Health Policy

Growing Older in World Cities: New York, Paris, London and Tokyo

Growing Older in World Cities: New York, Paris, London and Tokyo
Edited with Michael Gusmano. Nashville Tn: Vanderbuilt University Press,

Rodwin, V.G.
02/01/2006

Population aging often provokes fears of impending social security deficits, uncontrollable medical expenditures, and transformations in living arrangements, but public policy could also stimulate social innovations. These issues are typically studied at the national level; yet they must be resolved where most people live—in diverse neighborhoods in cities. New York, London, Paris, and Tokyo are the four largest cities among the wealthiest, most developed nations of the world. The essays commissioned for this volume compare what it is like to grow older in these cities with respect to health care, quality of life, housing, and long-term care. The contributors look beyond aggregate national data to highlight the importance of how local authorities implement policies.

Reliability and Validity of the Spanish Versions of the Crisis in Family Systems - Revised

Reliability and Validity of the Spanish Versions of the Crisis in Family Systems - Revised
Psychological Reports, Feb 2006, Vol. 98 Issue 1, p123-132, 10p.

Berry, C., Quinn, K.A., Portillo, N. & Shalowitz, M.
02/01/2006

Increasing the representation of Spanish-speaking study participants requires development and dissemination of reliable and valid translated scales. In the current study the construct validity was assessed of the Spanish version of the Crisis in Family Systems-Revised, a measure of contemporary life stressors, with a convenience sample of 377 parents interviewed in a study of childhood asthma, although over half of the respondents did not have children with asthma. Most respondents were foreign-born women between 20 to 60 years old (M = 35, SD = 7). 52% had not completed high school or its equivalent, and 55% reported a household income of $15,000 or less. For a subsample of 25 respondents test-retest reliability was .86 over 2 wk. Reporting more life stressors was associated with greater depressive symptomatology, poorer physical and mental health function, and lower household income. These relationships support the construct validity of the test in Spanish. This study provided strong evidence that this version is a valid and reliable measure of life stressors for a Spanish-speaking population living in the United States.

Training Psychiatrists for Public Sector Care: A Survey of Residency Directors on Current Priorities and Preparation

Training Psychiatrists for Public Sector Care: A Survey of Residency Directors on Current Priorities and Preparation
Psychiatric Services. 57:238-243, February

Yedidia, M.J., Gillespie, C.C. & Berstein, C.A.
02/01/2006

OBJECTIVE: This study assessed how resident psychiatrists are being prepared to deliver effective public-sector care.

METHODS: Ten leaders in psychiatric education and practice were interviewed about which tasks they consider to be essential for effective public-sector care. The leaders identified 16 tasks. Directors of all general psychiatry residency programs in the United States were then surveyed to determine how they rate the importance of these tasks for delivery of care and how their training program prepares residents to perform each task.

RESULTS: A total of 114 of 150 residency directors (76 percent) responded to the survey. Factor analysis divided 14 of the tasks into three categories characterized by the extent to which their performance requires integration of services: within the mental health system (for example, lead a multidisciplinary team), across social service systems (for example, interact with staff of supportive housing programs), and across institutions with different missions (for example, distinguish behavioral problems from underlying psychiatric disorders among prisoners). Preparation for tasks that involved integration of services across institutions was rated as least important, was least likely to be required, and was covered by less intensive teaching modalities. Tasks entailing integration within the mental health system were rated as most important, preparation was most likely to be required, and they were covered most intensively. Midway between these two categories, but significantly different from each, were tasks relying on integration across social service systems.

CONCLUSIONS: Tasks that involved integrating services across institutions with different missions were consistently downplayed in training. Yet the importance of such tasks is underscored by the assessments of the psychiatric leaders who were interviewed, the high valuation placed on this type of integration by a substantial subset of training directors, and the extent of mental illness among populations who are institutionalized in nonpsychiatric settings.

Inconsistencies in Place Definition: How Different Operational Place Definitions Affect Estimates of Adolescent Smoking and Drinking Risk

Inconsistencies in Place Definition: How Different Operational Place Definitions Affect Estimates of Adolescent Smoking and Drinking Risk
Health and Place, Vol. 13, No. 2.

Brady, J. & Weitzman, B.C.
01/15/2006

We find that estimates of the prevalence of teenage smoking and drinking in "urban," "suburban," and "rural" areas vary with different definitions of these types of geographic units. Given the salience of youth risk behavior to the public debate, we urge researchers to purposefully choose their definitions of geographic areas and to be explicit about those choices.

Fostering Organizational Change Through a Community-Based Initiative

Fostering Organizational Change Through a Community-Based Initiative
Health Promotion Practice 2006; 7:1-10.

Kaplan S.A., Calman N.S., Golub M., Ruddock C. & Billings J.
01/01/2006

Program funders and managers are increasingly interested in fostering changes in the policies, practices, and procedures of organizations participating in community-based initiatives. But little is know about what factors contribute to the institutionalization of change. In this study, we assess whether the organizational members of the Bronx Health REACH Coalition have begun to change their functioning and role with regard to their clients, their staff, and in the broader community, apart from their implementation of the funded programs for which they are responsible. The study identifies factors that seemed to contribute to or hinder such institutional change, and suggests several strategies for coalitions and funders that are seeking to promote and sustain organizational change.

