pye, A., Roberts, S.R., Blennerhassett, A., Iqbal, H., Beenstock, J. and Iqbal, Z., 2023. A public health approach to estimating the need for long COVID services. Journal of Public Health, 45(1), pp.169-175.

Perra, N., Baronchelli, A. and Tizzoni, M., 2021. Infodemics: A new challenge for public health. Cell, 184(25), pp.6010-6014.

Rahaman, M.R., Milazzo, A., Marshall, H. and Bi, P., 2019. Is a one health approach utilized for Q fever control? A comprehensive literature review. International journal of environmental research and public health, 16(5), p.730.

Rollins, N., Minckas, N., Jehan, F., Lodha, R., Raiten, D., Thorne, C., Van de Perre, P., Ververs, M., Walker, N., Bahl, R. and Victora, C.G., 2021. A public health approach for deciding policy on infant feeding and mother–infant contact in the context of COVID-19. The Lancet Global Health, 9(4), pp.e552-e557.

Ros, M., and Neuwirth, L. S. (2020). Increasing global awareness of timely COVID-19 healthcare guidelines through FPV training tutorials: Portable public health crises teaching method. Nurse education today, 91, 104479.

Schendel, D., Roux, A.M., McGhee Hassrick, E., Lyall, K., Shea, L., Vivanti, G., Wieckowski, A.T., Newschaffer, C. and Robins, D.L., 2022. Applying a public health approach to autism research: A framework for action. Autism Research, 15(4), pp.592-601.

Sharma, M. and Branscum, P.W., 2020. Introduction to community and public health. John Wiley & Sons.

Osterhaus, A.D., Vanlangendonck, C., Barbeschi, M., Bruschke, C.J., Christensen, R., Daszak, P., de Groot, F., Doherty, P., Drury, P., Gmacz, S. and Hamilton, K., 2020. Make science evolve into a One Health approach to improve health and security: a white paper. One Health Outlook, 2(1), pp.1-32.

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