INTRODUCTION: The projected growth of Alzheimer's disease (AD) and AD-related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD. METHODS: In this review, we employ Bronfenbrenner's ecological systems theory as a framework to posit how S/SDOH impact AD/ADRD risk and outcomes. RESULTS: Bronfenbrenner defined the "macrosystem" as the realm of power (structural) systems that drive S/SDOH and that are the root cause of health disparities. These root causes have been discussed little to date in relation to AD/ADRD, and thus, macrosystem influences, such as racism, classism, sexism, and homophobia, are the emphasis in this paper. DISCUSSION: Under Bronfenbrenner's macrosystem framework, we highlight key quantitative and qualitative studies linking S/SDOH with AD/ADRD, identify scientific gaps in the literature, and propose guidance for future research. HIGHLIGHTS: Ecological systems theory links structural/social determinants to AD/ADRD. Structural/social determinants accrue and interact over the life course to impact AD/ADRD. Macrosystem is made up of societal norms, beliefs, values, and practices (e.g., laws). Most macro-level determinants have been understudied in the AD/ADRD literature.

• Klíčová slova
• ADRD, Alzheimer's disease, Ecological Systems Theory, classism, dementia, genderism, macrosystem, racism, sexism, social determinants of health, structural determinants,
• MeSH
• Alzheimerova nemoc * MeSH
• demence * MeSH
• lidé MeSH
• sociální determinanty zdraví MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Research Support, N.I.H., Extramural MeSH

Roma represent one of the largest ethnic groups facing marginalization worldwide. However, significant knowledge gaps persist regarding: A) the social mechanisms supporting health-endangering practices among Roma; B) the social mechanisms adversely affecting their use of health services; and C) the social determinants underlying both above pathways. To fill these gaps, we conducted a series of four explorative ethnographic studies spanning over ten years. Beginning in 2004, the series involved 260 participants, including segregated Roma and health services staff in Slovakia. Of the four studies, two addressed gap A, two addressed gap B, and all addressed gap C. Regarding pathway A, we found that Roma in segregated Roma enclaves can be socialized into ethnically framed racialized ideologies that oppose the cultural standards of local non-Roma life, including certain healthy practices. This adherence to counter-cultural ideals of Roma identity increases specific health and care challenges. Regarding pathway B, we discovered that health service frontliners frequently lack any organizational support to better understand and accommodate the current living conditions and practices of segregated Roma, as well as their own and others' racism and professional expectations regarding equity. This lack of support leads many frontliners to become cynical about segregated Roma over their careers, resulting in health services being less effective and exacerbating health problems for both Roma and the frontliners themselves. Concerning pathway C, we found that the societal omnipresence of antigypsyism - racist and racialized anti-Roma ideas and sentiments - serves as a prominent driver of both the above pathways. We conclude that much of the unfavorable health status of Roma can be understood via a systems perspective that embraces structural racism.

• Klíčová slova
• Discrimination, Ethnic health inequalities, Healthcare, Marginalized Roma, Racism, Slovakia, Social determinants of health,
• MeSH
• dospělí MeSH
• kulturní antropologie * metody   MeSH
• lidé MeSH
• rasismus psychologie   MeSH
• Romové * psychologie   statistika a číselné údaje   MeSH
• sociální determinanty zdraví etnologie   MeSH
• sociální marginalizace psychologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovenská republika MeSH

We tested a social cognitive model of physical activity (PA) in the cultural context of the Czech Republic, a postcommunist central European country. In total, 546 older Czech adults (mean age = 68 years, data collected in 2013) completed a battery of questionnaires assessing indicators of PA and related social cognitive constructs, including self-efficacy, social support, and self-regulation strategies. Subsequently, a structural equation model was used to test the relationship between the social cognitive constructs and PA. Our analyses indicated an acceptable fit of the proposed model (CFI = .911; SRMR = .046; RMSEA = .073). Self-regulation was predicted by self-efficacy (β = .67) and social support (β = .23), which predicted PA (β = .45). The model explained 60.4% of the variance in PA self-regulation and 20.5% of the variance in PA participation. The results provide further evidence for the role of self-efficacy and social support in enabling PA in older adults, and suggest that this relationship is partially mediated by self-regulation.

