Health Policy

Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City

Calorie Labeling And Food Choices: A First Look At The Effects On Low-Income People In New York City
Health Affairs (Millwood). 2009;28(6):w1110-21 (published online October 6; 10.1377/ hlthaff.28.6.w1110)

Elbel, B., Kersh, R., Brescoll, V.L. & Dixon, L.B.
10/06/2009

We examined the influence of menu calorie labels on fast food choices in the wake of New York City's labeling mandate. Receipts and survey responses were collected from 1,156 adults at fast-food restaurants in low-income, minority New York communities. These were compared to a sample in Newark, New Jersey, a city that had not introduced menu labeling. We found that 27.7 percent who saw calorie labeling in New York said the information influenced their choices. However, we did not detect a change in calories purchased after the introduction of calorie labeling. We encourage more research on menu labeling and greater attention to evaluating and implementing other obesity-related policies.

 

Black–White Differences in Avoidable Mortality in the USA, 1980–2005

Black–White Differences in Avoidable Mortality in the USA, 1980–2005
Journal of Epidemiology and Community Health, Vol. 63 no. 9, pp. 715-721. 10.1136/jech.2008.081141

Macinko, J., and I.T. Elo
09/01/2009

Background: Avoidable Mortality (AM) describes causes of death that should not occur in the presence of highquality and timely medical treatment and from causes that can be influenced at least in part by public policy/ behaviour. This study analyses black–white disparities in AM.

Methods: Mortality under age 65 was analysed from: (1) conditions amenable to medical care; (2) those sensitive to public policy and/or behaviour change; (3) ischaemic heart disease; (4) HIV/AIDS; and (5) the remaining causes of death. Age-standardised death rates (ASDRs) were constructed for each race and sex group using vital statistics and census data from 1980–2005. Absolute rate differences and the proportionate contribution of each cause of death group to all-cause black–white mortality disparities are calculated based on the ASDRs. Negative binomial regression was used to model relative risks of death.

Results: In 2005, medical care amenable mortality was the largest source of absolute black–white mortality disparity, contributing 30% of the black–white difference in all-cause mortality among men and 42% among women; mortality subject to policy/behaviour interventions contributed 20% of the black–white difference for men and 4% for women. Although absolute black–white differences for most conditions diminished over time, relative disparities as measured by rate ratios showed little change, except for HIV/AIDS for which relative risks increased substantially for black men and women.

Conclusions: There is considerable potential for narrowing of the black–white difference in AM, especially from causes amenable to medical care and (for men) policy/behaviour interventions.

Achieving Horizontal Equity: Must We Have A Single-Payer Health System?

Achieving Horizontal Equity: Must We Have A Single-Payer Health System?
Journal of Health Politics, Policy and Law, Vol. 34, No. 4, August 2009 © 2009 by Duke University Press

Gusmano, M.K., Weisz, D. & Rodwin, V.G.
08/01/2009

The question posed in this paper is whether single-payer health care systems

are more likely to provide equal treatment for equal need (horizontal equity) than are multipayer systems. To address this question, we compare access to primary and specialty health care services across selected neighborhoods, grouped by average

household income, in a single-payer system (the English NHS), a multiple-payer system with universal coverage (French National Health Insurance), and the U.S. multiple-payer system characterized by large gaps in health insurance coverage. We find that Paris residents, including those with low incomes, have better access to health care than their counterparts in Inner London and Manhattan. This finding casts doubt on the notion that the number of payers influences the capacity of a health care system to provide equitable access to its residents. The lesson is to worry less about the number of payers and more about the system’s ability to assure access to primary and specialty care services.

