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Reducing inequalities in preconception health and care is critical to improving the health and life chances of current and future generations. A hybrid workshop was held at the 2023 UK Preconception Early and Mid-Career Researchers (EMCR) Network conference to co-develop recommendations on ways to address inequalities in preconception health and care. The workshop engaged multi-disciplinary professionals across diverse career stages and people with lived experience (total n = 69). Interactive discussions explored barriers to achieving optimal preconception health, driving influences of inequalities and recommendations. The Socio-Ecological Model framed the identified themes, with recommendations structured at interpersonal (e.g. community engagement), institutional (e.g. integration of preconception care within existing services) and environmental/societal levels (e.g. education in schools). The co-developed recommendations provide a framework for addressing inequalities in preconception health, emphasising the importance of a whole-systems approach. Further research and evidence-based interventions are now needed to advance the advocacy and implementation of our recommendations.
Understanding characteristics of healthcare personnel (HCP) with SARS-CoV-2 infection supports the development and prioritization of interventions to protect this important workforce. We report detailed characteristics of HCP who tested positive for SARS-CoV-2 from April 20, 2020 through December 31, 2021.
Methods:
CDC collaborated with Emerging Infections Program sites in 10 states to interview HCP with SARS-CoV-2 infection (case-HCP) about their demographics, underlying medical conditions, healthcare roles, exposures, personal protective equipment (PPE) use, and COVID-19 vaccination status. We grouped case-HCP by healthcare role. To describe residential social vulnerability, we merged geocoded HCP residential addresses with CDC/ATSDR Social Vulnerability Index (SVI) values at the census tract level. We defined highest and lowest SVI quartiles as high and low social vulnerability, respectively.
Results:
Our analysis included 7,531 case-HCP. Most case-HCP with roles as certified nursing assistant (CNA) (444, 61.3%), medical assistant (252, 65.3%), or home healthcare worker (HHW) (225, 59.5%) reported their race and ethnicity as either non-Hispanic Black or Hispanic. More than one third of HHWs (166, 45.2%), CNAs (283, 41.7%), and medical assistants (138, 37.9%) reported a residential address in the high social vulnerability category. The proportion of case-HCP who reported using recommended PPE at all times when caring for patients with COVID-19 was lowest among HHWs compared with other roles.
Conclusions:
To mitigate SARS-CoV-2 infection risk in healthcare settings, infection prevention, and control interventions should be specific to HCP roles and educational backgrounds. Additional interventions are needed to address high social vulnerability among HHWs, CNAs, and medical assistants.
Long was committed to a depiction of Jamaica as a successful ‘commercial society’ where white people could live comfortably on the labour of the enslaved. He mapped the island for his readers in such a way as to reassure them that the boundaries between the free and the unfree were secure. His picture provided a full account of island defences, against both external and internal enemies. He drew on his favourite English poets and writers to inspire poetic renditions of the beauties of this tropical paradise in which art and nature combined their glories. The island’s fecundity was there to be harnessed for profit. His racialized cartography utilized maps, engravings, tables and listings of commodities to illustrate boundless potential. Nature could be improved, tamed and catalogued, as people were. Alarming tales of colonists’ mortality could be challenged, mosquitoes kept at bay. White settlers could live a healthy life if only they would embrace moderation in all things. As an Enlightenment man and an enthusiastic reader of natural histories, Long was keen to represent the island as en route to a more civilized and ordered state, with more roads, more maps, more barracks, more settlements. But, he had to admit, it was a society sorely in need of more public virtue.
Long arrived in Jamaica in 1758 hoping to make money and to be able to return to England soon. The plantation would be the source of his wealth, and a settlement with his older brother Robert secured him in the ownership of Lucky Valley. Having speedily made a propitious marriage into the white elite, he devoted himself for the next eleven years to every aspect of the management of a sugar plantation, all of which he subsequently described in his History. He represents the planter’s life as one of constant work and anxiety, yet ‘smoothed by the allurements of profit’. He saw himself as the head of the enterprise, responsible at every level, and disavowed the skills of the enslaved. He acquired new enslaved labour, organized the plantation on the basis of gendered and racialized practices, bought new land and built new works, greatly increasing the production of sugar and rum. Foreseeing the likelihood of an end to the slave trade, he worried about the failure of enslaved women to reproduce themselves, which he blamed on them, thus threatening future prosperity. He proposed new practices to improve what was conceptualized as ‘breeding’.
Long lived in England, a place which was changing, for more than forty years until his death in 1813. He actively campaigned against black and white abolitionists and for the continuation of the slave trade. Despite making many additions and corrections, he never completed a second edition of the History. He had endeavoured to clinch his argument as to the essential inequality of white and black with a demolition of the free black Jamaican, Francis Williams. Educated in England, Williams was a poet and mathematician, and had established a school for black boys in Spanish Town. He had been cited by Hume in 1753 as providing an example of how ‘Negroes’ could never do more than mimic white Europeans. Williams represented for Long the terrifying spectre of African claims for equality: he claimed legal rights, could write Latin poetry, possessed a library of Enlightenment scholarship, taught his pupils Newtonian principles and dressed like a gentleman. It was essential to undermine him, pouring scorn on all his pretensions. But in so doing, Long demonstrated how his own privileged whiteness rested on sand. Only by denigrating blackness could he maintain his own sense of an entitled self; he needed that ‘otherness’ to know himself.
The Gentleman’s Son’ provides a brief account of the Long family from the time of the conquest of Jamaica in 1655 to the mid-eighteenth century, their marriages and children, their acquisition of property in land and enslaved people, their politics. It introduces the main cast of characters in the Long/Beeston family and what became the three distinct branches: the slave-owners in Jamaica, the merchant family in London and the landed gentry in Suffolk. Edward’s two great-grandfathers, Samuel Long and William Beeston, were founding figures of Jamaica as a slave society. Samuel Long’s acquisition of what was to become Longville and his purchase of Lucky Valley set the seal on the Jamaican family’s ownership of property and enslaved people, the source of their wealth for generations to come. What did it mean to be a colonist? Samuel’s great-grandson Edward, born in 1734, grew up in England and as a child lived in Cornwall. His father returned to Jamaica with the rest of the family to retrieve the family fortune by better management of the plantations. Edward was left alone for his education.
The productive and reproductive labour of the enslaved produced one form of capital; the gendered organization of marriage and inheritance amongst the planters and merchants produced another. If families such as the Longs were to survive, secure their land and increase their wealth, they had to reproduce themselves and ensure the continuity of their line: their hope was to establish a dynasty. Elite colonists reproduced the patterns of the landed English gentry, but with a difference, given their ownership of enslaved people. Merchants tended towards partible inheritance. Property was gendered in such a way as to try to assure the creation and accumulation of wealth. The work of white women was to produce heirs and bring capital to a marriage. Long believed in the importance of maintaining pure English blood and had clear views as to how ‘proper’ marriages and forms of family life were essential for an ordered colonial society. He abhorred the scale of miscegenation and illegitimacy and the irregular relations that characterized Jamaica. He loved his wife and children, and did much to support his mother and siblings. At the very same time, he refused those relationships to the enslaved and disavowed any connection between his family and those of the Africans on his plantation: they were naturally different.