• Klíčová slova
• older adults, physical activity, self-efficacy, self-regulation, social cognitive, social support, structural equation modeling,
• MeSH
• cvičení psychologie   MeSH
• geriatrické hodnocení MeSH
• kognice fyziologie   MeSH
• lidé MeSH
• sebeuplatnění MeSH
• senioři MeSH
• sociální determinanty zdraví * MeSH
• sociální opora MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

In Central and Eastern Europe (CEE), health-mediation programs (HMPs) have become central policy instruments targeting health inequities between segregated Roma and general populations. Social determinants of health (SDH) represent the root causes behind health inequities. We therefore evaluated how an HMP based in Slovakia addressed known SDH in its agenda and its everyday implementation. To produce descriptive data on the HMP's agenda and everyday implementation we observed and consulted 70 program participants across organizational levels and 30 program recipients over the long-term. We used a World Health Organization framework on SDH to direct data acquisition and consequent data content analysis, to structure the reporting of results, and to evaluate the program's merits. In its agenda, the HMP did not address most known SDH, except for healthcare access and health-related behaviours. In the HMP's everyday implementation, healthcare access facilitation activities were well received, performed as set out and effective. The opposite was true for most educational activities targeting health-related behaviours. The HMP fieldworkers were proactive and sometimes effective at addressing most other SDH domains beyond the HMP agenda, especially material conditions and psychosocial factors, but also selected local structural aspects. The HMP leaders supported such deliberate engagement only informally, considering the program inappropriate by definition and too unstable institutionally to handle such extensions. Reports indicate that the situation in other CEE HMPs is similar. To increase the HMPs' impact on SDH, their theories and procedures should be adapted according to the programs' more promising actual practice regarding SDH.

• Klíčová slova
• Roma, Slovakia, community health, ethnicity, health inequities, policy evaluation, qualitative research, social determinants,
• MeSH
• lidé MeSH
• longitudinální studie MeSH
• podpora zdraví statistika a číselné údaje   MeSH
• programy národního zdraví statistika a číselné údaje   MeSH
• Romové * MeSH
• sociální determinanty zdraví etnologie   MeSH
• zdravotní stav * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovenská republika MeSH

OBJECTIVES: Determinants of health in Central and Eastern Europe (CEE) have been discussed primarily in relation to the transition of the 1990's and early 2000's, citing lifestyles as the main culprit. This paper tries to draw a bigger picture of the health determinants in CEE in the first decade of the 21st century. To do so, the two main analytical approaches to health are united in one setting. One of them is based on the definition of health as a personal commodity relying mostly on micro-level subjective data. The other views health as a public commodity analysing objective societal characteristics and health care interventions with often a macro-level perspective. The current study incorporates these different approaches (subjective and objective) in a multi-level setting in CEE. METHODS: The analysis concentrates on health care, social, political, and economic factors as determinants of self-rated health. Multilevel analysis is carried out on a dataset of Life in Transition Survey (LiTS), conducted in 2006 and 2010, pooled cross-sectional data on 46,546 individuals in 27 CEE states. They are accompanied by macro-level data. RESULTS: The findings demonstrate that a complex mix of determinants influences subjective health in CEE. There are clear differences in the way objective and subjective indicators influence self-rated health. While societal economic prosperity does not influence health, there are strong country-specific differences in the effect of individual prosperity on health. CONCLUSIONS: The study adds to the recent literature on health in CEE by introducing an encompassing systematic approach to analysing health, as no leading cause for self-rated health variation was found. This paper also contributes to research on the determinants of health by fusing objective and subjective determinants in a hierarchical setting. Both subjective and objective determinants matter for health.