Micro-Insurance: The Next Revolution?

Micro-Insurance: The Next Revolution?
In Understanding Poverty, edited by Abhijit Banerjee, Roland Benabou, and Dilip Mookherjee. Oxford University Press, 2006.

Morduch, J.
01/01/2006

This essay focuses on the design of insurance products for poor customers. Several promising innovations are described: credit life insurance, health insurance partnerships, and weather insurance. Each was created to serve populations that were previously unserved, and workable institutional solutions are emerging. The next step must be to shift from the question of what creates workable institutions to the question of how to refine designs to best serve low-income populations. In doing so, current approaches must be reassessed in order to most improve clients’ lives and to avoid doing unintended harm.

Neighborhoods and Schools: Contexts and Consequences for the Mental Health and Risk Behaviors of Children and Youth

Neighborhoods and Schools: Contexts and Consequences for the Mental Health and Risk Behaviors of Children and Youth
In L. Balter and C. Tamis-LeMonda (Eds.), Child Psychology: A Handbook of Contemporary Issues (2nd ed.)

Gershoff, E.T. & Aber, J.L.
01/01/2006

This second edition of Child Psychology: A Handbook of Contemporary Issues reflects the increasingly sophisticated and varied research methods used to examine the highly complex interactions contributing to children's cognitive, emotional, and social development. Those chapters that appeared in the previous edition have been thoroughly updated and new chapters by outstanding researchers have been introduced. In addition, there is an entirely new section on Adolescence and thorough coverage of salient Ecological Influences, which make this second edition a truly comprehensive resource on the important issues in child psychology. The volume is divided into five sections - Infancy, Preschool Years, Childhood, Adolescence, and Ecological Influences - which: * Describe the nature of development and individual variations in developmental trajectories across multiple domains * Identify the processes and mechanisms underlying developmental and contextual change * Explore the varied contexts in which development unfolds, including family, school, neighborhood, and culture * Apply cutting-edge research designs, methodologies, and analytic approaches to models of development The volume provides an invaluable and practical resource for students and instructors on a wide variety of courses, and for researchers and professionals working in the field of child development.

Racial and Ethnic Disparities in Health: A View from the South Bronx

Racial and Ethnic Disparities in Health: A View from the South Bronx
Journal of Health Care for the Poor and Underserved 2006; 17:116-127.

Kaplan S.A., Calman N.S., Golub M., Davis J.H. & Billings J.
01/01/2006

This study seeks to understand the perspective of Black and Hispanic/Latino residents of the South Bronx, New York, on the causes of persistent racial and ethnic disparities in health outcomes. In particular, it focuses on how people who live in this community perceive and interact with the health care system. Findings from 9 focus groups with 110 participants revealed a deep and pervasive distrust of the health care system and a sense of being disrespected, exacerbated by difficulties that patients experience in communicating with their providers. The paper suggests how health care institutions might respond to these perceptions.

Separate and Unequal Care in New York City

Separate and Unequal Care in New York City
Journal of Health Care Law & Policy, Vol. 9, Number 1. 

Calman, N.S., Golub, M., Ruddock, C., Le, L. & Kaplan, S.A.
01/01/2006

Bronx Health REACH, a coalition of community- and faith-based groups, health care providers, and an academic institution, recently examined the causes of racial and ethnic health disparities in the southwest Bronx and identified separate systems of care for uninsured and publicly insured patients, who are predominantly people of color, and those with private insurance. We found evidence that patients are sorted into segregated pathways of care, a system of medical apartheid in which differential care contributes to disparities in health care and health outcomes.

The Role of Faith-Based Institutions in Providing Health Education and Promoting Equal Access to Care: A Case Study of an Initiative in the Southwest Bronx

The Role of Faith-Based Institutions in Providing Health Education and Promoting Equal Access to Care: A Case Study of an Initiative in the Southwest Bronx
Journal of Health Care for the Poor and Underserved 2006; 17.2: 9-19.

Kaplan S.A., Calman, N.S., Golub M., Davis J.H. & Billings, J.
01/01/2006

Although many public health initiatives have been implemented through collaborations with faith-based institutions, little is known about best practices for developing such programs. Using a community-based participatory approach, this case study examines the implementation of an initiative in the Bronx, New York, that is designed to educate community members about health promotion and disease management and to mobilize church members to seek equal access to health care services. The study used qualitative methods, including the collaborative development of a logic model for the initiative, focus groups, interviews, analysis of program reports, and participant observation. The paper examines three key aspects of the initiative’s implementation: (1) the engagement of the church leadership; (2) the use of church structures as venues for education and intervention; and (3) changes in church policies. Key findings include the importance of pre-existing relationships within the community and the prominent agenda-setting role played by key pastors, and the strength of the Coalition’s dual focus on health behaviors and health disparities. Given the churches’ demonstrated ability to pull people together, to motivate and to inspire, there is great potential for faith-based interventions, and models developed through such interventions, to address health disparities.

Pages

Subscribe to Health Policy