Inequality

Residential Mobility and the Reproduction of Unequal Neighborhoods

Residential Mobility and the Reproduction of Unequal Neighborhoods
Cityscape: A Journal of Policy Development and Research, 2012. Volume 14, Number 3

Sharkey, P.
09/01/2012

Housing assistance policy has shifted away from project-based assistance toward tenantbased assistance. This shift in approach reflects a common assumption that, if families have the option to find homes on their own in the private market, they will seek out better quality homes in racially diverse neighborhoods with lower levels of poverty. This article presents evidence to qualify this assumption by highlighting the limits of residential mobility in reducing, in any substantive way, the degree of racial and ethnic inequality in urban America. Two empirical observations form the basis of the argument. The first observation is that residential mobility typically serves to reproduce urban inequality instead of disrupting it. The second is that urban inequality is resilient: even when individuals or families make moves that disrupt patterns of racial and ethnic inequality, the changes such moves induce are undermined by system-level processes that serve to reproduce inequality in the urban landscape. As a result, changes in families’ neighborhood environments arising from residential mobility are often temporary and are diluted by subsequent changes occurring around families. The article concludes with a discussion of implications for housing assistance policy.

Socioeconomic Inequalities in Health in Older Adults in Brazil and England

Socioeconomic Inequalities in Health in Older Adults in Brazil and England
American Journal of Public Health: August 2012, Vol. 102, No. 8, pp. 1535-1541. doi: 10.2105/AJPH.2012.300765

Lima-Costa, M.F., C. De Oliveira, J. Macinko, and M. Marmot
08/01/2012

Objectives. We examined socioeconomic inequalities in health among older adults in England and Brazil.

Methods. We analyzed nationally representative samples of residents aged 50 years and older in 2008 data from the Brazilian National Household Survey (n = 75 527) and the English Longitudinal Study of Ageing (n = 9589). We estimated prevalence ratios for self-rated health, functional limitations, and reported chronic diseases, by education level and household income tertiles.

Results. Brazilians reported worse health than did English respondents. Country-specific differences were higher among the poorest, but also affected the wealthiest persons. We observed a strong inverse gradient of similar magnitude across education and household income levels for most health indicators in each country. Prevalence ratios (lowest vs highest education level) of poor self-rated health were 3.24 in Brazil and 3.50 in England; having 2 or more functional limitations, 1.81 in Brazil and 1.96 in England; and having 1 or more diseases, 1.14 in Brazil and 1.36 in England.

Conclusions. Socioeconomic inequalities in health affect both populations, despite a less pronounced absolute difference in household income and education in Brazil than in England.

Horizontal Equity in Health Care Utilization in Brazil, 1998–2008

Horizontal Equity in Health Care Utilization in Brazil, 1998–2008
International Journal for Equity in Health, Vol. 11 no. 33. 10.1186/1475-9276-11-33

Macinko, J., and M.F. Lima Costa
06/12/2012

Introduction This study assesses trends in horizontal equity in the utilization of healthcare services from 1998 to 2008--a period of major economic and social change in Brazil.

Methods Data are from nationally representative surveys repeated in 1998, 2003, and 2008. We apply established methods for assessing horizontal inequity in healthcare access (the principle that people with the same healthcare needs should have similar access to healthcare services). Horizontal inequity is calculated as the difference between observed healthcare utilization and utilization predicted by healthcare needs. Outcomes examined include the probability of a medical, dental, or hospital visit during the past 12 months; any health service use in the past two weeks; and having a usual source of healthcare. We use monthly family income to measure differences in socioeconomic position. Healthcare needs include age, sex, self-rated health, and chronic conditions. Non-need factors include income, education, geography, health insurance, and Family Health Strategy coverage.

Results The probability of having at least one doctor visit in the past 12 months became substantially more equitable over time, ending with a slightly pro-rich orientation in 2008. Any hospitalization in the past 12 months was found to be pro-poor in all periods but became slightly less so in 2008. Dental visits showed the largest absolute decrease in horizontal inequity, although they were still the most inequitably (pro-rich) distributed outcome in 2008. Service use in the past two weeks showed decreased inequity in 2003 but exhibited no significant change between 2003 and 2008. Having a usual source of care became less pro-rich over time and was nearly income-neutral by 2008. Factors associated with greater inequities include income, having a private health plan, and geographic location. Factors associated with greater equity included health needs, schooling, and enrolment in the Family Health Strategy.

Conclusions Healthcare utilization in Brazil appears to have become increasingly equitable over the past 10 years. Although this does not imply that equity in health outcomes has improved correspondingly, it does suggest that government policies aimed at increasing access, especially to primary care, have helped to make healthcare utilization in Brazil fairer over time.

The 2013 Federal Budget's Impact on Communities of Color and Low-Income Families

The 2013 Federal Budget's Impact on Communities of Color and Low-Income Families

Women of Color Policy Network
02/23/2012

The Obama administration's budget proposal for fiscal year 2013 (FY 2013) strengthens the national economy by investing in schools, communities and safety net programs. The FY 2013 budget also includes a number of important investments in infrastructure that will spur much needed job growth in a time of economic uncertainty for many working and low-income families. It is critical that such investments take into account the persistently high unemployment in communities of color, and target spending to increase the economic security of the communities most impacted by the "Great Recession." Additionally, the budget includes important changes to the tax code that will lay the foundation for a fairer and more equitable economy.