• Klíčová slova
• Central and Eastern Europe, Life in Transition survey, determinants of health, multilevel analysis, subjective health,
• MeSH
• lidé MeSH
• poskytování zdravotní péče * MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• sociální determinanty zdraví * MeSH
• socioekonomické faktory MeSH
• víceúrovňová analýza MeSH
• zdravotní stav * MeSH
• zpráva o sobě MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH
• východní Evropa MeSH

An estimated 56% of households in rural India defecated in the open in 2015, making India the most significant contributor to the global sanitation burden. This cross-sectional study uses data collected in 2016 from 499 households in rural Jharkhand to understand the constraints of latrine adoption and drivers of sanitation preferences (plans to adopt toilets and willingness to pay for toilets). Focusing on a region with a large tribal population, the study examines two types of predictors, namely structural factors (objective socioeconomic, sociocultural and ecological characteristics) and psychosocial drivers (perceived unaffordability of toilet, hygiene and sanitation knowledge, perceived health risks, attitudes, both descriptive and injunctive social norms, and perceived water stress). We find that structural constraints related to educational, economic and sociocultural inequalities predict toilet ownership. Low sanitation rates can neither be attributed to a lack of expressed demand nor lack of recognition of the disadvantages of open defecation. Similarly, variations in sanitation preferences are neither explained by differences in hygiene and sanitation knowledge nor by understandings of sanitation health risks. We find that perceived unaffordability, attitudes (perceived benefits of toilet and disadvantages of OD) and perceived descriptive social norms are of key importance. This implies a potential for persuasive strategies that manipulate social norms around sanitation, particularly if they simultaneously address perceptions around financial unaffordability of toilets and around the benefits of toilets. Importantly, however, attempts to change sanitation preferences by acting on forces of social (dis)approval (i.e. through perceived injunctive social norms) may be ineffective and generate negative unintended consequences.

• Klíčová slova
• Environmental health, India, Sanitation, Social norms, Toilets,
• MeSH
• lidé MeSH
• průřezové studie MeSH
• sanitace * MeSH
• toalety MeSH
• venkovské obyvatelstvo * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Indie MeSH

OBJECTIVES: Demographic differentiation caused by the history of migration in the Czech and Slovak Republics led the authors of this article to analyse generational differences in the groups of foreigners living in the Czech Republic (CR) and the impact of generational differences on selected aspects of their social situation and perceived health. The crucial research question was whether and to what degree do different generations of foreigners vary from each other and what impact this has had on their social situation and health determinants. METHODS: The main goal was to examine mutual relationships between selected characteristics of social situation and health determinants in various groups of foreigners living in the CR. A total of 1,003 questionnaires among foreigners officially living in the Czech Republic were collected and analysed. In the area of subjective perception of health, a comparison of foreigners with Czech citizens (representative sample of Czech seniors; 1,172 respondents) in the age category 65+ was made in order to find out whether this perception differs between senior foreign nationals and senior Czechs. RESULTS: Older individuals (50-64 years and 65+ years) appeared to have the best integration into Czech society. This age generation felt positive about stay and migration status in the CR. Older foreigners differ from older Czech citizens who tend to refer to their health as very good to rather good compared to foreigners who described their health as neither good nor bad. The middle generation (30-49 years) of foreigners was characterized by hard work and the initial stages of integration into Czech society. This group also reported positive feelings about living in the CR relative to their home country. CONCLUSION: The oldest generation of foreigners is the best integrated in the Czech Republic (with regard to selected aspects tested in this article). This generation is able to offer new immigrant effective integration strategies. However, they assess their subjective health one degree worse in comparison with Czech seniors (representative sample), this finding should lead to the setting of preventive programmes related to a healthy lifestyle, including lifestyle for foreigners living in the Czech Republic.

