Inequality

Who Experiences Discrimination in Brazil? Evidence From a Large Metropolitan Region

Who Experiences Discrimination in Brazil? Evidence From a Large Metropolitan Region
International Journal for Equity in Health, 2012 Dec 18;11:80. doi: 10.1186/1475-9276-11-80

Macinko, J., P. Mullachery, F.A. Proietti, and M.F. Lima-Costa
12/18/2012

Introduction Perceived discrimination is related to poor health and has been offered as one explanation for the persistence of health inequalities in some societies. In this study, we explore the prevalence and correlates of perceived discrimination in a large, multiracial Brazilian metropolitan area.

Methods The study uses secondary analysis of a regionally representative household survey conducted in 2010 (n=12,213). Bivariate analyses and multiple logistic regression assess the magnitude and statistical significance of covariates associated with reports of any discrimination and with discrimination in specific settings, including when seeking healthcare services, in the work environment, in the family, in social occasions among friends or in public places, or in other situations.

Results Nearly 9% of the sample reported some type of discrimination. In multivariable models, reports of any discrimination were higher among people who identify as black versus white (OR 1.91), higher (OR 1.21) among women than men, higher (OR 1.33) among people in their 30’s and lower (OR 0.63) among older individuals. People with many health problems (OR 4.97) were more likely to report discrimination than those with few health problems. Subjective social status (OR 1.23) and low social trust (OR 1.27) were additional associated factors. Perceived discrimination experienced while seeking healthcare differed from all other types of discrimination, in that it was not associated with skin color, social status or trust, but was associated with sex, poverty, and poor health.

Conclusions There appear to be multiple factors associated with perceived discrimination in this population that may affect health. Policies and programs aimed at reducing discrimination in Brazil will likely need to address this wider set of interrelated risk factors across different populations.

Beyond Black: Diversity among Black Immigrant Students in New York City Public Schools

Beyond Black: Diversity among Black Immigrant Students in New York City Public Schools
Randy Capps and Michael Fix, editors, Young Children of Black Immigrants in America: Changing Flows, Changing Faces. Washington, DC: Migration Policy Institute: 299-331

Doucet, F., Schwartz, A. E., & Debraggio, E.
12/14/2012

The child population in the United States is rapidly changing and diversifying — in large part because of immigration. Today, nearly one in four US children under the age of 18 is the child of an immigrant. While research has focused on the largest of these groups (Latinos and Asians), far less academic attention has been paid to the changing Black child population, with the children of Black immigrants representing an increasing share of the US Black child population.

To better understand a unique segment of the child population, chapters in this interdisciplinary volume examine the health, well-being, school readiness, and academic achievement of children in Black immigrant families (most with parents from Africa and the Caribbean).

The volume explores the migration and settlement experiences of Black immigrants to the United States, focusing on contextual factors such as family circumstances, parenting behaviors, social supports, and school climate that influence outcomes during early childhood and the elementary and middle-school years.  Many of its findings hold important policy implications for education, health care, child care, early childhood development, immigrant integration, and refugee assistance.

Changes in ten years of social inequalities in health among elderly Brazilians (1998-2008)

Changes in ten years of social inequalities in health among elderly Brazilians (1998-2008)
Revista de Saude Publica, Vol. 46, supp. 1. 10.1590/S0034-89102012005000059

Lima-Costa, M.F.; L.A. Facchini; D.L. Matos, and J. Macinko
12/11/2012

OBJECTIVE: To assess the changes in income-related inequalities in health conditions and in the use of health services among elderly Brazilians.

METHODS: Representative samples of the Brazilian population aged 60 years and more were analyzed between 1998 and 2008 (n = 27,872 and 41,198, respectively), derived from the Pesquisa Nacional por Amostra de Domicílios (National Household Sample Survey). The following variables were considered in this study: per capita monthly household income, self-rated health, physical functioning, medical consultations and hospitalizations in the previous 12 months and exclusive use of the Sistema Único de Saúde (Unified Health System). Data analysis was based on estimates of prevalence and prevalence ratios obtained with robust Poisson regression.

RESULTS: In 1998 and 2008, the prevalence of poor self-rated health, mobility limitations and inability to perform activities of daily living (ADLs), adjusted for age and sex, showed strong gradients associated with per capita household income quintiles, with the lowest values being found among those in the lowest income quintile. The prevalence ratios adjusted for age and sex between the lowest quintile (poorest individuals) and highest quintile (richest individuals) of income remained stable for poor self-rated health (PR = 3.12 [95%CI 2.79;3.51] in 1998 and 2.98 [95%CI 2.69;3.29] in 2008), mobility limitations (PR = 1.54 [95%CI 1.44;1.65 and 1.69 [95%CI 1.60;1.78], respectively) and inability to perform ADLs (PR = 1.79 [95%CI 1.52;2.11] and 2.02 [95%CI 1.78;2.29], respectively). There was a reduction in income-related disparities when three or more medical consultations had been made and with the exclusive use of the Unified Health System. Inequalities were not observed for hospitalizations. 

CONCLUSIONS: Despite reductions in income-related inequalities among indicators of use of health services, the magnitude of disparities in health conditions has not decreased. Longitudinal studies are necessary to better understand the persistence of such inequalities among elderly Brazilians.

Do Federally Assisted Households Have Access to High Performing Public Schools?

Do Federally Assisted Households Have Access to High Performing Public Schools?
Poverty & Race Research Action Council

Ellen, Ingrid Gould and Horn, Keren Mertens.
11/01/2012

A family’s housing unit provides more than simply shelter. It also provides a set of neighborhood amenities and a package of local public services, including, most critically, a local school. Yet housing and education policymakers rarely coordinate their efforts, and there has been little examination of the schools that voucher holders or other assisted households actually reach. In this project we describe the elementary schools nearest to households receiving four different forms of housing assistance in the country as a whole, in each of the 50 states, and in the 100 largest metropolitan areas.We compare the characteristics of these schools to those accessible to other comparable households. We pay particular attention to whether voucher holders are able to reach neighborhoods with higher performing schools than other low-income households in the same geographic area.

 

In brief, we find that assisted households as a whole are more likely to live near low-performing schools than other households. Surprisingly, Housing Choice Voucher holders do not generally live near higher performing schools than households receiving other forms of housing assistance, even though the voucher program was created, in part, to help low-income households reach a broader range of neighborhoods and schools. While voucher holders typically live near schools that are higher performing than those nearest to public housing tenants, they also typically live near schools that are slightly lower performing than those nearest to households living in Low Income Housing Tax Credit (LIHTC) and Projectbased Section 8 developments and lower performing than those nearest to other poor households.

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.

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