The Health Effects of Decentralizing Primary Care in Brazil

The Health Effects of Decentralizing Primary Care in Brazil
Health Affairs, Vol. 28 no. 4, pp. 1127-1135. doi 10.1377/hlthaff.28.4.1127

Guanais, F., and J. Macinko
07/01/2009

A renewed focus on primary health care could lead to improved health outcomes in developing countries. Moving more control to local authorities, or decentralization, is one approach to expanding primary care’s reach. Proponents argue that it increases responsiveness to local needs and helps local resources reach those in need. Critics argue that it might increase fragmentation and disparities and provide opportunities for local economic and political gains that do not improve population health. We explore questions surrounding decentralization using the example of infant mortality in Brazil. Our study of two programs identified positive effects on health outcomes in the context of infant mortality.

Portfolios of the Poor: How the World's Poor Live on $2 a Day

Portfolios of the Poor: How the World's Poor Live on $2 a Day
Princeton, NJ: Princeton University Press. May 2009

Collins, D., Morduch, J., Rutherford, S. & Ruthven, O.
05/01/2009

About forty percent of the world's people live on incomes of two dollars a day or less. If you've never had to survive on an income so small, it is hard to imagine. How would you put food on the table, afford a home, and educate your children? How would you handle emergencies and old age? Every day, more than a billion people around the world must answer these questions. Portfolios of the Poor is the first book to explain systematically how the poor find solutions.

The authors report on the yearlong "financial diaries" of villagers and slum dwellers in Bangladesh, India, and South Africa--records that track penny by penny how specific households manage their money. The stories of these families are often surprising and inspiring. Most poor households do not live hand to mouth, spending what they earn in a desperate bid to keep afloat. Instead, they employ financial tools, many linked to informal networks and family ties. They push money into savings for reserves, squeeze money out of creditors whenever possible, run sophisticated savings clubs, and use microfinancing wherever available. Their experiences reveal new methods to fight poverty and ways to envision the next generation of banks for the "bottom billion."

The Impact of Primary Healthcare on Population Health in Low‐ and Middle‐Income Countries

The Impact of Primary Healthcare on Population Health in Low‐ and Middle‐Income Countries
Journal of Ambulatory Care Management, Vo. 32 no. 2, pp. 150-171. 10.1097/JAC.0b013e3181994221

Macinko, J., B. Starfield, and T. Erinosho
04/01/2009

This article assesses 36 peer-reviewed studies of the impact of primary healthcare (PHC) on health outcomes in low- and middle-income countries. Studies were abstracted and assessed according to where they took place, the research design used, target population, primary care measures, and overall conclusions. Results indicate that the bulk of evidence for PHC effectiveness is focused on infant and child health, but there is also evidence of the positive role PHC has on population health over time. Although the peer-reviewed literature is lacking in rigorous experimental studies, a small number of relatively well-designed observational studies and the consistency of findings generally support the contention that an integrated approach to primary care can improve health. A few large-scale experiences also help identify elements of good practice. The review concludes with several recommendations for future studies, including a focus on better conceptualizing and measuring PHC, further investigation into the advantages of comprehensive over selective PHC, need for experimental or quasi-experimental research designs that allow testing of the independent effect of primary care on outcomes over time, and a more detailed conceptual framework guiding overall evaluation design that places limits on the parameters under consideration and describes relationships among different levels and types of data likely to be collected in the evaluation process.

Primary Care and Avoidable Hospitalizations: Evidence from Brazil

Primary Care and Avoidable Hospitalizations: Evidence from Brazil
Journal of Ambulatory Care Management, Vol. 32 no. 2, pp. 115-122

Guanais, F., and J. Macinko
04/01/2009

This article provides evidence of the effectiveness of family-based, community-oriented primary healthcare programs on the reduction of ambulatory care sensitive hospitalizations in Brazil. Between 1998 and 2002, expansions of the Family Health Program were associated with reductions in hospitalizations for diabetes mellitus and respiratory problems and Community Health Agents Program expansions were associated with reductions in circulatory conditions hospitalizations. Results were significant for only the female population only, suggesting that these programs were more effective in reaching women than men. Program coverage may have contributed to an estimated 126 000 fewer hospitalizations between 1999 and 2002, corresponding to potential savings of 63 million US dollars.

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