• Klíčová slova
• Czech Republic, foreigners, generational gaps, health status, social determinants of health,
• MeSH
• emigranti a imigranti * MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• zdravotní stav MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Slovenská republika MeSH

In contrast to the decreasing burden related to cardiovascular disease (CVD), the burden related to dysglycemia and adiposity complications is increasing in Czechia, and local drivers must be identified. A comprehensive literature review was performed to evaluate biological, behavioral, and environmental drivers of dysglycemia and abnormal adiposity in Czechia. Additionally, the structure of the Czech healthcare system was described. The prevalence of obesity in men and diabetes in both sexes has been increasing over the past 30 years. Possible reasons include the Eastern European eating pattern, high prevalence of physical inactivity and health illiteracy, education, and income-related health inequalities. Despite the advanced healthcare system based on the compulsory insurance model with free-for-service healthcare and a wide range of health-promoting initiatives, more effective strategies to tackle the adiposity/dysglycemia are needed. In conclusion, the disease burden related to dysglycemia and adiposity in Czechia remains high but is not translated into greater CVD. This discordant relationship likely depends more on other factors, such as improvements in dyslipidemia and hypertension control. A reconceptualization of abnormal adiposity and dysglycemia into a more actionable cardiometabolic-based chronic disease model is needed to improve the approach to these conditions. This review can serve as a platform to investigate causal mechanisms and secure effective management of cardiometabolic-based chronic disease.

• Klíčová slova
• adiposity, cardiometabolic risk, cardiovascular disease, chronic disease, dysglycemia, insulin resistance, nutrition, obesity, type 2 diabetes,
• MeSH
• adipozita etnologie   MeSH
• běloši statistika a číselné údaje   MeSH
• chronická nemoc epidemiologie   etnologie   MeSH
• diabetes mellitus 2. typu epidemiologie   etnologie   MeSH
• dieta škodlivé účinky   etnologie   MeSH
• disparity zdravotního stavu MeSH
• dospělí MeSH
• dyslipidemie epidemiologie   etnologie   MeSH
• hypertenze epidemiologie   etnologie   MeSH
• kardiometabolické riziko MeSH
• kardiovaskulární nemoci epidemiologie   etiologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metabolický syndrom epidemiologie   etnologie   MeSH
• obezita epidemiologie   etnologie   MeSH
• porucha glukózové tolerance epidemiologie   etnologie   MeSH
• prediabetes epidemiologie   etnologie   MeSH
• prevalence MeSH
• sedavý životní styl etnologie   MeSH
• sociální determinanty zdraví etnologie   MeSH
• stravovací zvyklosti etnologie   MeSH
• zdravotní gramotnost MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

It is generally recognized, that the delivery of healthcare to homeless population presents a number of specific challenges. In this paper, we try to assess the impact of the homeless people experience with the institutional framework including the access to health services on the health status of the homeless population in the Czech Republic. Multivariate regression is used to evaluate the impact of various dimensions of life experience and other social and economic characteristics of homeless people on their health status. Preliminary results indicate that the experience homeless people have with the institutional framework and their access to health care services are important determinants of their health status.

• MeSH
• disparity zdravotního stavu * MeSH
• dostupnost zdravotnických služeb organizace a řízení   MeSH
• kouření MeSH
• kvalita života MeSH
• lidé bez domova * MeSH
• lidé MeSH
• pití alkoholu MeSH
• sexuální faktory MeSH
• sociální opora MeSH
• socioekonomické faktory MeSH
• věkové faktory MeSH
• životní styl MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

Social determinants of health have been the focus of a three-year investigation by an eminent group of policy makers, academics, former heads of state, and former ministers of health. They comprise the World Health Organization's Commission on the Social Determinants of Health. The Commission presented its Final report: "Closing the gap in a generation - health equity through action on the social determinants of health", to the WHO Director-General Dr. Margaret Chan on 28 August 2008. The article gives information on the Commission's results, namely on the Final report and on some recommendations for reducing health inequities: improve daily living conditions, tackle the inequitable distribution of power, money and resources, and measure and understand the problem and assess the impact of action. Commission declared that social injustice is killing people in a large scale and reducing health inequities is an ethical imperative.

• MeSH
• celosvětové zdraví MeSH
• disparity zdravotní péče * MeSH
• lidé MeSH
• podpora zdraví MeSH
• poskytování zdravotní péče * MeSH
• sociální spravedlnost * MeSH
• socioekonomické faktory MeSH
• Světová zdravotnická organizace MeSH
• veřejná politika MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH