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Continuum of health equity practice and science: conceptualising health equity research and practice for injury prevention

Background

Integrating and advancing health equity are a core tenant of the Centers for Disease Control and Prevention’s mission. Comprehensive frameworks that clearly conceptualise equity are needed to prioritise and inform the advancement of health equity within public health.

Methods

To help meet this need, the investigative team developed The Continuum of Health Equity Practice & Science (The Continuum). The Continuum was developed in two phases: (1) an initial survey distributed to internal CDC Division of Injury Prevention investigators, and (2) a review of public health frameworks and the current health equity evidence base.

Results

The Continuum is a framework that includes seven key components of health equity and ultimately aims to guide public health practice and research towards the advancement of health equity. To illustrate its usefulness, we provide an example using adolescent suicide for each component of The Continuum and demonstrate how this may inform efforts to advance health equity.

Conclusion

With a specific focus on conceptualising health equity and addressing systemic inequities, The Continuum may be used to inform efforts to advance equity in injury prevention and beyond.

Expansion of SNAP eligibility and rates of firearm deaths

Introduction

Poverty is a consistent correlate of firearm-involved mortality, yet little work has considered the effects of social and economic policies on these deaths. This study examined associations of state elimination of the asset test and increases in the income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility with rates of firearm-involved suicide and homicide deaths in the United States.

Methods

This ecological repeated cross-sectional study used 2015–2019 data from the SNAP Policy Database and death certificate data from the National Vital Statistics System. The exposures were (1) state elimination of the asset test for SNAP eligibility and (2) state elimination of the asset test and increases in the income limit for SNAP eligibility, compared with (3) state adoption of neither policy. The outcomes were firearm-involved suicide deaths and firearm-involved homicide deaths. The research team conducted mixed-effects regressions to estimate associations.

Results

State elimination of the asset test for SNAP eligibility (incidence rate ratio (IRR), 0.67; 95% CI, 0.48 to 0.91) and state adoption of both eliminating the asset test and increasing the income limit for SNAP eligibility (IRR, 0.68; 95% CI, 0.49 to 0.92) were associated with decreased rates of firearm-involved suicide deaths compared with state adoption of neither policy. There were no associations with state firearm-involved homicide rates.

Conclusions

SNAP is an important social safety net programme that addresses food insecurity, and the present results suggest it may also contribute to reducing firearm-involved suicide.

Principles of Effective Gun Policy

Reduction of gun misuse by legitimate private owners and criminals can be accomplished without eliminating private ownership of firearms, including using gun possession as a criminal liability to criminals and supply-side regulations on gun transfers.

New US Surgeon General Advisory on Gun Violence

Deaths from firearms have soared in the US over the past few decades. Now, guns are the leading cause of death of children. In addition, the majority of adults report they’ve experienced gun violence, including being threatened by a firearm or witnessing someone getting shot.