Racial Segregation in Multiethnic Schools: Adding Immigrants to the Analysis

Racial Segregation in Multiethnic Schools: Adding Immigrants to the Analysis
In William Tate, Ed., Research on Schools, Neighborhoods and Communities: Toward Civic Responsibility. Rowman and Littlefield Publishing. 2012, pp. 67-82.

Ellen, I.G., O'Regan, K., Schwartz, A.E. & Stiefel, L.
02/03/2012

Racial segregation in America's schools remains persistently and disturbingly high, despite decades of institutional and policy changes. This paper considers one recent change common to many urban school districts - immigration - and examines whether and how the presence of a large number of immigrant students affects racial segregation. Exploiting a student-level data set including all elementary and middle school students in New York City's public schools, sixteen percent of whom are immigrants, we conduct a series of descriptive and exploratory analysis of possible avenues of influence. While it is unclear ex ante, both theoretically and compositionally, whether the presence of immigrants should increase or decrease inter-racial interaction, our results point to a decrease. Racial stratification of foreign-born students is generally higher than that of their native-born counterparts, and this is not solely attributable to income or language-skill differences. And while this heightened segregation decreases with time in the school system, the foreign-born/native-born differential is never eliminated. Importantly, we do find that there are very large differences within the immigrant population. Thus, the effect of immigrants on patterns of racial interaction in any district will depend crucially not only on the race of the immigrants, but also on their particular country of origin.

Above Board: Raising the Standards for Passenger Service Workers at the Nation's Busiest Airports

Above Board: Raising the Standards for Passenger Service Workers at the Nation's Busiest Airports

Mason, C. Nicole & Garcia, Lisette
02/01/2012

I n the fall of 2011, the Women of Color Policy Network at New York University's Robert F. Wagner Graduate School of Public Service conducted a survey of over 300 passenger service workers at the region's three major airports: LaGuardia, Kennedy International and Newark Liberty International.
Only workers contracted by the airlines were surveyed. This report focuses on the impact of the low-bid
contracting system on passenger service workers at the airports. It also proposes ways forward and concrete recommendations to raise job quality and performance standards for companies contracted directly with airlines.

Access to, use of and satisfaction with health services among adults enrolled in Brazil’s Family Health Strategy: evidence from the 2008 National Household Survey

Access to, use of and satisfaction with health services among adults enrolled in Brazil’s Family Health Strategy: evidence from the 2008 National Household Survey
Tropical Medicine & International Health, Vol. 17, no. 1, pp. 36-42. 10.1111/j.1365-3156.2011.02866.x

Macinko, J., and M.F. Lima Costa
01/01/2012

Objective  To assess the effects of participation in Brazil’s primary healthcare programme (the Family Health Strategy or FHS) on access, use and satisfaction with health services among adults.

Methods  Data are from the 2008 National Household Survey (PNAD) on 264 754 adults. This cross-sectional analysis compares FHS enrollees to both non-enrollees and those with private health plans. We calculated predicted probabilities of each outcome stratified by household wealth quintile, rural/urban location and sex using robust Poisson regression. We performed propensity score analysis to assess the differences in access among FHS enrollees and the rest of the population, once relevant socio-demographic characteristics and other determinants of access were balanced.

Results  Compared to families with neither FHS enrolment nor private health plans, adult FHS enrollees were generally more likely to have a usual source of care, to have visited a doctor or dentist in the past 12 months, to have access to needed medications and to be satisfied with the care they received. The FHS effect was largest among urban dwellers and the poorest.

Conclusions  The FHS appears to be associated with enhanced access to and utilization of health services in Brazil. However, it has not yet been able to match levels of access experienced by those with private health plans, perhaps because the population served by the FHS is among the poorest, most rural and least healthy in the country.

Demographics, clinical characteristics and outcomes of neonates diagnosed with fetomaternal haemorrhage.

Demographics, clinical characteristics and outcomes of neonates diagnosed with fetomaternal haemorrhage.
Arch Dis Child Fetal Neonatal Ed. 2012 Feb 28. [Epub ahead of print]

Stroustrup, Annemarie and Leonardo Trasande
01/01/2012

OBJECTIVE:

To determine clinical characteristics, demographics and short-term outcomes of neonates diagnosed with fetomaternal haemorrhage (FMH).

DESIGN:

The authors analysed the Nationwide Inpatient Sample, 1993 to 2008. Singleton births diagnosed with FMH were identified by International Classification of Diseases (ICD-9) code 762.3. Descriptive, univariate and multivariable regression analyses were performed to determine the national annual incidence of FMH over time as well as demographics and clinical characteristics of neonates with FMH.

RESULTS:

FMH was identified in 12 116 singleton births. Newborns with FMH required high intensity of care: 26.3% received mechanical ventilation, 22.4% received blood product transfusion and 27.8% underwent central line placement. Preterm birth (OR 3.7), placental abruption (OR 9.8) and umbilical cord anomaly (OR 11.4) were risk factors for FMH. Higher patient income was associated with increased likelihood of FMH diagnosis (OR 1.2), and Whites were more likely to be diagnosed than ethnic minorities (OR 1.9). There was reduced frequency of diagnosis in the Southern USA (OR 0.8 vs the Northeastern USA).

CONCLUSIONS:

Diagnosis of FMH is associated with significant morbidity as well as regional, socioeconomic and racial disparity. Further study is needed to distinguish between diagnostic coding bias and true epidemiology of the disease. This is the first report of socioeconomic and racial/ethnic disparities in FMH, which may represent disparities in detection that require national attention.

Reducing Racial and Ethnic Disparities: The Action Plan from the Department of Health and Human Services

Reducing Racial and Ethnic Disparities: The Action Plan from the Department of Health and Human Services
Health Affairs, 2011. Volume 30 / Issue 10 / October 2011, pp 1822-1829, Published online

Howard K. Koh, Garth Graham and Sherry Glied
10/12/2011

The Department of Health and Human Services (HHS) recently unveiled the most comprehensive federal commitment yet to reducing racial and ethnic health disparities. The 2011 HHS Action Plan to Reduce Racial and Ethnic Health Disparities not only responds to advice previously offered by stakeholders around the nation, but it also capitalizes on new and unprecedented opportunities in the Affordable Care Act of 2010 to benefit diverse communities. The Action Plan advances five major goals: transforming health care; strengthening the infrastructure and workforce of the nation’s health and human services; advancing Americans’ health and well-being; promoting scientific knowledge and innovation; and upholding the accountability of HHS for making demonstrable progress. By mobilizing HHS around these goals, the Action Plan moves the country closer to realizing the vision of a nation free of disparities in health and health care.

Converging Evidence for Neighborhood Effects on Children’s Test Scores: An Experimental, Quasi-Experimental, and Observational Comparison

Converging Evidence for Neighborhood Effects on Children’s Test Scores: An Experimental, Quasi-Experimental, and Observational Comparison
Whither Opportunity? Rising Inequality, Schools, and Children’s Life Chances, G. Duncan and R. Murnane, eds. New York: Russell Sage.

Burdick-Will, J., J. Ludwig, S. Raudenbush, R. Sampson, L. Sanbonmatsu, and P. Sharkey
09/01/2011

Rising income inequality has been found to be associated with rising segregation at the neighborhood level, generating concern about whether neighborhood environments themselves may influence children’s life chances, independent of other individual child and family characteristics. Because poor and minority Americans are overrepresented in our most disadvantaged neighborhoods, any “neighborhood effects” on children may contribute to persistent disparities in overall schooling outcomes across race and class lines in the United States.

A large body of nonexperimental research dating back to the Coleman Report in 1966 has produced evidence consistent with the idea of large neighborhood effects on children’s schooling outcomes. However, drawing causal inferences from these studies is complicated by the fact that the attributes of a neighborhood in which a family lives is likely correlated with characteristics of the family that predict schooling outcomes. These studies are therefore vulnerable to selection bias. The one formal randomized experiment in this literature is the five-city Moving to Opportunity (MTO) experiment, data from which suggests no statistically significant impacts, on average, on reading or math test scores for children in MTO measured four to seven years after baseline. How one should weight the findings from the MTO experiment versus the larger body of nonexperimental research remains the topic of ongoing debate within the research and policy communities.

In this chapter, we try to reconcile the experimental, quasi-experimental, and observational research literature regarding neighborhood effects on children, and we argue that the available findings are more convergent than many people believe. Drawing on a number of recent and unusually high-quality quasi-experimental and observational studies, together with a reexamination of MTO findings across the individual MTO demonstration sites, we believe that the available - 3 - evidence allows us to reject the null hypothesis that neighborhood environments never matter for children’s outcomes. Yet at the same time, the data also do not support the hypothesis that neighborhoods always matter.

In our view, the key question for research and public policy is to learn more about the conditions under which neighborhoods matter for children’s academic outcomes and why. Our ability to answer this question in the present chapter is restricted by the limited number of studies that have employed sufficiently strong research designs to support inferences about neighborhood effects on children’s outcomes, and by the fact that a disproportionate share of the studies that meet this research-design threshold have been carried out in a single city (Chicago).

With these important qualifications in mind, we believe that there is at least a suggestive case to be made that children’s test scores may be most strongly affected by community violence or may respond nonlinearly to concentrated neighborhood disadvantage or community violence. Put differently, what may matter most for children’s cognitive development is to avoid living in the most severely economically distressed or dangerous neighborhoods in the country, neighborhoods that are found in cities like Baltimore and Chicago but, surprisingly, are less prevalent even in other major urban areas such as Boston, Los Angeles, and New York. Given the limitations of the available evidence, we offer these as hypotheses to be tested further rather than as strong conclusions.

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